Improving alarm management to reduce alarm fatigue in critical care: a mixed-methods study

The excessive number of false alarms in the intensive care unit (ICU) environment constitutes a significant clinical issue, contributing to alarm fatigue among medical staff. Effective alarm management is crucial for reducing the incidence of false alarms and enhancing patient safety in the critical care setting. This study aimed to conduct a quantitative analysis of alarms generated by cardiac monitors, assess ICU staff attitudes toward the alarm system, and implement and evaluate the effectiveness of an intervention designed to improve alarm management in an anaesthesiology and intensive care unit.

The project employed an action research methodology. It incorporated pre- and post-intervention analysis of alarm data retrieved from patient monitoring systems, participant observation, a questionnaire-based survey, and root cause analysis (RCA). The intervention consisted of educational initiatives and technical adjustments.

A total of 119,158 alarms were recorded in the pre-intervention phase and 151,840 in the post-intervention phase (a 27.4% increase). Despite the overall increase in alarm volume, improvements were observed in the structure and classification of alarm. The number of red technical alarms decreased by 61.1%, while the number of short yellow alarms dropped by 2.3%. Participant observation revealed high noise levels, selective staff responsiveness to alarms, and varied proficiency in monitor operation. The staff confirmed that alarms were burdensome, caused fatigue, and had a negative impact on patient care. RCA analysis revealed the absence of a comfort profile for palliative patients and identified issues with device configuration and technical artefacts.

Despite an overall increase in alarm frequency, the intervention led to an improvement in alarm quality. ICU staff experience alarm fatigue, necessitating ongoing monitoring and support. The lack of standardized alarm management protocols highlights the need for threshold standardization and a clear delineation of responsibilities. Interventions combining staff education with technical optimization are the most effective.

Alarm management should be regarded as an interdisciplinary task, involving nursing staff, physicians, clinical engineers, and representatives from medical device manufacturers.