How One Healthcare System Used Two Interventions to Tackle Alarm Fatigue

By Sean Power
November 11, 2015

How many telemetry alarms are generated in a single month by two hospitals, 716 beds, 36,386 admissions, 93,634 visits to the emergency department, 3,418 births, 453 open-heart surgeries, and 11,688 surgical procedures?

Over a quarter million, according to Kevin Smith, BSN, RN, CNML, CVRN-BC, Director II Cardiac Telemetry Services at NCH Healthcare System in Naples, Florida, in a presentation shared at the Association for the Advancement of Medical Instrumentation Foundation’s (AAMI) Patient Safety Seminar.

The not-for-profit multi-facility healthcare system counted a total of 255,656 telemetry alarms on its patients, just in January 2015 alone.

Nineteen out of twenty readers just said to themselves, Yep. Sounds about right.

Alarm Fatigue An Alarming Problem

19 out of 20 hospitals are concerned about alarm fatigue

There is no denying that that alarm fatigue is an ongoing problem with growing discussion.

In 2013, The Joint Commission issued Sentinel Event Alert 50 on medical device alarm safety in hospitals.

Since then, hospitals have been more aggressive in their efforts to improve alarm management.

Hospitals have until 2016 to establish an alarm management program.

Solving the Alarm Fatigue Problem

NCH Healthcare System set out to meet the regulatory requirements for alarm management and patient safety by using technology and data to drive decisions.

Two interventions were used:

  1. Change electrodes on a daily basis
  2. Adjust telemetry alarm parameters based on individual patient needs.

According to Mr. Smith, who presented the NCH Healthcare System case study:

“Now that we’re able to read information and use it daily, I think it’s improved patient care dramatically…we’re going to take that data and bring it down to the specific room, to the specific hour, to the specific patient, so we can monitor those alerts that are coming through.”

Changing Electrodes and Adjusting Parameters

Starting the last week of August 2015, NCH Healthcare System began to change electrodes daily and saw weekly trend totals decline.

At the same time, the hospital evaluated “hot spots” to assess alarm activity at the bed level to identify which patients generated the most alarms.

NCH Healthcare System Hot Spots

Then, it evaluated “near-real-time” unit views at a granular level to identify patterns in dimensions such as time frame, particular unit, bed assignment, telemetry pack assignment, hourly analysis, and on-the-spot staff education, among others.

Shift Report

The analysis enabled staff to respond to alarms in a way that was tailored to the specific room, hour, and patient based on the patterns in the data, adjusting telemetry parameters as needed.

The result: the number of alarms decreased virtually across the board.

When a telemetry alarm sounds, the likelihood of it to be “real” is greater than before. Nurses respond and check on alarms as they occur, and they are saying that they are more aware of the overall clinical condition of their patients.

Alarm Count

Strategies for Addressing Alarm Fatigue

The NCH Healthcare System used two interventions that had a major impact on reducing alarms and improving patient care: changing electrodes daily and tailoring telemetry parameters according to the specific patient.

Gina Pugliese, Vice President, Premier Safety Institute and member of the board of advisors at Physician-Patient Alliance for Health & Safety, has also shared ten strategies that may help clinicians working to improve alarm management.

Below are some highlights from Ms. Pugliese’s list:

  1. Establish guidelines for alarm settings, and indicate when alarms are not “clinically necessary”
  2. Set up an inspection, cleaning and maintenance program for alarm-equipped medical devices, and test them regularly
  3. Routinely change single-use sensors to avoid false or nuisance alarms
  4. Determine whether the acoustics in patient care areas allow alarms to be easily heard, and make adjustments where needed.
  5. Set your priorities for replacing aging monitors with newer technology.

Tell us about your experiences managing alarms. What has your hospital done, or what does it plan to do? Leave a comment below.

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