Are there any significant benefits to loud alarms in the ICU?
I read that the loud alarms in the ICU have a deleterious effect on patients' outcomes. Are there any significant benefits to these loud alarms? Otherwise, shouldn't they use some more discrete alarms(e.g. in their pocket/phone) instead?
Alarms in the ICU can lead to a disruption of care, impacting both the patient and the clinical staff through noise disturbances, desensitization to warnings and slowing of response times [1], leading to decreased quality of care [2,3]. ICU alarms produce sound intensities above 80 dB that can lead to sleep deprivation [1,4,5], inferior sleep structure [6,7], stress for both patients and staff [10,11,12,13] and depressed immune systems [14]. There are also indications that the incidence of re-hospitalization is lower if disruptive noise levels are decreased during a patient's stay [15]. Furthermore, such disruptions have been shown to have an important effect on recovery and length of stay [2,10]. In particular, cortisol levels have been shown to be elevated (reflecting increased stress) [12,13], and sleep disruption has been shown to lead to longer stays in the ICU [5]. ICU false alarm (FA) rates as high as 86% have been reported, with between 6% and 40% of ICU alarms having been shown to be true but clinically insignificant (requiring no immediate action) [16]. In fact, only 2% to 9% of alarms have been found to be important for patient management [17].
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In my experience with one brand of monitors we tend to set multiple levels of severity of alarms at different volumes. The third tier alarms will be quite quiet and usually reflect a problem with monitoring (ie lead fallen off). The second tier are usually low-moderate volume and persistent. This would indicate an abnormal value that the patient condition has changed and needs attention. The first tier alarms are critical changes that are life-threatening and require immediate attention.
This first tier alarm is heard by all staff in the unit and can prompt other staff that there may be a need for assistance with that patient.
Further to this is the code alarm. This is activated by the nurse and indicates that assistance IS required.
I'm sure that not having adequate response to a cardiac arrest has more deleterious outcomes than loud alarms.
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