False apnea alarm in a patient breathing adequately on mechanical ventilation.

<p>The respiratory waveform (bottom tracing labelled “Resp”) has a flat line appearance. The detection of respirations from the ECG lead (impedance method) is inaccurate in this patient, displaying an erroneous respiratory rate of 4 per minute.</p

Hospital infrastructure to automatically store all physiologic monitor waveform and alarm data.

<p>Hospital infrastructure to automatically store all physiologic monitor waveform and alarm data.</p

ST-Segment Alarm Durations in a 16-Bed Cardiac ICU.

<p>ST-Segment Alarm Durations in a 16-Bed Cardiac ICU.</p

Schema for Counting and Reporting Physiologic Monitor Device Alarms.

<p>CVP = central venous pressure; RAP = right atrial pressure; PAP = pulmonary artery pressure; LAP = left atrial pressure; ART = invasive arterial line; FEM = invasive arterial line in femoral site.</p><p>Schema for Counting and Reporting Physiologic Monitor Device Alarms.</p

Physiologic monitor device in Intensive Care Unit.

<p>Bedside patient monitor (GE Healthcare, Milwaukee, WI) displays multiple physiologic waveforms and vital sign measurements. The nurse pictured here gave written informed consent to publish this photograph supplied by the San Francisco Chronicle newspaper (with permission) for their story on alarm fatigue at: <a href="http://www.sfgate.com/health/article/Hospitals-look-to-reduce-danger-of-alarm-fatigue-4918018.php" target="_blank">http://www.sfgate.com/health/article/Hospitals-look-to-reduce-danger-of-alarm-fatigue-4918018.php</a>.</p

Low amplitude QRS in a patient with an excessive number of alarms.

<p>Standard “diagnostic” 12-lead ECG recorded from the patient who contributed nearly half of the 12,671 arrhythmia alarms for annotation. The ECG shows left bundle branch block with low amplitude QRS complexes in the limb leads but not in the V leads. Since one of the available leads acquired with the physiologic patient monitoring device is a V lead, the arrhythmia algorithm could have avoided the excessive number of false alarms had all available leads been used for QRS detection.</p

Frequency of all unique alarms (N = 2,558,760) over a 31-day period.

<p>Frequency of all unique alarms (N = 2,558,760) over a 31-day period.</p

Alarm Default Settings for Adult ICUs during the Study Period.

<p>Alarm Default Settings for Adult ICUs during the Study Period.</p

True positive ventricular tachycardia alarm using seven available ECG leads for diagnosis.

<p>Page one of the alarm annotation analysis tool shows a 10-second rhythm strip of all seven available ECG leads at the time that a ventricular tachycardia alarm was triggered. In this and subsequent Figures, ECG Leads are displayed from top to bottom in the following sequence: Lead I, II, III, V (typically V₁), aVR, aVL, aVF. As evident at the beginning of the rhythm strip, the patient has an underlying rhythm of atrial fibrillation with a rapid ventricular rate of about 140. There is an isolated ventricular premature beat (4^th beat from the end) and its QRS morphology is identical to the initial beat of the alarm event. Knowing that the event is initiated by a ventricular ectopic beat provides strong evidence that this event is a true ventricular tachycardia alarm.</p

UCSF Alarm Study Units.

<p>UCSF Alarm Study Units.</p