Leveraging technology to reduce inactionable alarms from bedside physiologic monitors

Purpose:
Despite implementation of AACN Practice Alert recommendations for alarm management, alarms from bedside monitors remained problematic. The purpose of this project was to leverage technology to facilitate appropriate alarm settings to decrease inactionable alarms.

Relevance/Significance:
Alarm fatigue has been identified by multiple regulatory and professional agencies as a patient safety risk. Alarm limits are often set for high sensitivity at the expense of low specificity causing false positive alarms that do not accurately reflect the patient's condition or do not require immediate intervention. The high number of inactionable alarms leads to a decreased sense of urgency, auditory and mental fatigue, and can result in adverse patient events from lack of timely response.

Strategy and Implementation:
Baseline data was collected from bedside physiologic monitors in the critical care units. Current alarm settings were analyzed and changes were proposed to the medical and nursing directors of the units. Discussion with the vendor found a significant cost to make the proposed changes. An alternate plan was made to allow the biomed staff to change the programmed default settings. Inactionable alarms such as yellow dysrhythmia alarms and temperature were defaulted to “off.” Education was done with nursing staff about the current evidence, changes, and the ability of nursing to customize alarms based on a patient's individual needs. Historically, nurses were reluctant to turn off alarms to individualize for the patient for fear of missing important events. In the nurse's mind, it is more logical to turn on alarms deemed appropriate for the patient rather than turn alarms off to decrease nuisance alarms and improve patient safety.

Evaluation:
Data was collected at 2 weeks, 6 weeks and 6 months post implementation. Alarms per patient per day decreased 61% from 1377 to 561 (p<0.01). Yellow dysrhythmia alarms decreased 79% from 206 to 44 alarms per patient per day (p<0.001). The decrease in alarms was sustained at 6 months, showing the change was accepted. There have been no adverse patient events as a result of the practice change.

Implications for Practice:
When inactionable alarms are decreased, nurses are more aware of the alarms and the increased likelihood that the alarms are clinically significant, thus improving patient safety by creating the sense of urgency intended by the alarms.