Actionable Alarms Counter Alarm Fatigue

Device alarms can be a lifesaver, but not if they’re ignored. Ongoing quality improvement projects at the 923-bed Johns Hopkins Hospital in Baltimore have been looking at how nurses and other clinical staff respond to alarms and how to avoid alarm fatigue, which could lead to alarms being disabled, silenced, or ignored.

“I think one of the things that piqued my interest in [alarm fatigue] is that there is really no single technology out there today that we can point to that can solve this problem,” says Maria Cvach, MSN, RN, an assistant director of nursing, clinical standards, at Hopkins and coauthor of a study on alarm fatigue that appeared earlier this year in the American Journal of Critical Care.

Many alarms in a hospital have good sensitivity—but poor fidelity or specificity. This means that “you’re getting a lot of alarms, but those alarms are not necessarily true or clinically relevant,” Cvach says. “Even if you have the best technology out there, you’re going to get a lot of false alarms.”

Instead, the key is to learn to make your alarm “actionable,” Cvach says. “You’ve got to set parameters to a point where people will act.”

For instance, for the patient on a respiratory unit, you would not set the pulse oximeter at 92% as their low limit. “More likely than not, you’re not going to do much for [those patients] because they’re always at that level. Instead, we want to customize the alarm for that patient and make it a reasonable level that will prompt action.”

When setting at a lower limit, you’re setting it for when the patient is facing a crisis. “And then when it rings, you’re going to do something about it, as opposed to setting it higher and it rings and rings and nobody does anything about it,” Cvach says.