Alarm Safety Research Articles

Crying wolf, alarm safety and management in paediatrics: A scoping review.

To provide a contemporaneous evidentiary overview of neonatal and paediatric studies investigating alarm-related patient safety and alarm system management. Furthermore, to describe how clinical alarm burden is captured and reported, to identify clinical devices that contribute to alarm burden, to explore alarm-related and patient safety measures and terminologies and to review alarm management initiatives. Scoping review. A systematic search of PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus and EBSCOhost was conducted from 2013 to 2023 using predetermined search terms, index terms, medical subject headings and truncation. Observational and qualitative studies with neonatal and paediatric populations reporting monitoring and alarm practices; and interventional studies reporting the success of alarm safety interventions were included. The quality of the included studies was assessed using the mixed methods appraisal tool. The search yielded 37 studies of acceptable quality. The majority explored alarm burden associated with physiological monitoring (n = 35; 95%). Alarm definitions were reported in 46% (n = 17) of studies, and commonly included what constituted actionable and non-actionable alarms. While 32% (n = 12) of studies considered alarms in relation to clinical outcomes surrounding patient safety, clinician response to alarms was only reported in 19% (n = 7) of studies. Alarm and monitoring interventions were assessed in 51% (n = 19) of included studies, with categorization into six domains: changing alarm parameters, clinician education, communication and planning, technology, alarm ordering and standardization or guidelines. This review has demonstrated the enormity of alarms in clinical settings, heterogeneity of alarm definitions and outlined interventions associated with alarm burden and patient safety. Strategies to ensure appropriate alarm limits are set and clinicians are empowered through education to recognize and respond appropriately to alarms can maximize patient safety. This review adheres to the preferred reporting items for systematic reviews and meta-analysis protocols extension for scoping reviews. No patient or public contribution.

Fire and Alarm Safety.

Fire and Alarm Safety.

Ensuring Specificity as a Strategy for Increasing Alarm Safety

Backround: Alarms are systems created to ensure patient safety. However, when its specificity is not ensured, false positive alarms occur, causing the crying wolf phenomenon and compromising patient safety.
 Purpose: This study aimed to decrease the number of false-positive alarms by ensuring the standardization and specificity of alarms.
 Methods: This prospective, quasi-experimental study with a pre/post intervention study was conducted in the adult intensive care unit of a training and research hospital through repeated measurements at the beginning and after the intervention. 
 Results: The total alarm load decreased by 46% after the intervention, with the heart rate, saturation, and blood pressure alarms being reduced at a rate of 59%, 56%, and 23%, respectively. The hourly mean number of alarms decreased from 16.8 to 9. Differences between heart rate, oxygen saturation, and blood pressure alarms in terms of the parameter were statistically significant (p

Current approach to fever of unknown origin in the intensive care unit

This study examines the effects of the interventions in alarm management in intensive care units on reducing alarms on the basis of current evidence.This systematic review and meta-analysis study was conducted between January 1, 2010 and October 31, 2021 by searching 16 databases through an independent search by three researchers. The acronym of PICOS was used and the keywords as well as inclusion/exclusion criteria were determined. The Joanna Briggs Institute meta-Analysis of Statistics Assessment and Review Instruments (JBI-MAStARI) were used to assess methodological quality. Professional meta-analysis Software (ProMeta 3) statistical software package was used for data analysis. The study is preregistered on PROSPERO (CRD42021286770).Intensive care units.The systematic review included 25 studies, whereas the meta-analysis included 15. According to the heterogeneity test in the study, alarm-reducing interventions yielded a heterogeneous distribution. The overall effect size value of all studies, which was found using the random-effects model, was determined to be −0.03 [95 % confidence interval (CI)], a value between −0.16 and 0.10 CI. Based on the results, individual studies showed that the strategies suggesting to ensure alarm safety were effective in reducing the number of alarms; the combined results of the studies in this meta-analysis showed that the interventions made to reduce alarms had too little effect.This study showed that the interventions have a very weak effect size on reducing the number of alarms.

