International Journal of Critical Care (2022), Volume 18 Issue 4
CONFERENCE ABSTRACT
Improving Compliance to Clinical Alarm Safety in
Adult ICUs of a Tertiary Hospital in India
Minimole Varghese, Bincy Sunil Thomas
With increasing number of devices with alarms a corresponding increase in clinical
alarm-related adverse events was witnessed in ICUs of given hospital. Events like
missing of vital alarms, not responding promptly and indefinite suspending alarms,
etc., were on rise. Checking alarm settings before admitting patient to ICU was not
being routinely followed, at times alarm settings of previously admitted patients
being followed for new patient.
ICU audits revealed that alarm settings for vital equipment like cardiac
monitors & Ventilators were inconsistently documented (only 60%). The absence of
appropriate documentation was identified as a safety threat. For instance, for ICU
patients transferred-out to wards on non-Invasive ventilator (BiPAP), healthcare
providers were not able to effectively manage alarm triggers due to lack of clarity
regarding device settings.
A survey conducted among nurses (n-131) indicated that alarm fatigue had set
in, indicating high numbers of false alarms, leading to actionable alarms not being
promptly responded to. Another survey for ICU patients (n=20) elicited that 45%
patients experienced unbearable noise levels with 75% citing high noise levels to
equipment alarms.
The need for streamlining gaps led to rigorous brainstorming by relevant team
members and designing of a protocol for clinical alarm safety. It involved
identification of devices that triggered vital alarms, standardization of volumes & tone
of alarms as per urgency, creation of default settings for cardiac monitors & need for
documentation of ventilator as well as BiPAP settings by Clinicians, including the
change of settings. Central monitoring system was uniformly installed in ICUs.
The protocol further required nurses to: (1) ensure adequate skin preparation
before ECG lead application; (2) check all device alarm settings, leads and all
connections on patient admission to the unit & start of every shift; (3) ensure updating
of patient demographics on devices with each new patient, (4) change defective
equipment & accessories as indicated; (5) escalate to Clinicians the need to change
settings for acceptable deviation of patient’s vital parameters. ICU team was alerted
against suspending alarms without valid Clinician’s prescription. Biomedical team
performed weekly alarm checks and conducted equipment trainings with added focus
on clinical alarm troubleshooting. Additionally, training was imparted on: possible
reasons for alarms, priority-wise responding to alarms, escalation of patient condition
as per need, monitoring and management of patients on transit with critical
equipment support.
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International Journal of Critical Care (2022), Volume 18 Issue 4
Post implementation of protocol there was improvement in compliance to
alarm safety in adult ICUs, which increased from 61.42% (Nov-2023) to 90.25% (April-
20240). Alarm related incidents reduced from an average of 1.54 per month to 0 post
implementation of protocol.
The protocolling and standardization brought about improvement in clinical
alarm safety in adult ICUs with zero instances of alarm-related adverse events.
Considering the improvement in adult ICUs, the protocol was extended to pediatric
ICUs with creation of age-based default device alarm settings.
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