ADVANCE for Respiratory Care and Sleep Medicine | Printer Friendly

Ventilator alarm fatigue continues to be a serious problem that directly affects patient safety. Frequent ventilator alarms often desensitize health care providers, or the alarms can blend in with other accustomed sounds in the intensive care unit. Ventilator alarms that go unnoticed for extended periods of time often result in permanent patient harm or death. The intensive care unit can be a stressful and noisy environment that can distract health care providers because of the many different monitoring systems. For example, a typical ICU may have more than 40 alarm sources such as ventilators, electrocardiograms, arterial pressure, pulse oximetry, perfusion pumps, nutrition pumps, automatic syringes, dialysis systems, and bed monitoring alert systems. One ventilator on the market has 111 different alarm features listed in the operator's manual. Alarm fatigue or nuisance alarms continue to be listed by ICU personnel as one of the most annoying environmental problems. In a recent survey, health care providers identified that false alarms or nuisance alarms occurred 81 percent of the time and that they distrusted the alarm devices. 1 Often health care providers simply silence ventilator alarms without notifying other health care team members, which could lead to sentinel events. The health care providers might not realize that when they silenced the alarm for a brief time they subsequently disabled or silenced multiple internal alarms that would normally sound to alert changes in the patient's status. In 2002, the Joint Commission published a Sentinel Event Alert entitled the "prevention of ventilator-related deaths" in which 23 deaths or injuries were reported. They found that 87 percent of the incidents were related to inadequate orientation/training; 22 percent were related to alarm off or set incorrectly, no alarm for certain disconnects, or the alarm was not audible in all areas. 2 Purpose of ventilator alarms Patients in the modern hospital ICU environment range from the micro preemie to the morbidly obese. This requires health care providers to be familiar with age-appropriate vital sign ranges and have a thorough understanding of normal physiological parameters. Unfortunately, many of our patients have abnormal vital signs and physiological parameters, and yet we are faced with the admonition of "do no harm" in trying to provide mechanical ventilation for them. The interaction between the patient and the mechanical ventilator is one of the most complex tasks to coordinate in the ICU. All available monitors provide reliable information both on the setting parameter …