Implementing a Unit-Based Alarm Management Bundle for Critical Care Nurses

Clinical alarms are designed to signal an unsatisfactory patient physiological state and alert staff members to malfunctioning medical equipment. Alarm desensitization and fatigue can occur when clinicians are exposed to an overwhelming number of clinical alarms, particularly nonactionable alarms. Alarm fatigue and alarm management competency related to use of Philips monitoring systems were noted to be problematic among nurses working in the 27-bed surgical intensive care unit of a teaching hospital in northeastern Florida. A quality improvement project was conducted to reduce alarm fatigue and improve nursing competency in managing alarms. The CEASE (Communication, Electrodes, Appropriateness, Setup, and Education) evidence-based alarm management bundle was implemented on the unit, and a representative from the alarm manufacturer conducted in-service training sessions. A clinical alarms survey developed by the Healthcare Technology Foundation was distributed both before and after the intervention to 115 nurses working in the unit. Descriptive and inferential statistics were used to assess for differences between the preintervention and postintervention periods. Nurse participants demonstrated improved alarm management competency, resulting in significant improvements in their perceptions of alarm functionality, settings, response time, and policy adherence. There was a statistically significant decrease in self-reported alarm fatigue, and the CEASE bundle was found to influence nursing practice. The Joint Commission's 2022 goal of improving clinical alarm safety remains a top priority nationwide. Implementation of the CEASE alarm management bundle was effective in reducing surgical intensive care unit nurses' alarm fatigue and improving their alarm management practices.

Determinants of Medical Equipment Alarm Fatigue in Practicing Nurses: A Systematic Review

Objective This study aimed to systematically evaluate the level of medical equipment alarm fatigue and its influencing factors among clinical nurses. Methods PubMed, Embase, CNKI, and Wanfang databases were systematically searched to identify articles on alarm fatigue of clinical nurses published before September 25, 2022. According to the evaluation criteria of prevalence studies recommended by JBI Evidence-Based Health Care Center, the quality of the literature meeting the inclusion criteria was evaluated, and Stata MP17 software was used for meta-analysis. Results A total of 14 cross-sectional studies were included, with a total sample of 2,848 nurses. The results showed that the alarm fatigue score of clinical nurses was 21.76 (95% CI [20.27, 23.25]). Subgroup analysis showed that the nurses who worked night shift and had lower professional title had higher alarm fatigue. Conclusion The alarm fatigue of clinical nurses was at a moderate level. To reduce the alarm fatigue level of clinical nurses, nursing managers should strengthen the alarm safety awareness of nurses, rationally arrange nurse manpower, carry out training to actively improve the alarm management ability of nurses, and optimize the alarm level and frequency of alarm equipment.

Reducing False Alarms and Alarm Fatigue from Pulse Oximeters in a Neonatal Care Unit: A Quality Improvement Study

Background: Pulse oximeters play a vital role in monitoring sick newborns, but majority of the times, their alarms are of little clinical significance. False alarms from pulse oximeters were frequent in our neonatal intensive care unit, causing desensitization of staff and inattention to clinically important alarms. Objectives: The objective of the study was to reduce the burden of false alarms and alarm fatigue. Methods: This was a quality improvement (QI) study. During the baseline phase, alarms for heart rate and SPO2 (percentage of oxygenated blood) were evaluated. Response to them within 30 s was checked. Major causes of false alarms were the movement of the newborns, inappropriate alarm limits, and loose probe. Fishbone chart was prepared, and Plan-Do-Study-Act (PDSA) model was designed using point of care quality improvement (POCQI) principles. During the first PDSA (implementation phase), the staff was trained to adjust alarm limits using the reference chart. A lecture on noise hazards, emphasis on muting the alarms, and advice to change probe site at beginning of their duty was given. In the second PDSA (sustenance phase), components of the first PDSA were strengthened by supportive supervision and guidance and the training of new staff. Results: Total 494, 329, and 162 alarms were observed during baseline, implementation, and sustenance phases, respectively. In the baseline phase majority, 364 (73.7%) were false alarms, which occurred at a frequency of 0.39 alarms/patient/h. More than one-third of the alarms were not responded timely. After QI, false alarms reduced to 214 (65%; 0.22 alarms/patient/h) and 100 (61.7%; 0.16 alarms/patient/h) in implementation and sustenance phases, respectively. Response to true alarms improved from 101 (77.7%) to 104 (90.4%) to 62 (100%) during the 3 phases consecutively. Conclusion: Frequent false alarms lead to desensitization of health care workers. POCQI principles can be a practical approach for reducing false alarms and improving alarm safety.

