​Statement on Principles for Alarm Management for Anesthesia Professionals

Developed By: Committee on Quality Management and Departmental Administration
Last Amended: October 18, 2023 (original approval: October 16, 2013)

Purpose:

As anesthesia professionals, we interact with many different types of monitors, machines, infusion pumps and other equipment; many of these devices have audible and/or visual alarms. We rely on alarms to signal us when set parameters or thresholds are violated and/or when a potentially abnormal situation has occurred. A given alarm’s clinical usefulness depends on numerous factors including attributes of the patient (e.g., baseline clinical status and vital signs), the clinical situation at the time (e.g., anesthetic and procedural factors), the intended recipient(s) (e.g., experience, ability in an operating room environment to hear and see alarms), and the physical environment (e.g., noise and light levels). Management of these alarms becomes challenging, especially in that we must rapidly discern when a trigger is life threatening, meaningful, or trivial.

The principles below are applicable only to anesthesia professionals and the environment in which they care for patients. Principles for alarm management for other health care providers and in other facility environments may be different and should be established based upon the clinical setting.

Alarm Management Policy and Principles:

• Each facility should have an Alarm Management Policy (henceforth, the AMP) pertaining to anesthesia equipment and / or devices used by anesthesia professionals.
• Anesthesia professionals who use, operate, and/or monitor anesthesia equipment and medical devices that have alarm systems should be involved in the creation and maintenance of the AMP.
• The AMP should describe the equipment and alarms found in each care environment (including, but not limited to, the operating room, postanesthesia care unit, intensive care unit, pain clinic, non-operating room anesthetizing locations, special procedures, etc).
• The AMP should define the different types of professionals involved in setting default settings. The AMP must address the different categories of alarms based on how critical they are to ensure patient safety. In general, individual anesthesia professionals should not be able to change default alarm settings of any anesthesia equipment. The AMP should specify an institutional process for changing default alarm settings.
• Anesthesia professionals should adjust alarm settings as appropriate for a particular patient prior to starting an anesthetic or as indicated during the course of the case. Any significant changes away from the default settings should be communicated during handovers from one anesthesia professional to another.
• Alarm system settings must balance patient and provider safety risks against unintended consequences (distraction, intrusiveness, etc.). Thus, alarm system settings should be customized to reflect the patients, the practice, and the perceived risks of the alarm conditions in each clinical setting, while also taking into account any potential downside from variability between sites.
• Anesthesia professionals should not indefinitely silence or disable alarms on any device, unless necessary because of (a) the device or module is not in use, (b) the device or module has malfunctioned (in this case, the device should not be used again until fully functional), or (c) the alarm is not relevant to the patient’s medical condition and supports using the AUDIO OFF or ALARM OFF modes. The alarm volume should be adjusted to an audible level factoring in the noise level of the clinical setting and to not create additional distractions.
• Anesthesia professionals should be aware of alarm artifacts or “false alarms” that may occur because of artifactual signals registered by the monitor or correct signals that are misinterpreted or processed falsely by the monitoring system. Although alarms should not be ignored, anesthesia professionals should assess the validity of the alarm while interpreting its clinical significance with the state of the patient. Therefore, anesthesia professionals should be vigilant and appropriately trained to operate anesthesia equipment, interpret monitor data, and make appropriate adjustments.
• The AMP should delineate the process for familiarizing all anesthesia professionals with the recommended use of alarm systems in use in the facility. The nature and occurrence of such familiarization for each alarm system should be documented.