Abstract
Excessive numbers of clinical alarms in the intensive care unit (ICU) contribute to alarm fatigue. Efforts to eliminate unnecessary alarms, including during end of life (EOL) care, are pivotal. This study describes electrocardiographic (ECG) arrhythmia alarm usage following the decision for comfort care. We conducted a review of electronic health records (EHR) in patients who died and had comfort care orders that were in place during our study. The occurrences of ECG arrhythmia alarms among these patients were examined. We found 151 arrhythmia alarms that were generated in 11 patients after comfort care was initiated: 72% were audible, 21% were manually muted, and 7% had an unknown audio label. Level of alarm: 33% crisis, 58% warning, 1% message, and 8% were labeled unknown. Our report shows that ECG monitoring was commonly maintained during the EOL care. Since the goal of care during this phase is for both patient and family comfort, it is important for the clinicians to weigh the benefits versus harms of the continuous ECG monitoring.
Highlights
Electrocardiographic (ECG) monitoring is one of the essential and most common components of patient monitoring in the intensive care unit (ICU)
We examined the frequency of six arrhythmia alarms, following the initiation of comfort care
While the total number of alarms in our study was relatively small, we believe that this observation emphasizes the problem of unnecessary alarms that might contribute to unnecessary alarm burden for clinicians and be distressing for patients and families
Summary
Electrocardiographic (ECG) monitoring is one of the essential and most common components of patient monitoring in the intensive care unit (ICU). Such tools have been found to be associated with the unexpected consequence of alarm fatigue. Alarm fatigue is a condition in which clinicians, mostly being nurses, become desensitized to the sound of clinical alarms. Responses to alarm fatigue by nurses can include disabling alarm features or silencing clinical alarms altogether, which threatens patients’ safety [1,2]. One study showed that nurse’s response times increased as the number of nonactionable alarms increased [3]. In response to the problem of alarm fatigue, The Joint
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