Algorithm reduces « alarm fatigue »

Medical device alarms may pose a threat to patient safety when they generate alarms that are either false or clinically insignificant, resulting in nurses’ desensitization or « alarm fatigue ». Staff may fail to respond to a true emergency.

Innovations to reduce false alarms include using « smart alarms », which apply multiparameter filters ; employing expensive human monitor-watchers ; and using pagers, which may have connectivity issues and lack necessary filters. At a new two-ward cardiac unit at Johns-Hopkins Hospital, Baltimore, USA, nurses trialled a new system which had the two aims of decreasing « the average frequency and duration of high-priority cardiac monitor alarms per monitored bed » and improving « nurses attitudes about clinical alarms, including their perception of effectiveness of notification devices ».

An alarm escalation algorithm was developed after analysing alarm logs. It determined which cardiac monitor alarms were actionable, prioritized them and sent them to a nurse’s radio-based pager. The nurse then closed the communication loop by acknowledging receipt of the page. Results indicate that the algorithm and acknowledgement pager improved nurse notification of high-priority alarms and reduced alarm fatigue. Best results were noted in the ward where each nurse carried a pager, as opposed to the ward where only the charge nurse carried a pager.