Challenges of customizing electrocardiography alarms in intensive care units: A mixed methods study

Halley Ruppel, Marjorie Funk, Holly Powell Kennedy, Christopher P. Bonafide, Shu Fen Wung, Robin Whittemore

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: Customizing monitor alarm settings to individual patients can reduce alarm fatigue in intensive care units (ICUs), but has not been widely studied. Objectives: To understand ICU nurses’ approaches to customization of electrocardiographic (ECG) monitor alarms. Methods: A convergent mixed methods study was conducted in 3 ICUs in 1 hospital. Data on the type and frequency of ECG alarm customization were collected from patient monitors (n=298). Nurses’ customization clinical reasoning was explored through semi-structured interviews (n=27). Results: Of the 298 patients, 58.7% had ≥1 alarm(s) customized. Heart rate limits, irregular heart rate, and atrial fibrillation were the most commonly customized alarms. Interviews revealed that customization practices varied widely and were influenced by factors including clinical expertise, lack of customization education, and negative experiences. Conclusion: Alarm customization is nuanced and requires adequate support to develop safe and effective practices. The challenges identified can inform development of strategies to improve alarm customization.

Original languageEnglish (US)
Pages (from-to)502-508
Number of pages7
JournalHeart and Lung
Issue number5
StatePublished - Sep 1 2018


  • Alarm Customization
  • Clinical Alarms
  • Critical Care Nursing
  • Electrocardiography
  • Intensive Care Units
  • Physiologic Monitor Alarms

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine


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