Ventilator alarm fatigue continues to be a serious problem that directly affects patient safety. Frequent ventilator alarms often desensitize healthcare providers, or the alarms can blend in with other accustomed sounds in the ICU. Ventilator alarms that go unnoticed for extended periods of time often result in permanent patient harm or death.
The ICU can be a stressful and noisy environment that can distract healthcare providers because of the many different monitoring systems. For example, a typical ICU may have more than 40 alarm sources such as ventilators, electrocardiograms, arterial pressure, pulse oximetry, perfusion pumps, nutrition pumps, automatic syringes, dialysis systems and bed monitoring alert systems. One ventilator on the market has 111 different alarm features listed in the operator's manual.
Alarm fatigue or nuisance alarms continue to be listed by ICU personnel as one of the most annoying environmental problems. In a recent survey, healthcare providers identified that false alarms or nuisance alarms occurred 81 percent of the time and that they distrusted the alarm devices.1
Often healthcare providers simply silence ventilator alarms without notifying other healthcare team members, which could lead to sentinel events. The healthcare providers might not realize that when they silenced the alarm for a brief time they subsequently disabled or silenced multiple internal alarms that would normally sound to alert changes in the patient's status.
In 2002, the Joint Commission published a Sentinel Event Alert titled the "prevention of ventilator-related deaths" in which 23 deaths or injuries were reported. They found that 87 percent of the incidents were related to inadequate orientation/training; 22 percent were related to alarm off or set incorrectly, no alarm for certain disconnects, or the alarm was not audible in all areas.2
Purpose of Ventilator Alarms
Patients in the modern hospital ICU environment range from the micro preemie to the morbidly obese. This requires healthcare providers to be familiar with age-appropriate vital sign ranges and have a thorough understanding of normal physiological parameters. Unfortunately, many of our patients have abnormal vital signs and physiological parameters, and yet we are faced with the admonition of "do no harm" in trying to provide mechanical ventilation for them.
The interaction between the patient and the mechanical ventilator is one of the most complex tasks to coordinate in the ICU. All available monitors provide reliable information both on the setting parameter and the recognition of adverse events. Often the audible alarm systems are based on settings that trigger an alarm to notify healthcare providers about safe patient care.
Regardless of the type of alarm, it is necessary to set the threshold alarm limit. Although, there is no standard for default alarm setting from one monitoring system to another. Some mechanical ventilators allow healthcare providers to "autoset" alarm parameters based on the current measured parameters. This can be helpful when the patient is deteriorating; however, multiple alarms can have a distracting effect on the healthcare provider working directly at the bedside.
The priority in alarm management is first to recognize and locate the source of the alarm and determine its significance. For experienced healthcare providers, locating the alarm is determined by the different sounds produced by the equipment. The interpretation of an alarm event by healthcare providers can depend on their experience working in ICU, their knowledge about the equipment and their ability to intervene during non-emergency situations.
For example, a patient who is disconnected from a ventilator produces the same audible alarm as a high level of minute ventilation. In the first case, the alarm is vital for the patient, but in the second case it may be related to ventilator settings and is not immediately critical to the patient. Yet, what are bothersome are the repetition, loudness, and continual nuisance of the alarms when after analysis of the problem the equipment does not allow for silence.