Contribution of Electrocardiographic Accelerated Ventricular Rhythm Alarms to Alarm Fatigue

Abstract

Background Excessive electrocardiographic alarms contribute to “alarm fatigue,” which can lead to patient harm. In a prior study, one-third of audible electrocardiographic alarms were for accelerated ventricular rhythm (AVR), and most of these alarms were false. It is uncertain whether true AVR alarms are clinically relevant. Objectives To determine from bedside electrocardiographic monitoring data (1) how often true AVR alarms are acknowledged by clinicians, (2) whether such alarms are actionable, and (3) whether such alarms are associated with adverse outcomes (“code blue,” death). Methods Secondary analysis using data from a study conducted in an academic medical center involving 5 adult intensive care units with 77 beds. Electronic health records of 23 patients with 223 true alarms for AVR were examined. Results The mean age of the patients was 62.9 years, and 61% were white and male. All 223 of the true alarms were configured at the warning level (ie, 2 continuous beeps), and 215 (96.4%) lasted less than 30 seconds. Only 1 alarm was acknowledged in the electronic health record. None of the alarms were clinically actionable or led to a code blue or death. Conclusions True AVR alarms may contribute to alarm fatigue. Hospitals should reevaluate the need for close monitoring of AVR and consider configuring this alarm to an inaudible message setting to reduce the risk of patient harm due to alarm fatigue. Prospective studies involving larger patient samples and varied monitors are warranted.

The Current Situation and Influencing Factors of the Alarm Fatigue of Nurses’ Medical Equipment in the Intensive Care Unit Based on Intelligent Medical Care

“…At present, there is no universally recognized standard for the classification of medical equipment alarms. According to the validity, the alarms are classified into true positive alarms, true negative alarms, false negative alarms, and false positive alarms [ 17 , 18 ]. True positive alarm is to indicate that the patient is truly abnormal, which is a true alarm that is meaningful for the treatment of the patient; true negative alarm refers to the situation where the patient has an abnormal condition without any alarm [ 19 ]; false positive alarms refer to useful alarms that are not related to the condition of clinical patients, including alarms for technical problems of the instrument; false negative alarms refer to false alarms that cannot reflect changes in the patient's status.…”

Computer Assisted Patient Monitoring: Associated Patient, Clinical and ECG Characteristics and Strategy to Minimize False Alarms

“…However, we found that only 9% of false arrhythmia alarms were due to poor signal quality (i.e., unanalyzable due to excessive noise, baseline wander, or leads off). Rather, our group has shown that false arrhythmia alarms are more common in patients with ECG features such as bundle branch block, a ventricular pacemaker, and/or low amplitude QRS complexes [3,24,25,38]. Of note, these features, present in only a few patients, were shown to be responsible for 60% of false alarms.…”

“…However, the Pacer Mode feature was not turned on (star) in this patient, which led to non-stop false AVR alarms. We found that the Pacer Mode had been activated in only 33% of the patients with a ventricular pacer [2,25]. ECG Artifact: Motion artifact is a common cause of false alarms.…”

Ventricular tachycardia and in-hospital mortality in the intensive care unit

“…The new VT algorithm, which was recently published, 16 was designed to decrease false VT by addressing ECG factors identified as primary sources of false VT (ie, motion/noise artifact, bundle branch block [right or left], and/or ventricular paced rhythm). 12 , 13 , 15 , 17 , 18 For example, false VT can occur in patients with wide QRS complexes (ie, bundle branch block or ventricular pacer) when the heart rate exceeds the standard VT criteria of 100 bpm. Current algorithms are not designed to recognize these ECG features and can lead to false alarms for VT. One algorithm strategy we have used is identification of P waves to avoid labeling wide QRS complexes associated with bundle branch block or ventricular paced rhythms as potential VT. Another algorithm strategy we used was correlation of simultaneous drops in SpO 2 and invasive arterial BP waveforms during a potential VT event, which the current bedside monitor algorithm does not do.…”