Nurses Perception and Assessment Regarding False Alarms at Intensive Care Unit, Saudi Arabia

Nurses Perception and Assessment Regarding False Alarms at Intensive Care Unit, Saudi Arabia

Fatimah Almaqadi^1*, Amira Mohammed²

1. Critical Care Nurse Specialist Saudi Arabia.

2. Assistant Professor of Pediatric Nursing, college of Nursing ,university of Hafr Al Batin and assistant professor of pediatric Nursing, Faculty of Nursing, Tanta University.

*Correspondence to: Fatimah Almaqadi, Critical Care Nurse Specialist Saudi Arabia.

Copyright
© 2025: Fatimah Almaqadi. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received:  25  July 2025

Published: 07 Aug 2025

DOI: https://doi.org/10.5281/zenodo.18005428 

ABSTRACT

Background The Intensive Care Unit (ICU) is a critical component of the healthcare system, relying on advanced medical devices to monitor and manage critically ill patients. While clinical alarms are essential for patient safety, their excessive frequency often leads to alarm fatigue, which can reduce nurses' responsiveness to critical alerts. Alarm fatigue occurs when healthcare providers become desensitized to frequent, nonactionable alarms, increasing the risk of adverse patient outcomes. Despite global recognition of this issue, there is limited research on ICU nurses' knowledge and perceptions regarding false alarms in Saudi Arabia. This study aimed to assess ICU nurses' knowledge, perceptions, and assessment of false alarms at East Jeddah General Hospital.

Methods A descriptive cross-sectional study was conducted in May 2024 among 84 ICU nurses at East Jeddah General Hospital in the kingdom of Saudi Arabia. Data was collected using a structured questionnaire assessing demographic characteristics, nurses' knowledge of clinical alarms, and their perceptions of false alarms. The questionnaire was distributed electronically, and responses were analyzed using descriptive statistics and inferential tests, including correlation analysis and ANOVA, to examine associations between demographic variables and knowledge scores. A p-value threshold of <0.05 was applied to determine statistical significance.

Results The findings revealed a significant knowledge deficit among ICU nurses, with 92.9% demonstrating poor knowledge regarding alarm management. Only 33.3% had received ICU-specific training, and 32.1% had undergone alarm management training. Nurses aged 25–35 years had significantly higher knowledge scores (8.6) than those aged 45–55 years (6.1) (p = 0.014). Similarly, ICU-trained nurses scored higher (8.9) than those without ICU training (6.7) (p = 0.003). Most nurses (79.8%) reported frequent nuisance alarms, with 66.7% stating that false alarms reduced their trust in alarm systems. Additionally, 58.3% noted difficulty hearing alarms, and 66.7% struggled to identify active alarms when multiple devices were in use.

Conclusion The study highlights a significant gap in ICU nurses' knowledge and training regarding clinical alarms, contributing to alarm fatigue and potential patient safety risks. Younger and recently trained nurses exhibited better alarm management competencies, showing the importance of continuous education. To improve alarm management, hospitals should implement mandatory alarm training, optimize alarm configurations, and introduce technological solutions such as smart alarm systems and dedicated alarm administrators. Addressing these challenges is crucial for enhancing nurse efficiency, reducing alarm fatigue, and improving patient safety in ICU settings.

Keywords Alarm fatigue, false alarms, ICU nurses, clinical alarms, patient safety, alarm management, East Jeddah General Hospital, Saudi Arabia.

Introduction

The Intensive Care Unit (ICU) is a fundamental component of the healthcare system, providing specialized monitoring and intensive treatment for critically ill patients (Wang et al., 2023). These units rely on advanced medical devices such as ventilators, physiological monitors, and infusion pumps, which assist healthcare professionals in making timely clinical decisions and delivering safe patient care. Over the past three decades, the number of medical devices equipped with alarm functions in the ICU has increased significantly, rising from approximately ten to around forty devices (Wang et al., 2023). This expansion has enhanced patient monitoring but has also contributed to an overwhelming frequency of alarms, creating challenges for ICU staff.

Clinical alarms play a crucial role in alerting medical staff when a patient’s condition deteriorates, allowing them to intervene promptly. However, as Drew et al. (2014) stated, the frequent activation of alarms can result in alarm fatigue, a phenomenon where nurses become desensitized due to the excessive number of nonactionable alerts. This issue was highlighted in a study by Wang et al. (2023), which analyzed 2.55 million physiological monitor alarms from five adult ICUs over 31 days. The findings revealed that an ICU receives an average of 942 alarms per day, with one critical alarm occurring every 92 seconds (Wang et al., 2023). Similarly, Mendez et al. (2020) noted that an average of 43 alarms occur per hour in the ICU, with 52.8% coming from multiparameter monitors. However, 42.5% of these alarms are ignored, and only about 6.4% are linked to actual physiological abnormalities in patients.

