Patient characteristics associated with false arrhythmia alarms in intensive care

Abstract

IntroductionA high rate of false arrhythmia alarms in the intensive care unit (ICU) leads to alarm fatigue, the condition of desensitization and potentially inappropriate silencing of alarms due to frequent invalid and nonactionable alarms, often referred to as false alarms.ObjectiveThe aim of this study was to identify patient characteristics, such as gender, age, body mass index, and diagnosis associated with frequent false arrhythmia alarms in the ICU.MethodsThis descriptive, observational study prospectively enrolled patients who were consecutively admitted to one of five adult ICUs (77 beds) at an urban medical center over a period of 31 days in 2013. All monitor alarms and continuous waveforms were stored on a secure server. Nurse scientists with expertise in cardiac monitoring used a standardized protocol to annotate six clinically important types of arrhythmia alarms (asystole, pause, ventricular fibrillation, ventricular tachycardia, accelerated ventricular rhythm, and ventricular bradycardia) as true or false. Total monitoring time for each patient was measured, and the number of false alarms per hour was calculated for these six alarm types. Medical records were examined to acquire data on patient characteristics.ResultsA total of 461 unique patients (mean age =60±17 years) were enrolled, generating a total of 2,558,760 alarms, including all levels of arrhythmia, parameter, and technical alarms. There were 48,404 hours of patient monitoring time, and an average overall alarm rate of 52 alarms/hour. Investigators annotated 12,671 arrhythmia alarms; 11,345 (89.5%) were determined to be false. Two hundred and fifty patients (54%) generated at least one of the six annotated alarm types. Two patients generated 6,940 arrhythmia alarms (55%). The number of false alarms per monitored hour for patients’ annotated arrhythmia alarms ranged from 0.0 to 7.7, and the duration of these false alarms per hour ranged from 0.0 to 158.8 seconds. Patient characteristics were compared in relation to 1) the number and 2) the duration of false arrhythmia alarms per 24-hour period, using nonparametric statistics to minimize the influence of outliers. Among the significant associations were the following: age ≥60 years (P=0.013; P=0.034), confused mental status (P<0.001 for both comparisons), cardiovascular diagnoses (P<0.001 for both comparisons), electrocardiographic (ECG) features, such as wide ECG waveforms that correspond to ventricular depolarization known as QRS complex due to bundle branch block (BBB) (P=0.003; P=0.004) or ventricular paced rhythm (P=0.002 for both comparisons), respiratory diagnoses (P=0.004 for both comparisons), and support with mechanical ventilation, including those with primary diagnoses other than respiratory ones (P<0.001 for both comparisons).ConclusionPatients likely to trigger a higher number of false arrhythmia alarms may be those with older age, confusion, cardiovascular diagnoses, and ECG features that indicate BBB or ventricular pacing, respiratory diagnoses, and mechanical ventilatory su...

Challenges of customizing electrocardiography alarms in intensive care units: A mixed methods study

“…Nurses were frustrated by PVC and ventricular arrhythmia alarms that they could not eliminate by customizing, resulting in excessive clinically irrelevant alarms. This finding is consistent with a study demonstrating that most alarms come from a small number of patients, and are often associated with the presence of a bundle branch block or ventricular pacing (Harris et al, 2017). In our study, better understanding of PVC alarm settings and default settings may have assisted nurses in customizing alarms in some situations, but in others, nurses described that the monitor was misinterpreting a rhythm, creating an inaccurate alarm.…”

“…Alarm customization is often cited as a promising method for reducing alarm fatigue (Harris et al, 2017;Konkani, Oakley, & Bauld, 2012;Sendelbach & Funk, 2013) and has been included as part of quality improvement interventions (Graham & Cvach, 2010;Sendelbach et al, 2015;Turmell et al, 2017). However, recommendations for how to improve customization practices among nurses are lacking, especially given that customization is a complex process where more is not necessarily better.…”

Alarm fatigue and the implications for patient safety

“…Hence, with the objective of promoting patient safety, and avoiding possible clinical complications as well as alarm fatigues, it becomes necessary to emphasize the importance of alarms and review the time professionals take to attend them. In addition, we emphasize the need of health professionals thinking the importance of risk management related to technology, especially those which provide advanced life support in intensive care unit (14) .…”

A call to alarms: Current state and future directions in the battle against alarm fatigue

“…Some patient characteristics (e.g. age >70 years, confused mental state, cardiovascular or respiratory diagnosis, mechanical ventilation, wide QRS or low amplitude, ventricular arrhythmias) are associated with false alarms [9]. Patient movement is a predominant cause for invalid alarms due to waveform disturbance interpreted as parameter threshold violation or arrhythmia [10].…”