Error loading player: No playable sources found

P42

Alarm Fatigue – Partnering to Detect and Address  




Reducing patient harm associated with clinical alarm systems is a national patient safety goal that is a multifaceted problem, requiring systematic and interdisciplinary coordinated solutions [1]. Collaborative partnerships between Health Care Organizations (HCO) and patient monitoring vendors can create a change management paradigm that meets this Joint Commission patient safety goal. In addition, this collaboration can also be used to further understand and improve upon the emotional pressure caregivers feel in alarm-rich environments, precipitating alarm fatigue [2].

Clinical consultants from a patient monitoring vendor and HCO agreed upon a Scope of Work to identify alarm management opportunities through 3 days of onsite observations. This included policy and procedure review, and analysis of alarm data. A validated Alarm Fatigue Survey (AFS) was electronically distributed to measure baseline alarm fatigue in staff [2]. Additionally, three sites encompassing four telemetry units, 1 NICU, and 1 ICU were in scope. Observations, baseline AFS data from 109 respondents, and alarm data were analyzed with opportunities categorized into people, process, and technology categories.

The team found that people and process opportunities were often interconnected:

Opportunities related to understanding alarm policies led to varying practices related to alarm response and alarm parameter adjustments.
Additional research is needed on SpO2 utilization in telemetry environments. Utilization criteria should be present in the policy.
Opportunities related to skin prep and electrode maintenance written into policy and procedure led to nuisance alarms and delayed interaction with technical alarms.

30 days of alarm data further validated the opportunities derived from onsite activities:

SpO2 low limit alarms were a top 3 alarm on all tele units.
Skin prep and electrode maintenance opportunities were validated. ECG leads-off reminder alarms accounted for 53% of one unit’s alarms; the initial ECG leads-off alarm accounted for 4.69%, suggesting alarm response opportunities.

Tailoring alarms to patient needs is supported as best practice; this practice reduces the occurrence of non-actionable alarms [3]. For example, autonomy to make a SpO2 low limit change by 1% could reduce low SpO2 alarms by 33% and 30% in two respective tele units. The same units would reduce HR alarms by 34% and 61% with a high HR limit change from 120 bpm to 130 bpm.

Technology recommendations included:

Guidance from a patient monitoring policy for patient profile usage with ECG or SpO2-only monitoring.
Aperiodic SpO2 mode in the monitoring system
An end user is allowed to pause alarms in the NICU to reduce SpO2 alarms during direct care.

An interdisciplinary team from an HCO and patient monitoring vendor can identify actionable alarm management opportunities through a people, process, and technology assessment framework.

References:

National Patient Safety Goals. The Joint Commission. 2021. URL: https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2021/npsg_chapter_hap_jan2021.pdf [accessed 2022-08-22]
Torabizadeh, C., Yousefinya, A., Zand, F., Rakhshan, M., & Fararooei, M. (2017). A nurses’ alarm fatigue questionnaire: development and psychometric properties. Journal of Clinical Monitoring and Computing, 31(6), 1305-1312.
Graham, K. C., & Cvach, M. (2010). Monitor alarm fatigue: standardizing use of physiological monitors and decreasing nuisance alarms. American Journal of Critical Care, 19(1), 28-34.

Speakers

Speaker Image for David Conder
David Conder, MSN-NI, MSDS, BSN, RN
Speaker Image for Valerie Fernald
Valerie Fernald, MSN, RN, CCRN, CNML
Speaker Image for Kyle Karajankovich
Kyle Karajankovich, MS, RN, NI-BC, CEN, CPHQ

Related Products

Thumbnail for Promoting EMR Competency in the Newly Hired Nurse
Promoting EMR Competency in the Newly Hired Nurse
Background: The ability of nurses to effectively utilize the electronic medical record in today’s high technology healthcare setting is critical. The electronic medical record provides accurate and timely patient care information shared among the patient care team…
Thumbnail for Nursing Informatics Transforming Transfusion Management
Nursing Informatics Transforming Transfusion Management
With the shortage of blood supplies, management of blood products for patients, patient preference and religious beliefs, and patient care outcomes post-blood administration, an alternative source for treating patients requiring transfusion management transformed and improved patient care managemen…
Thumbnail for Challenges and Triumphs - BCMA and Navigating Surgical Patient Care Center Variants in Implementation
Challenges and Triumphs - BCMA and Navigating Surgical Patient Care Center Variants in Implementation
Just an ordinary medical center in an extraordinary world, striving to standardize medication administration across the ambulatory care enterprise - including complex surgical and wound care clinics…
Thumbnail for Applying Chatbots to Improve the Effectiveness of College Students' Autonomous Learning
Applying Chatbots to Improve the Effectiveness of College Students' Autonomous Learning
Introduction: During the school learning process, students often need to inquire about relevant subject knowledge and school information-related resources and information…
Privacy Policy Update: We value your privacy and want you to understand how your information is being used. To make sure you have current and accurate information about this sites privacy practices please visit the privacy center by clicking here.