1. How Can We Safely Reduce 50% of Patient Monitor Alarms in the Surgical Intensive Care Unit? Samuel Galvagno, DO PhD1; Peter F. Hu, PhD1,2, Li-Chien Lee, MS1, Hsiao-Chi Li, PhD1, Shiming Yang, PhD1, Samuel Tisherman, MD2, Steven Gee, RN2, Peter Rock, MD1 1. Department of Anesthesiology, University of Maryland School of Medicine. 2. Department of Surgery, University of Maryland School of Medicine.
25% of alarms were less than 28 seconds (C1), 4 seconds (C2), 2 seconds (C3), and 4 seconds (C4).
50% of alarms were less than 322 seconds (C1), 10 seconds (C2), 13 seconds (C3), and 12 seconds (C4).
Alarm fatigue
Results
426,647 alarms were recorded during the study period resulting in 148 alarms per bed per day in the 24 bed Surgical Intensive Care Unit (SICU)
The majority of the alarms were classified as “C1: and System Warning” (66,300, 15.5%); “C2: Patient Advisory” alarms (n = 245,779, 57.6%); “C3: Patient Warning” (98,024, 23%)
Only 3.9% were in the “C4: Patient Crisis” alarm category.
“We didn’t hear it”
“We couldn’t tell what was alarming”
“We just got too busy”
“Things were just crazy that day”
“The place is like a casino with so many
bells and whistles”
Background
Alarm fatigue is a critical patient safety concern
Hypothesis: a significant reduction in the number of monitor alarms can be achieved by instituting a short delay (seconds) in activating the alarm to eliminate brief, transitory alarms, and by changing alarm limits
SpO2 Low
SpO2% ≤ 90%  88%
41%
Methods
Retrospective analysis of patient vital signs in a 24-bed Surgical Intensive Care Unit
Alarm data were collected between October 12, 2015 and February 15, 2016
Data were obtained from networked vital signs monitors (GE Solar ®) using the BedMasterEX® system
Duration (seconds) was analyzed to achieve alarm reductions of 25% then 50%
To reduce individual VS alarms, different alarm limit settings were compared with the default settings of hypoxia (SpO2 low ≤ 85%,) and tachycardia (heart rate: HR high ≥ 130 bpm)
Fig 2: SpO2 low limit change from the default setting (SPO2 ≤ 85%)
and associated alarm reduction
( frequency n, change % and duration in hrs.)
Fig 1: 24 Beds SICU Alarm reduction study. 18 weeks pre and 8 weeks post intervention (44% total alarm reduction)
Tachycardia
HR ≥ 130  ≥ 135 bpm
40%
Alarm (Top 10)
Total N 1 2 3 4 5 6 7 8 9 10
Level
Category
(C1)
System Warning
66300 (15.5%)
SPO2 PROBE
NO ECG
CONNECT PROBE
NBP MAX TIME
SENSOR
ARRHY SUSPEND
SPO2 SENSOR
NBP FAIL
RR LEADS FAIL
NBP OVER PRES
33.4%
23.6%
16.2%
14.7%
5.8%
4.6%
1.0%
0.4%
(C2)
Patient Advisory
245779
(57.6%)
ART S LO
PVC
CHECK ADAPTER
ART S HI
NBP S LO
ART M LO
CO2 RSP HI
NBP S HI
ART D HI
ART M HI
25.7%
15.7%
13.6%
13.3%
6.2%
4.7%
4.2%
3.5%
3.4%
2.7%
(C3)
Patient Warning
98024
(23.0%)
SPO2 LO
ART DISCONN
V TACH
VT > 2
NO BREATH
FEM2 DISCONN
HR HI
93.4%
2.8%
1.8%
1.1%
0.9%
0.0%
(C4)
Patient Crisis
16544
(3.9%)
LEADS FAIL
HR LO
BRADY 
V TACH 
ASYSTOLE 
V BRADY 
VFIB/VTAC 
27.1%
25.0%
14.9%
12.4% 
11.8% 
6.5% 
1.4% 
0.6% 
0.3% 
Fig 3: Heart rate high limit change from the default setting (130)
and associated alarm reduction
(frequency n, change % and duration in hrs.)
Triple-redundant BedMaster®
VS System
Next Step: Hospital wide alarm dashboard
Target: Reduce 30% alarms in 12 months
Near 100% complete VS and alarm collection
Conclusion
4-month data from 24 SICU beds
Alarm fatigue from physiologic alarms is a well recognized problem
A viable solution to safely reduce alarms has not been established
Delaying all alarms for 4 seconds could reduce 31% of the total alarms
Lowering alarm thresholds of the lower SpO2 limit by 2% and increasing the tachycardia threshold by 5 bpm could reduce 41% and 40% of alarms for SpO2 and tachycardia respectively
Further study is needed to determine what impact such changes would have upon the safety of patients being cared for in the SICU
Table 1: Top 10 most frequent alarms in each category
Supported by University of Maryland School of Medicine, Department of Anesthesiology and University of Maryland Medical Center.