AST Guideline - Best Practices in Alarm Management in the Operating Room

3 or reduce the failures, starting the highest priorties. 21 “Failure modes” means the way in which the alarm can fail and affect the patient; “effects analysis” refers to studying the consequences of the failures. 21 Failures are prioritized according to the seriousness of the consequences and actions to address the failures are completed. 21 2) Evidence-based indications should be considered for the appropriate initiation, maintenance and discontinuation of medical devices that have an alarm. 2 C. Establish policies and procedures (P&P) for alarm settings on alarm-equipped medical devices, including identification of situations when alarm signals are not clinically necessary. This can prevent false alarms, also called nuisance alarms, from occurring that are a source of noise and distraction that can disrupt patient care. 12 If an alarm has been silenced/turned off, it should be recorded who turned off the alarm; when the alarm was turned off; and the reason why. 1) To prevent nuisance alarms it is recommended to customize alarm settings according to individual surgical patients and use smart alarms when available. 12 Smart alarms can reduce the number of nuisance alarms through technology that takes into account multiple parameters, rate of change and signal quality and the alarms are based on physiologic trends sensed over a period of time. 26 2) Protocols, based upon evidence-based practices, should be established for proper skin preparation and placement of electrodes to prevent false alarms. 11 Additionally, artifacts (e.g. patient movement or manipulation of sensors) should be taken into consideration for the cause of false alarms. 17 3) Evidence-based practice has also confirmed that single-use pulse oximeter sensors are less prone to false alarms versus recycled sensors. 11 4) Electrical cords and cables from alarm equipped devices such as the electrodes and pulse oximeter should be regularly inspected for damage to prevent false alarms. 11 D. Establish P&Ps for situations in which alarm settings and limits may be modified to minimize alarm signals and the extent to which alarms may be modified. E. Based upon a study by F. R. Man et al. (2013) the number of alarms significantly increase during induction and emergence of anesthesia as opposed to maintenance; however, a large percentage of the alarms are clinically irrelevant. 8 The increase in the number of alarms can be expected due to hemodynamic and respiratory changes, in particular during emergence. 8 The surgical team should maintain awareness of the clinical alarms while taking into consideration the work activities that are occurring during the care of the patient during induction and emergence. F. Based upon manufacturers’ recommendations and instructions-for-use (IFU), the surgery department should establish a schedule with the input of the healthcare technology management technicians for the inspection and maintenance of alarm- equipped devices to ensure proper operation of the devices as well as accurate and appropriate alarm settings.