Abstract 127: Novel Approach to the Management of Clinical Alarm Fatigue

Abstract

Is the answer to clinical alarm fatigue to silence an increasing number of alarms as many centers have done to improve staff sensitivity to alarms or to layer additional technology such as viewing stations or alarm alert paging systems to capture clinician attention? An Alarm Management Pilot at Boston Medical Center shows a different strategy. BMC clinicians observed that RN staff frequently did not respond to Arrhythmia and HR violation Warning Alarms allowing these often to self reset. They were almost always continuously present in the background competing with other alarms even call lights. A QI initiative was proposed for a Pilot on a 24 bed general cardiology floor to remove Warning Alarms for Arrhythmia and HR Limit violations. We chose not to silence HR violations as had been done in other medical centers but to elevate these to Crisis Alarm slightly widening their defaults. We did this having seen bradycardia or tachycardia alarms precede life threatening events not caused by sudden death from VF. As a Crisis Alarm these alarms would now require RN staff to view and act on the alarm in real time either responding to the patient or modifying alarm limits . The Pilot was an overnight success the noise reduction immediately noticed by staff and as this occurred alarm culture changed. We saw a startling 87% decrease in the total number of audible alarms from 87823/ week Pre Pilot to 9967/ week Post Pilot on pilot unit with the average number of daily alarms dropping from 12546 to 1424. The decibel level too decreased from an average peak value in the mid 80s Pre Pilot to the mid 60s Post Pilot. RNs queried with a Monkey Survey tool when asked “ Do you believe that the Pilot has improved the noise level on the unit?", 100% of respondents said yes. Among their comments ~The monitors were an irritant. Now they no longer seem that way. ~I can spend more time on patient care instead of answering meaningless alarms. ~I feel so much less drained going home at the end of my shift. Patient Satisfaction scores Post Pilot showed significant improvement : noise level in and around room increasing by 7%, nurse domain increasing by 30%, promptness to call light increasing by 31% and overall assessment increasing by 59%. Since there had been no interventions targeted specifically at improving the scores it suggest that the improvement in scores had been effected by the alarm changes and perhaps clinical alarm fatigue played a role as a major patient dissatisfier as well. Boston Medical Center is among the hospitals nationally attempting to tackle clinical alarm fatigue. This Alarm Management Pilot now rolling out to the rest of BMC provides a strategy for managing clinical alarm fatigue without adding additional technology or costs and demonstrates such a strategy not only can improve patient safety but can have a measurable positive effect on staff and patient satisfaction .