Intravenous Smart Pump Alarms in Everyday Hospital Use: A Real-world Descriptive Analysis

Background: Frequent intravenous smart-pump (IVSP) alarms can disrupt workflow, increase alarm fatigue, and threaten patient safety. Objectives: To describe the frequency, distribution, and care-area variation of IVSP alarms from the Baxter Sigma Spectrum IVSP over a 2-year period at a large academic medical center. Methods: A retrospective study of IVSP alarms was performed for all inpatient areas at a US academic medical center. Alarm events and infusion starts were extracted using the Care Everywhere analytics platform and aggregated by frequency of alarms, number of infusions, alarm type, and care area. Analyses were done using descriptive statistics. Results: A total of 5,129,505 alarms were linked to 1,102,303 infusion starts (mean = 4.65 alarms per infusion). Four alarm categories accounted for 86.5% of events: downstream occlusion (42.5%), air-in-line (15.5%), infusion complete (14.4%), and upstream occlusion (14.1%). Although they accounted for only 6% of total infusion starts, the NICU, pediatrics, and pediatric intensive care unit (PICU) had the highest alarm rates, averaging 28.6, 9.0, and 7.7 alarms per infusion, respectively. Downstream occlusion rates peaked in Pediatrics (696/100 starts) and PICU (536/100), while upstream occlusions were highest in the NICU (337/100). Air-in-line alarms were greatest in Oncology (103/100). Conclusion: Downstream occlusion, air-in-line, infusion-complete, and upstream occlusion alarms dominated the 2 years of alarm data, generating the majority of the 5 million IVSP alarms. Although adult medical-surgical (Med/Surg) and critical care generated the most alarms overall, pediatric and neonatal areas experienced the highest number of alarms per infusion, placing them at the greatest risk for alarm fatigue.