Exploring intensive care unit nurses' decision-making in alarm management: A qualitative study

Alarm fatigue occurs when there is frequent exposure to an increased amount of false or nonactionable alarms. Alarm fatigue can lead to alarm desensitization and reduced clinical response by nurses, posing a significant risk to patient safety. Alarm fatigue is an important and growing safety concern that needs to be explored and addressed.

The purpose of this qualitative study was to better understand how Intensive Care Unit (ICU) nurses make decisions about and respond to alarms, specifically how they recognize different alarms, and how they triage and manage them within the ICU setting.

Twelve nurses from three ICUs participated in-depth semi-structured interviews. Using Interpretive Description methodology, the decision-making regarding alarm response was explored. Thematic analysis was used to identify key themes.

The ICU nurses' decision-making consisted of three steps: their awareness, including how they heard the alarms; how different alarms were triaged; and how they responded and prioritized different alarms. Factors that affected nurses' awareness included competing tasks and priorities, the busy nature of the unit, inadequate staffing, increased unit noise, and an increased amount of false/nonactionable alarms. Next, nurses triaged their alarm response based on their experience, character/nature, situational fatigue and burnout. Lastly, nurses incorporated multiple factors when considering how quickly to respond to an alarm. Urgent responses occurred with high priority electrocardiogram alarms, alarms on more acute patients, bed alarms and intravenous (IV) pumps infusing life sustaining medication.

A positive safety culture, standardized alarm-related education, and mentorship should be evaluated to implement an effective alarm response and management and reduce alarm fatigue.