Alarm fatigue: or, the monitor that cried “wolf”

If you’ve ever been inside a PICU, or any ICU for that matter, I’m sure you were surrounded by fancy-looking equipment. There are monitors coming off the wall that measure a large assortment of patient variables. These can include include heart rate, breathing rate, blood pressure, amount of oxygen in the blood, amount of carbon dioxide in the patient’s breath. If the patient has various invasive monitoring devices in place in the bloodstream, or even in the brain, the monitors measure pressures inside the blood vessels and brain. Most of these monitors also display a waveform of these things moving across a screen in multiple colors. It’s very impressive-looking. If the patient is on a mechanical ventilator, a breathing machine, it has monitors built into it, too. This child has a bunch of those, including the brain one.

We use these monitors to measure important things, and they all have alarm settings that go bing or bong, often quite loudly, if the thing the monitor is measuring drifts outside whatever parameters are set for the monitor. That’s for safety. But many of those monitors are so sensitive that one or another of them is always making noise. Nurses are frequently resetting one or another of the alarm buttons. Virtually all the time it’s a false alarm in that the particularly bing or bong is not significant for the patient. Often it means there’s something amiss with the monitor.

I think you can see where this is going — alarm fatigue sets in. With so much alarm noise, most of it like the proverbial boy calling wolf, it can be a problem when to know when there’s a real wolf in the room. The FDA has recognized the problem, which I can tell you from practical experience is a real one, by scrutinizing new medical equipment for a balance between alarm sensitivity and usefulness. You can read more about that here.

The best advice for doctors and nurses in dealing with this issue is what the good ones always do: when some alarm goes off indicating a problem, look at the patient more than the monitor.


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