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Combating Alarm Fatigue

Nix, Maria MSN, RN

AJN The American Journal of Nursing: February 2015 - Volume 115 - Issue 2 - p 16
doi: 10.1097/01.NAJ.0000460671.80285.6b
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Abstract

The overload of cardiac monitor alarms can lead to desensitization, or “alarm fatigue,” which may lead to providers turning down or turning off alarms, adjusting alarm settings, or simply failing to hear alarms. Alarm hazards consistently top the ECRI's list of health technology hazards. In the wake of hundreds of deaths linked to alarm-related events over five years, the Joint Commission made improving alarm-system safety a National Patient Safety Goal, effective January 2014.

A recent initiative at Cincinnati Children's Hospital Medical Center, in Cincinnati, Ohio, sought to reduce the number of cardiac monitor alarms on the facility's bone marrow transplantation unit while not missing signs of patient decompensation. A team of physicians, nurses, care assistants, engineers, and family representatives performed an initial assessment of the unit, which revealed an average of 5,300 alarms daily—95% were false alarms. They found a number of common errors: monitors weren't set with age-appropriate parameters, electrodes were placed incorrectly and replaced too infrequently, and there were no standard processes for ordering patient-specific parameters.

The team developed and implemented a standardized cardiac monitor care process, which included daily monitoring of setting parameters, daily electrode replacement, and criteria for discontinuing monitoring. Challenges included discomfort to patients from electrode replacement and compliance with the process. Solutions to these challenges included replacing electrodes during daily bathing, which reduced discomfort and increased compliance.

Researchers found that use of the new process successfully reduced the number of alarms from 180 to 40 per patient day, and the proportion that were false fell from 95% to 50%. It would follow that significantly decreasing the number of alarms on a unit—particularly false alarms—would translate into a decrease in alarm fatigue, and although that wasn't one of the study measures, 95% of patient families thought alarms had been responded to in a timely manner.—Maria Nix, MSN, RN

REFERENCE

Dandoy CE, et al. Pediatrics. 2014;134(6):e1686–e1694
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