State of Science in Alarm System Safety: Implications for Researchers, Vendors, and Clinical Leaders.

Alarm fatigue is a complex phenomenon that needs to be assessed within the context of the clinical setting. Considering that complexity, the available information on how to address alarm fatigue and improve alarm system safety is relatively scarce. This article summarizes the state of science in alarm system safety based on the eight dimensions of a sociotechnical model for studying health information technology in complex adaptive healthcare systems. The summary and recommendations were guided by available systematic reviews on the topic, interventional studies published between January 2019 and February 2022, and recommendations and evidence-based practice interventions published by professional organizations. The current article suggests implications to help researchers respond to the gap in science related to alarm safety, help vendors design safe monitoring systems, and help clinical leaders apply evidence-based strategies to improve alarm safety in their settings. Physiologic monitors in intensive care units-the devices most commonly used in complex care environments and associated with the highest number of alarms and deaths-are the focus of the current work.

Detecting False Alarms by Analyzing Alarm-Context Information: Algorithm Development and Validation.

BackgroundAlthough alarm safety is a critical issue that needs to be addressed to improve patient care, hospitals have not given serious consideration about how their staff should be using, setting, and responding to clinical alarms. Studies have indicated that 80%-99% of alarms in hospital units are false or clinically insignificant and do not represent real danger for patients, leading caregivers to miss relevant alarms that might indicate significant harmful events. The lack of use of any intelligent filter to detect recurrent, irrelevant, and/or false alarms before alerting health providers can culminate in a complex and overwhelming scenario of sensory overload for the medical team, known as alarm fatigue.ObjectiveThis paper’s main goal is to propose a solution to mitigate alarm fatigue by using an automatic reasoning mechanism to decide how to calculate false alarm probability (FAP) for alarms and whether to include an indication of the FAP (ie, FAP_LABEL) with a notification to be visualized by health care team members designed to help them prioritize which alerts they should respond to next.MethodsWe present a new approach to cope with the alarm fatigue problem that uses an automatic reasoner to decide how to notify caregivers with an indication of FAP. Our reasoning algorithm calculates FAP for alerts triggered by sensors and multiparametric monitors based on statistical analysis of false alarm indicators (FAIs) in a simulated environment of an intensive care unit (ICU), where a large number of warnings can lead to alarm fatigue.ResultsThe main contributions described are as follows: (1) a list of FAIs we defined that can be utilized and possibly extended by other researchers, (2) a novel approach to assess the probability of a false alarm using statistical analysis of multiple inputs representing alarm-context information, and (3) a reasoning algorithm that uses alarm-context information to detect false alarms in order to decide whether to notify caregivers with an indication of FAP (ie, FAP_LABEL) to avoid alarm fatigue.ConclusionsExperiments were conducted to demonstrate that by providing an intelligent notification system, we could decide how to identify false alarms by analyzing alarm-context information. The reasoner entity we described in this paper was able to attribute FAP values to alarms based on FAIs and to notify caregivers with a FAP_LABEL indication without compromising patient safety.

Educational Program for Physiologic Monitor Use and Alarm Systems Safety: A Toolkit.

Clinical alarm systems safety is a national healthcare concern in the United States. Physiologic monitors are the medical devices associated with the highest number of false and clinically insignificant alarms, producing alarm fatigue and a challenge to meet the national clinical alarm systems safety goal. Modern physiologic monitors are high-tech complex devices with multimeasurement modalities and high sensitivity for alarms. This complexity hinders safe operation of the monitors by nurses and appropriate management of associated alarms. Nurses need to integrate cognitive knowledge, psychomotor skills, and critical thinking to safely operate the monitors and support clinical decisions. Limited resources are available to support clinical education for nurses on physiologic monitor use and alarm management. This toolkit presents an educational framework for physiologic monitor use and alarm safety guided by adult learning principles. The components of the program are (1) knowledge, skills, and attitude of physiologic monitor use; (2) scenario-based learning model to support the knowledge, skills, and attitude necessary for safe monitor use; and (3) a framework for evaluating the educational program. Education should be ongoing and customized per facility to ensure safe use of complex technology and to decrease alarm fatigue, the leading cause of alarm-related sentinel events.

