In the NICU, we often speak of sensory overload. Although we are usually referring to the effects on our patients, the multitude of clinical alarms heard nearly nonstop in most NICUs is without a doubt a source of sensory overload to the staff as well. Although physiological monitoring devices are critical to the safe care of hospitalized patients, alarms can have numerous negative effects. Alarms can:

* Raise overall and peak noise to unsafe levels

* Mask critical alarms when many alarms are triggered simultaneously

* Desensitize staff to the sounds of alarms, resulting in alarms being ignored, turned off, or set inappropriately

* Distract nurses while they are performing tasks that require focused attention, such as safe medication administration

Clearly, we can't do without alarms in neonatal intensive care. However, the ECRI Institute, a nonprofit independent organization devoted to researching the best approaches to patient care and patient safety, identifies key contributors to alarm overload that might be amenable to modification and that would reduce the burden of alarms in patient care environments. False alarms, technical alarms, ineffective electrode or sensor placement and application, inappropriate protocols for alarm inactivation, inappropriate alarm limits, and overuse of patient monitoring are among the sources of potentially unnecessary alarms.

The ECRI has published a guidance document, "The Hazards of Alarm Overload," that provides guidelines for monitor use and alarm compliance.1 The chief recommendations are to identify the sources of unnecessary alarms in a particular patient care area and take systematic actions to address each source. When more effective alarm strategies are implemented, clinical efficiency and patient safety are improved.

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