Newswise — Hospitals should reevaluate the need for close monitoring of accelerated ventricular rhythm (AVR) or consider setting the alarm for the arrhythmia to inaudible, according to a study from the ECG Monitoring Research Lab at the School of Nursing at the University of California, San Francisco (UCSF).

In a study published in American Journal of Critical Care (AJCC), the UCSF researchers found that none of the 223 true AVR alarms they examined was clinically actionable and none was associated with adverse patient outcomes.

The research team took a deeper dive into the results from one of the ECG Monitoring Research Lab’s earlier studies that included alarm data from all 77 bedside monitors in five adult critical care units at UCSF Medical Center during a 31-day period. The primary study showed AVR to be the most common audible ECG alarm category, accounting for one third of the over 12,600 annotated arrhythmia alarms. Importantly nearly 95% of the AVR alarms in the study were determined to be false alarms. However, before recommending that AVR alarms be adjusted to an inaudible setting, the researchers carefully examined whether true AVR alarms were actionable.

The secondary analysis evaluated only the remaining 5% of the AVR alarms, those considered to be true alarms. The researchers examined data from the electronic health records of patients with true alarms for AVR.

They found that only one alarm was acknowledged in the patient’s record, and that none was followed within 15 minutes by a clinical intervention related to the alarm, such as a new medication being started to treat AVR or an adjustment to a current arrhythmia medication.

The findings reported in “Contribution of Electrocardiographic Accelerated Ventricular Rhythm Alarms to Alarm Fatigue” suggest that AVR alarms are nuisance alarms that, even when true, are not clinically actionable.

Principal investigator Michele M. Pelter, PhD, RN, is an assistant professor at the UCSF School of Nursing, where she serves as director of the ECG Monitoring Research Lab. She received an Impact Research Grant from the American Association of Critical-Care Nurses to support this study.

“Whether true or false, AVR alarms are significant contributors to the problem of alarm fatigue,” Pelter said. “Current practice guidelines state that only sustained or symptomatic ventricular rhythms are clinically important and thus require treatment. Our findings support this recommendation and suggest that the need to configure bedside monitors to alarm for AVR should be reevaluated.” Pelter and her research team are using this same approach to examine other arrhythmia alarms. “Just because an alarm is available on the bedside monitor doesn’t mean we should turn it on, particularly if treatment for that alarm is not indicated,” Pelter said. However, careful evaluation of patient outcomes is warranted before any recommendations are made. 

When AVR alarms are configured as audible, nurses are exposed to a high volume of nonactionable alarms. The excessive clinical alarms can cause alarm fatigue, in which nurses become desensitized to alarms, delay their response to them, and in extreme cases turn them off, all of which may result in patient harm due to missed emergencies.

The American Association of Critical-Care Nurses (AACN), which publishes AJCC, has an extensive collection of resources related to alarm management and ECG monitoring. Its library of clinical resources includes AACN Practice Alerts for managing physiological alarms, and monitoring arrhythmia and ST segments for critically ill patients. AACN Practice Alerts are available as a free download on the AACN website, www.aacn.org/practicealerts, after signing in.  

To access the article and full-text PDF, visit the AJCC website at www.ajcconline.org.

About the American Journal of Critical Care: The American Journal of Critical Care (AJCC), a bimonthly scientific journal published by the American Association of Critical-Care Nurses, provides leading-edge clinical research that focuses on evidence-based-practice applications. Established in 1992, the award-winning journal includes clinical and research studies, case reports, editorials and commentaries. AJCC enjoys a circulation of more than 120,000 acute and critical care nurses and can be accessed at www.ajcconline.org.

About the American Association of Critical-Care Nurses: Founded in 1969 with 400 members, the American Association of Critical-Care Nurses (AACN) is now the world’s largest specialty nursing organization. In 2019, AACN celebrates 50 years of acute and critical care nursing excellence, serving more than 120,000 members and over 200 chapters in the United States. The organization remains committed to its vision of creating a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. During its 50th anniversary year, AACN continues to salute and celebrate all that nurses have accomplished over the last half century, while honoring their past, present and future impact on the evolution of high-acuity and critical care nursing.

American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656-4109; 949-362-2000; www.aacn.org; facebook.com/aacnface; twitter.com/aacnme

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