Alarm fatigue: more research suggests AVR alarms may be more of a nuisance than a help
Research has indicated that hospitals should reevaluate the need for close monitoring of accelerated ventricular rhythm (AVR) or consider setting the alarm for the arrhythmia to inaudible. A study from the ECG Monitoring Research Lab at the School of Nursing at the University of California, San Francisco (UCSF) found that none of the 223 true AVR alarms they examined was clinically actionable and none was associated with adverse patient outcomes. The study was published in the American Journal of Critical Care (AJCC).
“Whether true or false, AVR alarms are significant contributors to the problem of alarm fatigue,” said Principal investigator Michele M. Pelter, PhD, RN, an assistant professor at the UCSF School of Nursing, where she serves as director of the ECG Monitoring Research Lab. “Current practice guidelines state that only sustained or symptomatic ventricular rhythms are clinically important and thus require treatment. Our findings support this recommendation and suggest that the need to configure bedside monitors to alarm for AVR should be reevaluated.”
When AVR alarms are configured as audible, nurses are exposed to a high volume of nonactionable alarms, said the study authors. The excessive clinical alarms can cause alarm fatigue, in which nurses become desensitized to alarms, delay their response to them, and in extreme cases turn them off, all of which may result in patient harm due to missed emergencies.
The research looked more closely at the results from one of the ECG Monitoring Research Lab’s earlier studies that included alarm data from all 77 bedside monitors in five adult critical care units at UCSF Medical Center during a 31-day period. The primary study showed AVR to be the most common audible ECG alarm category, accounting for one third of the over 12,600 annotated arrhythmia alarms. Importantly nearly 95 percent of the AVR alarms in the study were determined to be false alarms. However, before recommending that AVR alarms be adjusted to an inaudible setting, the researchers carefully examined whether true AVR alarms were actionable.
The secondary analysis evaluated only the remaining 5 percent of the AVR alarms, those considered to be true alarms. The researchers examined data from the electronic health records of patients with true alarms for AVR.
They found that only one alarm was acknowledged in the patient’s record, and that none was followed within 15 minutes by a clinical intervention related to the alarm, such as a new medication being started to treat AVR or an adjustment to a current arrhythmia medication.
“Just because an alarm is available on the bedside monitor doesn’t mean we should turn it on, particularly if treatment for that alarm is not indicated,” Pelter said. However, careful evaluation of patient outcomes is warranted before any recommendations are made.
