• Sukardi Suba, Cass Piper Sandoval, Jessica K Zègre-Hemsey, Xiao Hu, and Michele M Pelter.
• Sukardi Suba is a doctoral student, Department of Physiological Nursing, School of Nursing, University of California, San Francisco (UCSF), San Francisco, California. Cass Piper Sandoval is an adult critical care clinical nurse specialist and clinical nurse coordinator, Interventional Cardiology, UCSF Heart and Vascular Center, UCSF Health, San Francisco, California. Jessica K. Zègre-Hemsey is an assistant professor, School of Nursing and an adjunct assistant professor, Department of Emergency Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Xiao Hu is a professor, Department of Physiological Nursing, School of Nursing, and Department of Neurological Surgery, and a core member, Institute for Computational Health Sciences, UCSF-UC Berkeley Joint Graduate Program in Bioengineering, UCSF. Michele M. Pelter is an assistant professor, School of Nursing, and director, ECG Monitoring Research Lab, UCSF. sukardi.suba@ucsf.edu.
• Am. J. Crit. Care. 2019 May 1; 28 (3): 222-229.

BackgroundExcessive electrocardiographic alarms contribute to "alarm fatigue," which can lead to patient harm. In a prior study, one-third of audible electrocardiographic alarms were for accelerated ventricular rhythm (AVR), and most of these alarms were false. It is uncertain whether true AVR alarms are clinically relevant.ObjectivesTo determine from bedside electrocardiographic monitoring data (1) how often true AVR alarms are acknowledged by clinicians, (2) whether such alarms are actionable, and (3) whether such alarms are associated with adverse outcomes ("code blue," death).MethodsSecondary analysis using data from a study conducted in an academic medical center involving 5 adult intensive care units with 77 beds. Electronic health records of 23 patients with 223 true alarms for AVR were examined.ResultsThe mean age of the patients was 62.9 years, and 61% were white and male. All 223 of the true alarms were configured at the warning level (ie, 2 continuous beeps), and 215 (96.4%) lasted less than 30 seconds. Only 1 alarm was acknowledged in the electronic health record. None of the alarms were clinically actionable or led to a code blue or death.ConclusionsTrue AVR alarms may contribute to alarm fatigue. Hospitals should reevaluate the need for close monitoring of AVR and consider configuring this alarm to an inaudible message setting to reduce the risk of patient harm due to alarm fatigue. Prospective studies involving larger patient samples and varied monitors are warranted.© 2019 American Association of Critical-Care Nurses.

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