On any given day in certain hospital units, up to several hundred alarms may sound per patient, according to the Joint Commission. Yet 85% to 99% of these signals do not require clinical intervention, and as a result, nurses can become desensitized to the sounds. This can ultimately put patient safety at risk.

For example, a ventricular tachycardia alarm may signal if a patient is simply moving, which means the alarm is inaccurate. One method that may help to eliminate inaccurate alarms in this scenario is to change electrodes regularly and ensure proper skin preparation for the electrodes, said Ruppel. An example of a clinically irrelevant alarm would be an accurate alert for a transient oxygen desaturation of 89% that does not require action on a nurse’s part, she said. “Nurses usually want to know if oxygen saturation drops below the default setting for a patient, but for patients with COPD, for example, the default may not be an important threshold,” Ruppel said. In these cases, the alarm settings could be customized by a nurse based on a patient’s needs, she said. Her review revealed that only 5% to 13% of the alarms in the studies were clinically relevant and she hopes this data will prompt more research about ways to reduce the number of alarms that are clinically irrelevant.  ECG alarms also are often clinically irrelevant, said Ruppel, and alarm settings can be tailored to address this problem. An athletic patient who has a low normal resting heart rate, for example, may need a different setting than the default configurations. Similarly, PVC [premature ventricular contraction] alarms often don’t require clinical intervention because PVCs are generally not treated, said Ruppel, and “these alarms can be configured to be inaudible in some cases.”  

Learning to use alarms wisely

Customizing monitor settings may be a logical strategy to reduce the number of clinically irrelevant alarms, but training new nurses to tailor settings for each patient requires education, said Ver Hage. For example, new critical care nurses should be taught how to silence arterial line alarms when they are drawing blood for labs, she said, and ideally this type of training should be started by the preceptor during orientation.  Reducing the number of alarms will not only decrease the , but help nurses avoid the tendency to become dependent on alarms more than their own assessments at the bedside, Ver Hage said. “In the acute care setting where nurses are monitoring multiple devices with alarm capabilities, we can begin to assume that more alarms is better,” she said. “But this is not the case. This can lead to unnecessary distractions and less time to focus on the patient.” Nurses like Ruppel and Ver Hage agree the goal is to create an environment in which the sound of an alarm means action is required, but more studies are needed that measure the clinical relevance of alarms, said Ruppel. Her article focused on physiological monitors for heart rate, oxygen saturation, respiratory rate, arrhythmias and blood pressure, and more research is needed that specifically addresses other device alarms, such as ventilator alarms, she said. “I think it is really important that we tackle this issue from multiple perspectives,” Ruppel said. “Excessive alarms are a patient safety problem, but they are often normalized in ICUs and other acute care environments because they seem like an inevitable part of care.”