Alarm Effectiveness in the Medical Intensive Care Unit

Abstract

PURPOSE: ICU alarms are intended to inform staff of a patient needing attention or to alert them to trouble with a medical device. The accuracy of such alarms in reflecting patient or device condition has been questioned. Our aim was to explore whether alarms draw healthcare providers to a patient’s room and are effective, which we defined as leading to an alarm-related action within 5min of the alarm end. METHODS: Observations were performed in a 12 bed tertiary care center MICU. A bedside observer recorded the frequency of alarms, the presence of healthcare providers in the patient’s room, and the tasks performed in the room. Some information from this study has been previously reported (Anesth Analg. 2009:1546-52). Data were re-analyzed with a focus on alarms generated when no healthcare provider was in the patient’s room. RESULTS: 1214 auditory alarms occurred over a 200hr observation period. A healthcare provider was not in the patients’ room when 524 of these alarms occurred. A healthcare provider entered during or within 2min of these alarms in 111 and 180 episodes respectively. In these settings the alarms were effective only 79 (15%) and 87 (17%) of the times. Of the 413 alarms that did not illicit a response and stopped by themselves when the variable returned to the normal range, 236 alarms sounded multiple times within 10min after the onset of the first alarm. However, only 21 of these repeated alarms elicited an alarm related response from a healthcare provider. CONCLUSION: Only a minority of ICU alarms are acted upon by healthcare providers. This suggests that alarms are not felt to properly reflect the patient condition and are thus not recognized as helpful. With noise in the ICU having a detrimental effect on patient’s sleep and ICU outcome, auditory alarms should sound outside the patient’s room or be transmitted directly to the responsible healthcare provider, if none is present at the bedside. CLINICAL IMPLICATIONS: Alarms may not be achieving their desired effect.