AACN outlines evidence-based protocols and clinical strategies to manage alarms

Clinical alarms are designed to alert clinicians to changes in their patients' conditions, but their sheer numbers and resulting noise instead pose a significant threat to patient safety, according to the American Association of Critical-Care Nurses (AACN).

The sensory overload from sounds emitted by monitors, infusion pumps, ventilators and other devices can cause a person to become desensitized to the alarms. In addition, recent studies have estimated that approximately 90 percent of alarms in various critical care settings are either false or clinically irrelevant.

The subsequent alarm fatigue contributes to delayed or reduced clinician response to alarms, which can lead to missed critical events and patient death.

The Joint Commission has identified alarm management as a national patient safety goal and requires hospitals to take action to reduce unnecessary alarms as a condition of accreditation.

A newly released AACN Practice Alert, "Managing Alarms in Acute Care Across the Life Span: Electrocardiography and Pulse Oximetry," outlines evidence-based protocols and clinical strategies that healthcare organizations can implement to address issues related to alarm management.

The practice alert summarizes expected nursing practice related to alarm management for both bedside care providers and nurse leaders as they seek ways to reduce false or nonactionable alarms and improve the effective use of these monitoring aids.

"This practice alert takes what is known about alarm management and puts it into action-oriented strategies to help nurses provide the safest patient care possible when managing clinical alarms in acute and critical care environments," said Linda Bell, MSN, RN, AACN clinical practice specialist. "The issue of alarm fatigue can most effectively be addressed, and eventually eliminated, by working with the people closest to the patient and those who support the needs of the patient."

Among the recommended interventions for staff nurses and bedside caregivers:

• Provide proper skin preparation for and placement of ECG electrodes.
• Use proper oxygen saturation probes and placement.
• Check alarm settings at the start of every shift, with any change in patient condition and with any change in caregiver.
• Customize alarm parameter settings for individual patients in accordance with unit or hospital policy.

The strategies for nursing leaders include the following:

• Establish an interprofessional team to gather data and address issues related to alarms.
• Develop unit-specific default parameters and alarm management policies.
• Provide initial and ongoing education on monitoring systems and alarm management for unit staff.
• Develop policies and procedures for monitoring only those patients with clinical indications for monitoring.

The alert is the latest in the growing library of clinical resources from AACN with the latest evidence-based resources and research. Each AACN Practice Alert outlines the scope of the problem, summarizes the expected nursing practice and provides supporting evidence and research. The AACN Practice Alerts are available at no cost electronically on the AACN website, www.aacn.org/practicealerts, once users sign in.

Supported by authoritative evidence, each AACN Practice Alert seeks to ensure excellence in practice along with promotion of safe and humane work environments. Topics address both nursing and interprofessional activities of importance for patients and families in acute and critical care environments. Some alerts include additional resources for staff education and performance-improvement activities.

Previously released alerts address verification of feeding-tube placement, pulmonary artery pressure monitoring, family presence during CPR and invasive procedures, and prevention of aspiration.