Detection, Localization and Volume Estimation of Deflagrations

Deflagration-like combustions pose a serious threat in various (e.g. industrial) scenarios. Detecting, locating and distinguishing these in their developing phase may significantly reduce the resulting damage to material and individuals. In this work, an image processing based algorithm for detection, localization and volume estimation of deflagrations with a multi-camera-system is proposed. The proposed algorithm has been tested with image sequences of real deflagrations as well as possible false alarm scenarios. In comparison to state of the art methods, false alarm safety, localization quality and robustness to noise have been improved significantly.

Alarm Audit and Enforcement: Automating the Integrity of Alarms for Manufacturing Systems

This work details the development of a continuous monitoring system technology to track the compliance of alarms in a manufacturing environment. A problem arose due to having simultaneous capital projects and continual process optimization work at several production sites. With continual changes to the control systems, a project was developed to ensure that alarm adjustments never violated established safety thresholds for systems. A technique was used to rationalize alarms using a risk based objective analysis to establish safety thresholds for each alarm. Then a tool was developed that continually cross-referenced alarm safety server with process control network to immediately notify management and engineering of any adjustments that violated alarm and safety rules for the site. This work led both to improved site safety and to an improvement of alarm metrics due to greater confidence in adjusting alarms with this audit tool. One site saw a monthly reduction of the quantity alarms by 55% and the elimination of alarm floods.

Classifying Alarms: Seeking Durability, Credibility, Consistency, and Simplicity.

Alongside the development and testing of new audible alarms intended to support International Electrotechnical Commission 60601-1-8, a global standard concerned with alarm safety, the categories of risk that the standard denotes require further thought and possible updating. In this article, we revisit the origins of the categories covered by the standard. These categories were based on the ways that tissue damage can be caused. We consider these categories from the varied professional perspectives of the authors: human factors, semiotics, clinical practice, and the patient or family (layperson). We conclude that while the categories possess many clinically applicable and defensible features from our range of perspectives, the advances in alarm design now available may allow a more flexible approach. We present a three-tier system with superordinate, basic, and subordinate levels that fit both within the thinking embodied in the current standard and possible new developments.

Alarm safety and oxygen saturation targets in the Vermont Oxford Network iNICQ 2015 collaborative.

To assess progress of neonatal intensive care units (NICUs) participating in the Vermont Oxford Network iNICQ 2015: Alarm Safety Collaborative in achieving Joint Commission 2014 alarm safety goals with respect to oximeters, and to compare patient-level oxygen saturation (SpO2) and oximeter alarm data to local policies. Prospective multicenter audits in February and August 2015 assessed implementation of policies addressing Joint Commission 2014 Alarm Safety goals, and ascertained SpO2 targets, oximeter alarm settings and compliance with policy-specified SpO2 targets and alarms. Eighty-six NICUs completed both audits. Of 13 policies addressing mandated goals, median (interquartile range) 8 (5, 9) policies were implemented at audit 1 and 9 (6, 11) at audit 2 (P=0.004). At audit 1, 28 NICUs had implemented ⩾9 policies versus 47 at audit 2. For 794 infants <31 weeks gestation, <36 weeks postmenstrual age, and on supplemental oxygen, median SpO2 target lower limit was 88% (interquartile range 87%, 90%; range 75% to 94%), upper limit 95% (interquartile range 94%, 96%; range 85% to 100%). High oximeter alarm was set according to local policy for 63% of infants, for whom SpO2 >97% was less frequent than when high alarm was not set to policy (10.1% vs 21.5%, P=0.006). Participating NICUs showed significant progress between audits in their implementation of Joint Commission Alarm Safety goals for oximeter monitoring. Oximeter high alarm not set per local policy is associated with increased hyperoxemia in preterm infants. Recommendations to standardize oxygen saturation targets for infants at risk for oxygenation-related outcomes have not been widely adopted.

A Community Hospital's Evaluation of Alarm Management Safety Factors.

The Joint Commission's 2014 National Patient Safety Goals required hospitals to evaluate alarm safety in 2014-2015 and implement alarm safety policies. The aim of this study was to assess common alarm management safety factors in our 187-bed community hospital. Two weeks' worth of IV pump report data was evaluated to characterize 33 IV pump alarm types. Hospital and IV pump noise was measured, and an alarm management nurse survey was conducted. There were 8731 total IV pump alarms/alerts (24-hour mean, 623.6) across 6 units. The 2-minute idle alarm accounted for 32.4% of all total IV alarms/alerts, suggestive of high levels of nurse multitasking and nurse work interruptions. IV pump volumes contributed to overall hospital noise. Survey data identified patient units and alarm safety practices needing additional support. Characterization of IV pump alarms/alerts is an emerging area of scientific inquiry. Findings indicate the need for organizations to evaluate alarm burden and alarm management safety practices to reduce alarm fatigue risks.

