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AACN practice alert addresses alarm fatigue in ICU


A new practice alert from the American Association of Critical-Care Nurses outlines evidence-based protocols to reduce false or non-actionable alarms and improve the effective use of these monitoring aids.

Clinical alarms designed to alert nurses to changes in their patients’ conditions have become a continual barrage of noise that poses a significant threat to patient safety, the AACN stated.

Since 1983, the average number of alarms in an ICU has increased from six to 40, despite the fact that humans have difficulty learning more than six different alarm sounds, according to the AACN. The sensory overload from sounds emitted by monitors, infusion pumps, ventilators and other devices can cause a person to become desensitized to the alarms. Such alarm fatigue may result in delayed responses or missed alarms, sometimes contributing to patient deaths.

Based on the latest available evidence, the AACN practice alert summarizes expected nursing practice related to alarm management, including:

• Provide proper skin preparation for ECG electrodes, which can improve conductivity and decrease the number of false alarms;

• Change ECG electrodes daily;

• Customize alarm parameters and levels on ECG monitors;

• Customize delay settings and threshold settings on oxygen saturation via pulse oximetry monitors. The combination of appropriate alarm delays and threshold settings optimizes the monitor to its highest potential, producing an alarm when action is required;

• Provide initial and ongoing education about devices with alarms;

• Establish interprofessional teams to address issues related to alarms, such as the development of policies and procedures;

• Monitor only those patients with clinical indications for monitoring.

This alert is the latest in a series of guidelines issued by AACN to standardize practice and update nurses and other healthcare providers on new healthcare advances and trends. Additional alerts address ventilator associated pneumonia, pulmonary artery pressure monitoring, dysrhythmia monitoring, ST segment monitoring, family presence during resuscitation and invasive procedures and verification of feeding-tube placement.

AACN alerts can be downloaded free of charge at


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