Most alarms are not clinically relevant
A review of research studies that assessed alarm accuracy and/or clinical relevance in hospitalized patients published over a 30-year period found low proportions of clinically relevant patient alarms.
The findings underscore the need for more rigorous alarm intervention research as hospitals work to meet Joint Commission requirements to reduce unnecessary alarms and implement new practice standards related to electrocardiographic (ECG) monitoring from the American Heart Association.
“Measurement of Physiological Monitor Alarm Accuracy and Clinical Relevance in Intensive Care Units” examined the approaches used to measure alarm accuracy and/or clinical relevance of physiological monitor alarms in intensive care units (ICUs).
The integrative review also compared proportions of inaccurate and clinically irrelevant alarms reported in the studies, which were published from 1986 through 2015. When clinically irrelevant alarms were compared as a percentage of total annotated alarms, most studies revealed that only 5 to 13 percent were clinically relevant; however, the definitions of clinical relevance were inconsistent across studies, which made clinical relevance of alarms difficult to determine.
Co-author Halley Ruppel, RN, MS, is a PhD candidate at Yale University School of Nursing, West Haven, Connecticut, and a Robert Wood Johnson Foundation Future of Nursing scholar. She worked with Yale nursing professors Marjorie Funk, PhD, RN, and Robin Whittemore, PhD, APRN, on the article.
Advances in monitoring technology may have improved the accuracy of alarm systems and simplified much of the data collection but haven’t affected the clinical relevance of alarms.
“Clinical relevance can be a subjective term, and interventions should focus on reducing clinically irrelevant alarms, with careful consideration for how clinical relevance is defined and measured,” Ruppel said. “Especially in ICUs, nurses may use alarms to help them track changes in a patient’s condition. Clinical relevance should reflect alarms that may be informative, even if not immediately actionable or corresponding to a life-threatening incident.”
For the review, the authors conducted an in-depth search of five databases for relevant articles, analysing more than 1,700 records before identifying 12 studies that met the inclusion criteria.
The review follows the recent publication of “Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association.” The comprehensive document provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration and implementation of continuous ECG monitoring of hospitalized patients. The updated practice standards address several emerging issues related to ECG monitoring, including the overuse of arrhythmia monitoring among a variety of patient populations and alarm management.
“Alarms have become ubiquitous in ICUs, but inaccurate or clinically irrelevant alarms remain a threat to patient safety,” said Funk, who also served as a co-author of the AHA statement. “Further research is needed to ensure that we are providing the best-quality monitoring for those who truly benefit from this diagnostic intervention.”
American Association of Critical-Care Nurses