Abstract
Objective Alarm fatigue (AF) happens when professionals are exposed to many alarms and they
become desensitized to them. It is related to proliferation of devices, not standardized
alarm limits, and high prevalence of “nonactionable alarms,” i.e., false alarms (triggered
by equipment issues) or nuisance alarms (physiological change not requiring clinical
action). When AF happens, response time seems to be longer and important alarms could
be dismissed. After evaluating the situation in our neonatal intensive care unit (NICU),
an alarm management program (AMP) was developed to reduce AF. The objective of this
study were to compare the proportion of true alarms, nonactionable alarms, and to
measure response time to alarms in the NICU before and after implementing an AMP and
also to determine variables associated with nonactionable alarms and response time.
Study Design This was a cross-sectional study. A total of 100 observations were collected between
December 2019 and January 2020. After an AMP was implemented, 100 new observations
were collected between June 2021 and August 2021. We estimated the true and nonactionable
alarms proportion. Univariate analyses were performed to determine variables associated
with nonactionable alarms and response time. Logistic regression was performed to
assess independent variables.
Results The proportion of true alarms before and after AMP was 31 versus 57% (p = 0.001), whereas the proportion of nonactionable alarms was 69 versus 43% (p = 0.001). Median response time was significantly reduced (35 versus 12 seconds; p = 0.001). Before AMP, neonates with less intensive care needs had a higher proportion
of nonactionable alarms and a longer response time. After AMP, response time was similar
for true and nonactionable alarms. For both periods, the need of respiratory support
was significantly associated with true alarms (p = 0.001). In the adjusted analysis, response time (p = 0.001) and respiratory support (p = 0.003) remained associated with nonactionable alarms.
Conclusion AF was highly prevalent in our NICU. This study shows that after the implementation
of an AMP, response time to alarms and the proportion of nonactionable alarms can
be significantly reduced.
Key Points
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AF happens when professionals are exposed to many alarms and they become desensitized
to them.
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The presence of AF can compromise patients' safety.
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The implementation of an AMP can reduce AF.
Keywords
alarm fatigue - patient safety - clinical alarms - neonatal intensive care
