Ventilator Alarms: A Closer Look at Patient Safety and Clinician Burnout

Abstract

Background:

Mechanical ventilators are essential for survival of critical care patients. Although ventilator alarms promote patient safety, their importance is often overlooked and seldom studied. This is due in part to their very high rate of occurrence, leading to alarm fatigue, thus increasing burnout. The main goals of this study were to evaluate ventilator alarm parameter selection by healthcare providers, and to determine the healthcare provider’s perception of alarm fatigue in the adult ICU.

Methods:

This cross-sectional study surveyed healthcare professionals (HCP) 18 years and older working in adult ICUs. A questionnaire created using Google Form consisted of 29 items that was distributed via social media to participants in North America. It included sections addressing the participants demographics, occupation, area of patient care, basic ventilator inquiries and scenarios, as well as covid related issues. Descriptive statistics were used to report means and standard deviations. IRB approval was obtained.

Results:

A total of 53 participants completed the survey; most were respiratory therapists (n = 47; 88.7%), and the HCP responsible for adjusting the ventilator setting and alarms in their facilities according to most respondents (84.9%). When selecting the alarm setting for the high peak pressures (PIP high), 56.6% agreed to setting the alarm 10 cwp above PIP, 43.4% of participants would set the low PEEP alarm 5 cwp below set, and 49.1% of participants would set the low minute volume (VE low) alarm 2 L/min below patient's VE. When simulated scenarios were presented to participants, selections for VE high alarm varied the most, with 42.3% of participants selecting 4-6L/min above the average VE and 40.4% selecting 2-4 L/min above. When asked about alarm nuisance, two-thirds of participants had experienced alarm fatigue and felt they addressed the PIP high alarm most frequently (66%). However, 34.6% of participants stated alarm fatigue was caused by a multitude of false-negative alarms. The remaining 65.4% believed alarm fatigue was caused due to a shortage of staff, heavy workloads, or loud environments. Most participants (71.2%) believed COVID-19 caused an excess of ventilator alarms.

Conclusions:

The results of this study suggest that while most participants select alarm parameters that are consistent with recommendations, the majority of HCP report alarm fatigue. Reducing alarm fatigue should be a priority to ensure patient safety remains our number one concern.