The excessive number of alarms in ICU settings is often triggered by factors such as improper configuration of alarm thresholds, the high sensitivity of monitoring devices, and insufficient routine maintenance of equipment, leading to sensor or cable failures (Li et al., 2024). As Yousefinya et al. (2021) pointed out, nurses serve as the primary monitors of patient conditions, with physiological monitoring systems acting as supplementary tools. However, when nonactionable alarms become excessive, they disrupt workflow and lead to alarm fatigue, which, as Turmel et al. (2017) observed, results in nurses silencing or muting alarms, thereby increasing the risk of missing critical warnings.

As noted by Lewandowska et al. (2020), prolonged exposure to frequent alarms negatively affects nurses' well-being, causing stress, tension, and anxiety. This issue is not limited to specific regions; rather, it is a global concern. For instance, a Korean study found that alarm fatigue among ICU nurses was in the upper-middle range, highlighting the prevalence of the problem (Cho et al., 2016; Wang et al., 2023). Likewise, a Turkish study during the COVID-19 pandemic reported a significant rise in ICU alarm occurrences, intensifying the workload and exhaustion of ICU nurses (Akturan et al., 2022). As Winters et al. (2021) showed, alarm fatigue is a major threat to patient safety in modern healthcare settings, making it imperative to establish structured alarm management systems, improve nurse training, and implement strategies to reduce alarm fatigue.

A major issue contributing to alarm fatigue is the high percentage of false alarms, which generate unnecessary noise and distractions, reducing the effectiveness of nurses in providing safe patient care. As Bach et al. (2018) pointed out, clinical alarms are designed to detect unsatisfactory patient conditions, malfunctioning medical equipment, or potential hazards. However, as Bosm (2022) explained, the parameters set by manufacturers are often generic and do not always align with individual patient needs, leading to excessive false alarms. Research has shown that ICU monitoring systems generate around 942 alarms daily due to their high sensitivity and low specificity (Bach et al., 2018; Bosm, 2022).

False alarms create a significant burden for nurses, increasing their workload and reducing efficiency. According to Bosma (2022), between 80% and 99% of alarms in ICUs turn out to be false, causing delays in response times and exacerbating alarm fatigue. As Pelletier (2013) reported, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) documented 98 alarm-related adverse events between 2009 and 2012, including 80 deaths, 13 cases of permanent disability, and five cases of prolonged hospitalization (Li et al., 2024). Given these serious consequences, addressing alarm fatigue and improving alarm management should be a priority in ICU settings.

Several studies have examined the impact of false alarms on ICU nurses and patient safety, showed the challenges associated with alarm fatigue. Asadi et al. (2023) and Dehghan et al. (2023) highlighted the critical role of ICU nurses in managing alarms while ensuring high-quality care for critically ill patients. Their findings align with the recommendations of the World Health Organization (WHO), which suggests maintaining hospital noise levels below 35 A-weighted decibels (dBA) to minimize distractions and improve patient outcomes (Obeid & Hassan, 2021).

According to Morton and Fontaine (2017), the function of medical device alarms is twofold: first, to alert nurses about changes in a patient's physiological condition, and second, to notify them when a specific parameter surpasses a predetermined threshold. However, as noted by Obeid and Hassan (2021), ICU nurses are often overwhelmed with an average of 150-400 alarms per patient per day, making it difficult to distinguish between critical and non-critical alarms. This high frequency of alarms not only increases cognitive load but also contributes to alarm fatigue, leading to potential delays in responding to real emergencies.

Similarly, studies by Huo et al. (2023) and Cobus & Heuten (2019) demonstrated that false alarms can be classified into three main categories: clinical, technical, and intervention-based. Clinical false alarms arise from misinterpretations of patient data, technical false alarms stem from device malfunctions, and intervention-based false alarms occur due to unintended staff actions. McCoy (2024) found that some ICUs report alarm rates as high as 350 per patient per day, further exacerbating the issue. The phenomenon known as the "cry wolf" effect, as discussed by Cobus & Heuten (2019), occurs when nurses become desensitized to frequent alarms, leading to decreased trust in alarm systems and a higher likelihood of missing true alarms. Sinno et al. (2021) showed the role of advanced ICU technology in improving patient monitoring but warned that without proper management, these systems could contribute to alarm overload. Additionally, Alkubati et al. (2024) investigated the Saudi Arabian context, focusing on how ICU nurses experience alarm fatigue due to high alarm frequency, workload intensity, and environmental stressors. Their findings suggest that to reduce alarm fatigue, hospitals must implement targeted interventions such as staff training, technological enhancements, and improved alarm management policies. As summarized by Ramlaul et al. (2021) and Paredath & Al Jarary (2023), integrating human-centered alarm management approaches can enhance patient safety, optimize nurse workflow, and reduce the overall burden of false alarms in ICU settings.

