Clinical alarms: improving efficiency and effectiveness.

The clinical environment contains a plethora of bells, beeps, and buzzers. As clinicians, each audible disruption in the care environment must be analyzed to decide if the sound or visual is clinically significant. Alarms may signal a clinically significant change in a patient's condition (true positive), an alarm violation that is clinically insignificant (false positive), or a reflection of poorly set monitoring parameters. Our challenge is to develop monitors that are sensitive and specific. This coupled with protocols that are designed for a specific population, and customized for each individual patient, enable the caregiver to maximize the use of monitoring systems and ensure patient safety. This article guides the critical care nurse through an assessment of alarms in the critical care environment, beyond the cardiorespiratory alarms, assessing the impact of clinical and environmental alarms.