Team-Based Approach Reduces Monitor Alarm Fatigue

A new study describes a standardized, team-based approach to reduce cardiac monitor alarms and subsequent "alarm fatigue," in which caregivers become desensitized to the ever-present beeping.

Researchers at Cincinnati Children's Hospital Medical Center (OH, USA) developed a standardized cardiac monitor care process (CMCP) for a 24-bed pediatric bone marrow transplant unit. The project involved a process for initial ordering of monitor parameters based on age-appropriate standards, daily replacement of electrodes in a manner that was pain-free for patients, individualized daily assessment of monitor parameters, and an appropriate method for discontinuation of monitor use. They then used a model to design, test, and implement changes.

The results showed that from January to November 2013, compliance with each of the four individual components of the CMCP increased, with the overall compliance increasing from a median of 38% to 95%. During this time, the median number of alarms per patient-day decreased from 180 to just 40. The researchers therefore recommended a team-based approach to monitor care. The study was published online on November 10, 2104, in the journal Pediatrics.

“Cardiac monitors constitute the majority of alarms throughout the hospital. We think our approach to reducing monitor alarms can serve as a model for other hospitals throughout the country,” said lead author Christopher Dandoy, MD. “With fewer false alarms, the staff can address significant alarms more promptly. We believe the roles and responsibilities entailed in this process can be applied to most units with cardiac monitor care.”

The constant sounds of alarms and noises from blood pressure machines, ventilators, and cardiac monitors causes a "tuning out" of the sounds due to the brain adjusting to stimulation, an issue plaguing hospitals, home care providers, nursing homes, and other medical facilities alike. On April 18, 2013, the Joint Commission (Oakbrook Terrace, IL, USA) issued a sentinel event alert that highlighted the widespread problem of alarm fatigue. Recommendations issued included establishing guidelines to tailor alarm settings, training all members of the clinical team on safe use of alarms, and sharing information about alarm-related incidents.

Related Links:
Cincinnati Children's Hospital Medical Center
Joint Commission