What are examples of monitor alarms that should not be set to a blanket "on" setting?

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Last updated: November 11, 2026 • View editorial policy

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Monitor Alarms That Should NOT Be Set to Blanket "On"

Alarms that generate predominantly false or non-actionable signals—such as accelerated ventricular rhythm (AVR), brief premature ventricular contractions (PVCs), persistent atrial fibrillation, momentary ST-segment changes, and low-priority technical alarms—should not be set to blanket "on" because they contribute to alarm fatigue without improving patient outcomes.

The Core Problem: Alarm Fatigue and Patient Harm

The evidence is unequivocal: 68-99% of monitor alarms are false or non-actionable 1. This overwhelming burden of meaningless alarms has resulted in documented patient deaths—566 deaths were linked to monitor alarms between 2005-2008, with 80 of 98 alarm-related sentinel events resulting in death 1. The mechanism is clear: excessive false alarms create the "cry wolf" effect, where clinicians become desensitized and response rates drop proportionally to the perceived reliability of the alarm 1.

Specific Alarms to Avoid Having Blanket "On"

1. Accelerated Ventricular Rhythm (AVR) Alarms

  • 96.4% of true AVR alarms lasted less than 30 seconds 2
  • Only 1 of 223 true AVR alarms was acknowledged by clinicians 2
  • None were clinically actionable or led to adverse outcomes 2
  • Recommendation: Configure AVR alarms to inaudible message settings rather than audible warnings 2

2. Brief or Isolated PVC Alarms

  • Paired PVCs were among the highest alarm generators but are typically non-actionable 3, 4
  • These create excessive noise without clinical benefit 3
  • Recommendation: Disable alarms for isolated or paired PVCs; only alarm for sustained runs

3. Persistent Atrial Fibrillation Alarms

  • Continuous alarming for established atrial fibrillation is non-actionable 3
  • Recommendation: Limit atrial fibrillation alarms to new onset and termination only 3

4. Brief ST-Segment Changes

  • Momentary ST-segment spikes are frequently false positives 3
  • Recommendation: Configure delays for ST-segment alarms to avoid transient artifact 3

5. Non-Sustained Ventricular Tachycardia

  • 93% of 168 true ventricular tachycardia alarms were not sustained long enough to warrant treatment 3
  • Recommendation: Set VT alarms to trigger only after sustained duration (e.g., >30 seconds or per unit protocol)

6. Low-Priority Technical Alarms

  • Technical alarms (equipment-related) comprised 88% of all alarms in one study 3
  • Examples include electrode issues, sensor problems, and transient signal loss
  • Recommendation: Configure technical alarms as visual-only notifications when appropriate, reserving audible alarms for critical equipment failures

Context-Specific Considerations

When Monitoring IS Indicated but Alarms Need Customization

The American Heart Association guidelines specify clear indications for monitoring (acute coronary syndrome, arrhythmias, post-procedure) 1, but even when monitoring is appropriate, alarm settings must be individualized rather than using blanket defaults 1.

The DNR/DNI Exception

For patients with do-not-resuscitate/do-not-intubate orders, monitoring that triggers interventions inconsistent with patient wishes causes harm 1. When comfort-focused care is the goal and data will not be acted upon, monitoring itself may be inappropriate (Class III: Harm) 1.

Implementation Strategy

What SHOULD Be Done Instead:

  1. Customize alarm parameters based on patient age, condition, and clinical context rather than using factory defaults 4, 5, 6

  2. Add appropriate delays to allow self-correction of transient changes (e.g., 15-30 second delays for parameter alarms) 4

  3. Widen alarm thresholds for stable patients where clinically appropriate 6

  4. Use smart alarm technology with algorithms that assess alarm priority and clinical importance 7

  5. Standardize unit-level alarm defaults through interprofessional consensus, then individualize from that baseline 7

  6. Ensure infusion pump alarms remain enabled for high-pressure, cessation, empty syringe, disconnection, and low battery—these should have audible alarms by default 7

Critical Pitfalls to Avoid

  • Do not disable all alarms of a certain type across all patients—this is equally dangerous as having them all on
  • Changing default settings alone is insufficient without staff education and ongoing monitoring 5
  • Alarm reduction must be accompanied by tracking of adverse events to ensure patient safety is maintained 4
  • Simply providing in-service education without changing alarm settings does not reduce alarm burden 5

The Evidence on Outcomes

Studies implementing targeted alarm reduction bundles (customized parameters, appropriate delays, staff education) achieved 61% reduction in alarm burden without increasing cardiorespiratory events 4. The key is data-driven, targeted interventions rather than blanket approaches in either direction.

References

2
Research

Contribution of Electrocardiographic Accelerated Ventricular Rhythm Alarms to Alarm Fatigue.

American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2019

4
Research

Data-Driven Implementation of Alarm Reduction Interventions in a Cardiovascular Surgical ICU.

Joint Commission journal on quality and patient safety, 2017

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.