Authors: Justin Yeh, BA; Ruth Wilson, MHS, RNC-NIC, NE-BC; Lufei Young, PhD, APRN; Lisa Pahl, MSN, RN; Steven Whitney, MSN, RN, CCRN; Kevin C. Dellsperger, MD, PhD; Pascha E. Schafer, MD
As published by the Journal of Nursing Care Quality, September 10, 2019 (ahead of print issue)
Background: Nonactionable alarms comprise over 70% of alarms and contribute a threat to patient safety. Few studies have reported approaches to translate and sustain these interventions in clinical settings.
Purpose: This study tested whether an interprofessional team-based approach can translate and implement effective alarm reduction interventions in the adult intensive care unit. Methods: The study was a prospective, cohort, pre- and postdesign with repeated measures at baseline (preintervention) and post-phase I and II intervention periods. The settings for the most prevalent nonactionable arrhythmia and bedside parameter alarms were adjusted during phases I and II, respectively.
Results: The number of total alarms was reduced by 40% over a 14-day period after both intervention phases were implemented. The most prevalent nonactionable parameter alarms deceased by 47% and arrhythmia alarms decreased by 46%.
Conclusions: It is feasible to translate and sustain system-level alarm management interventions addressing alarm fatigue using an interprofessional team-based approach.
Alarms generated by physiologic monitoring systems notify clinicians of changes to patient conditions.1 These alarms allow appropriate clinical actions to be taken to prevent adverse outcomes. The established threshold to trigger these alarms often sacrifices specificity to increase sensitivity in a critical care setting to reduce false negatives. This results in many nonactionable alarms being generated.2,3
These nonactionable alarms are composed of either false positives that inaccurately convey the patient’s condition or true positives in which no clinical action is warranted despite a change in the patient’s physiologic status. In the intensive care setting, nonactionable alarms comprise over 70% of alarms and are responsible for the large volume of alarms generated.4,5 The high proportion of nonactionable alarms contributes to the well-described phenomenon of alarm fatigue where health care workers become desensitized due to frequent nonactionable alarms and response to alarms decreases.6
Alarm fatigue has been recognized as an increasingly important safety issue in recent years. Patient safety is negatively impacted by nonactionable alarms, ranging from disrupted patient care to disabled alarms ultimately resulting in death.7-9 It is estimated that up to 28% of alarm-related patient deaths are due to operator distraction, including alarm fatigue.6
Patient death is the most severe consequence of excess alarms but is not the only potential harm. Electronic alarm sounds contribute to sleep disruption in patients, possibly affecting healing and recovery rate.10 Similarly, health care workers are also impacted by frequent alarms. In the intensive care setting, surveyed nurses report that alarm noise affected aspects of their work performance and health.
Consequently, 56% of nurses reported ignoring alarms, and 49% reported decreasing alarm volume to be inaudible.11,12 These responses, along with delayed response time, can cause adverse outcomes in patients.13 With highly publicized cases and data establishing its prevalence, the issue of alarm fatigue is one of national significance: The Joint Commission originally announced alarm management as a 2014 National Patient Safety Goal with an additional update in 2017 to improve alarm safety.14
Read the full article at Team-Based Intervention to Reduce the Impact of Nonactionable Alarms in an Adult Intensive Care Unit