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Research Outcomes of Implementing CEASE

An Innovative, Nurse-Driven, Evidence-Based, Patient-Customized Monitoring Bundle to Decrease Alarm Fatigue in the Intensive Care Unit/Step-down Unit

Lewis, Carmencita Lorenzo, BSN, RN, CCRN; Oster, Cynthia A., PhD, RN, APRN, MBA, ACNS-BC, ANP, FAAN

Dimensions of Critical Care Nursing: May/June 2019 - Volume 38 - Issue 3 - p 160–173
doi: 10.1097/DCC.0000000000000357
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Introduction The research literature is replete with evidence that alarm fatigue is a real phenomenon in the clinical practice environment and can lead to desensitization of the need to respond among nursing staff. A few studies attest to the effectiveness of incorporating parts of the American Association of Critical-Care Nurses recommended nursing practices for alarm management. No studies could be found measuring the effectiveness of the American Association of Critical-Care Nurses recommendations in their entirety or the effectiveness of a nursing-driven, evidence-based, patient-customized monitoring bundle.

Purpose/Research Question The purpose of this study was to describe the effect of implementing CEASE, a nurse-driven, evidence-based, patient-customized monitoring bundle on alarm fatigue. CEASE is an acronym for Communication, Electrodes (daily changes), Appropriateness (evaluation), Setup alarm parameters (patient customization), and Education (ongoing). Research questions: (1) In a 36-bed intensive care unit/step-down unit (ICU/SDU) with continuous hemodynamic and respiratory monitoring, does application of an evidence-based, patient-customized monitoring bundle compared with existing monitoring practice lead to less alarm fatigue as measured by the number of hemodynamic and respiratory monitoring alarms? (2) In a 36-bed ICU/SDU with continuous hemodynamic and respiratory monitoring, does application of an evidence-based, patient-customized monitoring bundle compared with existing monitoring practice lead to less alarm fatigue as measured by duration of alarms? and (3) In a 36-bed ICU/SDU with continuous hemodynamic and respiratory monitoring, does application of an evidence-based, patient-customized monitoring bundle compared with existing monitoring practice lead to less alarm fatigue as measured by nurse perception?

Methods This was an institutional review board approved exploratory, nonrandomized, pretest and posttest, 1-group, quasi-experimental study, without-comparators design describing difference in pretest and posttest measures following CEASE Bundle implementation. The study was conducted over a 6-month period. Convenience sample of 74 registered nurses staffing a 36-bed ICU/SDU using the CEASE Bundle participated. Preimplementation/postimplementation number of alarms and alarm duration time for a 30-day period were downloaded from the monitoring system and compared. Nurses completed an electronic 36-item Clinical Alarms Survey provided by the Healthcare Technology Foundation: 35 before implementation and 18 after implementation. Researchers measured CEASE alarm bundle adherence. χ2 and t-tests determined statistical significance.

Results Total number of monitoring alarms decreased 31% from 52 880 to 36 780 after CEASE Bundle implementation. Low-priority Level 1 alarms duration time significantly decreased 23 seconds (t = 1.994, P = .045). Level 2 duration time did not change. High-priority Level 3 alarms duration time significantly increased to 246 seconds (t = 4.432, P < .0001). CEASE alarm bundle adherence significantly improved to 22.4% (χ2 = 5.068, P = .0244). Nurses perceived a significant decrease in nuisance alarm occurrence (68% to 44%) postimplementation (χ2 = 3.243, P = .0417). No adverse patient events occurred.

Conclusions Decreased total number of monitoring alarms improved nurse perception of alarm fatigue. Continued monitoring of CEASE Bundle adherence by nursing staff is required. Longer high-priority Level 3 alarms duration suggests need for further research.

Carmencita Lorenzo Lewis, BSN, RN, CCRN, is a staff nurse and charge nurse at the intensive care unit/step-down unit, Porter Adventist Hospital in Denver, Colorado. She is currently enrolled in the clinical nurse specialist master's degree program at the University of Colorado, College of Nursing, Aurora, Colorado.

Cynthia A. Oster, PhD, RN, APRN, MBA, ACNS-BC, ANP, FAAN, is nurse scientist for patient safety, Emory Healthcare, and adjunct assistant professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia. At the time this study was conducted, she was the nurse scientist and clinical nurse specialist for critical care and cardiovascular services at Porter Adventist Hospital, Denver, Colorado. In 2016, Dr Oster received a 2nd Place American Journal of Nursing Book Award in the Professional Issues Category for the textbook High Reliability Organizations: A Healthcare Handbook for Patient Safety & Quality.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

Address correspondence and reprint requests to: Carmencita Lorenzo Lewis, BSN, RN, CCRN, Centura Health–Porter Adventist Hospital, 2525 S Downing St, Denver, CO 80210 (carmencita.lorenzo@gmail.com).

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