This study aim to explore the extent to which nurses recognize and assess false alarms in the ICU at East Jeddah General Hospital. It seeks to evaluate how nurses perceive false alarms, identify factors contributing to alarm fatigue, and propose strategies to improve alarm management.  This study aims to assess nurses' perceptions of false alarms and provide recommendations to enhance alarm management systems in the ICU at East Jeddah General Hospital. Addressing this issue requires a comprehensive approach, including structured alarm training programs, improved device configurations, and the integration of smart alarm systems to reduce the burden of false alarms on ICU nurses.

Methods

This study applied a descriptive research design to examine nurses' perceptions and assessments of false alarms in the Intensive Care Unit (ICU) without manipulating any variables. The descriptive approach was chosen to provide a comprehensive understanding of the challenges associated with false alarms and their impact on nursing practice and patient care.

The research was conducted in May 2024 at East Jeddah General Hospital, in the kingdom of Saudi Arabia, a leading healthcare facility in Saudi Arabia known for its advanced critical care services. The study took place over a four-month period, from February to May 2024, ensuring adequate time for data collection and analysis. The study population consisted of registered nurses actively employed in the ICU, all of whom had a minimum of one year of experience to ensure sufficient exposure to clinical alarm systems. A total coverage sampling method was employed, allowing the inclusion of all 84 eligible nurses. This approach ensured that the study captured the full range of perceptions and assessments regarding false alarms, thereby enhancing the reliability and validity of the findings.

Data were collected using a structured questionnaire designed to assess demographic characteristics, nurses' knowledge of clinical alarms, and their perceptions of false alarms in the ICU. The questionnaire was divided into three sections: the first section gathered demographic data such as age, gender, education, years of experience, and specialized training in ICU alarm management. The second section assessed nurses' knowledge of clinical alarms through 24 multiple-choice questions, each with one correct answer. Responses were categorized based on a scoring system adapted from Uehara (2011), with knowledge levels classified as good (≥75% correct answers), fair (50% to <75%), or poor (<50%). The third section measured nurses’ perceptions and evaluations of false alarms using 24 yes/no questions that explored the frequency, impact, and management of alarms within the ICU. To ensure accessibility and ease of participation, the questionnaire was distributed electronically via Google Forms, with follow-up reminders sent to maximize response rates.

The collected data were analyzed using SPSS version 28.0. Descriptive statistics were used to summarize demographic variables, while inferential statistical methods, including correlation tests and Analysis of Variance (ANOVA), were conducted to examine relationships between nurses’ demographic characteristics and their knowledge and perceptions of false alarms. A p-value threshold of <0.05 was applied to determine statistical significance. The study findings were presented using tables and graphical representations to enhance clarity and facilitate interpretation.

Ethical considerations were strictly followed to ensure compliance with research ethics and safeguard participant rights. Ethical approval was obtained from the Institutional Review Board (IRB) at East Jeddah General Hospital before the commencement of the study. Participants were informed of the study's purpose, procedures, and potential implications, and informed consent was obtained before data collection. Confidentiality measures were implemented to protect the identities of participants, and all data were anonymized and securely stored to prevent unauthorized access.

While the study provided valuable insights into the issue of false alarms in ICUs, several limitations were acknowledged. The reliance on a total coverage sampling method meant that the findings were specific to the nurses at East Jeddah General Hospital and may not be generalizable to other ICU settings. Additionally, the use of self-reported data introduced the possibility of response biases, including social desirability bias, where participants might have provided responses they perceived as favorable rather than their actual experiences.

Despite these limitations, this study contributes to the growing body of research on alarm management in ICUs by offering empirical evidence on how nurses perceive and respond to false alarms. The findings showed the need for targeted interventions, such as improved training programs, optimized alarm settings, and the integration of smart alarm technologies to reduce nonactionable alarms.

Results

The demographic and professional characteristics of the participating nurses in the Intensive Care Unit (ICU) at East Jeddah General Hospital reveal a diverse workforce (Table 1). The majority of nurses (44%) were aged between 25 and 35 years, followed by 36.9% in the 36–44-year category and 19.1% in the 45–55-year range. The nursing workforce was predominantly female, comprising 88.1% of the participants, while males accounted for only 11.9%. In terms of education, the majority (78.6%) held a Bachelor of Science in Nursing, 9.5% had a diploma, and 11.9% held a Master of Science in Nursing. Regarding marital status, nearly half of the nurses (48.8%) were married, 42.9% were single, 6.0% were divorced, and 2.4% were widowed.

Professional experience among the nurses varied, with 45.2% having more than five years of experience, 31.0% having between two and five years, and 23.8% with less than two years of experience. When it came to specialized training, only 33.3% had received ICU-specific training, while the remaining 66.7% had not. Additionally, only 32.1% of nurses had undergone alarm management training, leaving 67.9% without formal training in handling clinical alarms. Most of the respondents (76.2%) worked as primary nurses, while 19.0% were assistant nurses, and only 4.8% held head nurse positions.

Table (1) Demographic and Professional Characteristics of ICU Nurses (n = 84)