Human Factors and Health-Care Professionals Collaboration to Reduce Alarm Fatigue in ICU Settings at a Large Academic Medical Center

Key stakeholders across healthcare’s complex socio-technical environment have been called by the Joint Commission to take part in the shared responsibility to improve alarm safety. This project demonstrated the value added from applying Human Factors principles to a process supporting the safety of patients and the work of health-care providers by reducing the non-actionable alarms in 4 in-patient care units. An Alarm Safety Quality Improvement project is described with specific objectives, methods and results. Results from this project demonstrated an iterative process which provided data and empowerment to the team. The data provided the unit leaders new actionable information and targeted intervention planning with associated meaningful measurements. The process has empowered units to tackle alarm fatigue with the necessary knowledge, tools, and support. The four in-patient care units that have completed this process saw a combined average weekly decrease of 14,000 alarms.

Alarm Fatigue: Are You Tuning Out?

CAN YOU RECALL TIMES after a busy day at work when you thought you could still hear the alarms from the postanesthesia care unit at home? I thought I could hear the beeps of the pulse oximeters and the alarms of ventilators in the distance. Do you quickly respond to the alarms at work? Are you tempted to turn down the volume of those alarms? That may be one of the reasons that The Joint Commission announced their 2014 National Patient Safety Goal on clinical alarm safety. Beginning last year, hospitals were required to make alarms a priority within their facilities. Hopefully you are hearing about this within your institutions. Jacqueline Ross, PhD, RN, CPAN, is a Senior Clinical Analyst, Department of Patient Safety, TDC, Napa, CA

Balancing the Tension Between Hyperoxia Prevention and Alarm Fatigue in the NICU.

After the implementation of narrowed oxygen saturation alarms, alarm frequency increased in the C.S. Mott Children's Hospital NICU which could have a negative impact on patient safety. The Joint Commission on the Accreditation of Healthcare Organizations issued a Sentinel Event Alert for hospitals in 2013 to improve alarm safety, resulting in a 2014 National Patient Safety Goal requiring institutional policies and procedures to be in place to manage alarms. A multidisciplinary improvement team developed an alarm management bundle applying strategies to decrease alarm frequency, which included evaluating existing strategies and developing patient care-based and systems-based interventions. The total number of delivered and detected saturation alarms and high saturation alarms and the total time spent within a targeted saturation range were quantitatively tracked. Nursing morale was assessed qualitatively. SpO2 alarms per monitored patient-day increased from 78 to 105 after the narrowing of alarm limits. Modification of the high saturation alarm algorithm substantially decreased the delivery and escalation of high pulse oxygen saturation (SpO2) alarms. During a pilot period, using histogram technology to individually customize alarm limits resulted in increased time spent within the targeted saturation range and fewer alarms per day. Qualitatively, nurses reported improved satisfaction when not assigned >1 infant with frequent alarms, as identified by an alarm frequency tool. Alarm fatigue may detrimentally affect patient care and safety. Alarm management strategies should coincide with oxygen management within a NICU, especially in single-patient-bed units.

Understanding Clinical Alarm Safety.

Patient safety organizations and health care accreditation agencies recognize the significance of clinical alarm hazards. The Association for the Advancement of Medical Instrumentation, a nonprofit organization focused on development and use of safe and effective medical equipment, identifies alarm management as a major issue for health care organizations. ECRI Institute, a nonprofit organization that researches approaches for improving patient safety and quality of care, identifies alarm hazards as the most significant of the "Top Ten Health Technology Hazards" for 2014. A new Joint Commission National Patient Safety Goal focusing on clinical alarm safety contains new requirements for accredited hospitals to be fully implemented by 2016. Through a fictional unfolding case study, this article reviews selected contributing factors to clinical alarm hazards present in inpatient, high-acuity settings. Understanding these factors improves contributions by nurses to clinical alarm safety practice.

What's that sound? Managing alarm fatigue

What's that sound? Managing alarm fatigue