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27 opportunities to reduce alarm fatigue

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Performance improvement consulting to improve alarm management

A large hospital in the southeast recognized alarm fatigue as a patient safety issue in their patient monitoring areas. They also recognized the need to align with The Joint Commission’s (TJC) National Patient Safety Goal (NPSG) #6 on alarm management.

Aware of the complexities and challenges, the hospital engaged with Philips clinical consultants to assist with developing an alarm management program. The consultants collaborated with key staff and leadership to identify opportunities aimed at reducing non-actionable alarms by incorporating published best practices and improving current-state process flows, as well as establishing a dedicated alarm management committee.

Assessment

After aligning project goals with key stakeholders, the consultants provided a comprehensive current-state assessment of four inpatient monitoring units. Insights were collected through stakeholder interviews and real-time unit observations of the end-to-end monitoring process, captured in a workflow map.

30 days of monitoring alarm data was analyzed, which identified non-actionable alarms, and subsequently validated observations and interview feedback. Since technology is an integral piece of this process, an analysis of applicable equipment was performed, including interface capabilities as well as staff understanding and use of relevant functionalities. A sound pressure level analysis was also conducted to evaluate overall environmental noise.

The current-state assessment culminated in the synthesis of qualitative and quantitative findings, resulting in identification of practice and process gaps, barriers, and opportunities for improvement.

A phased improvement approach

Based on the findings, a phased alarm management strategy was recommended, beginning with formalization of a multi-disciplinary alarm committee. The committee will oversee the improvement efforts, prioritize the identified opportunities, and develop an implementation plan with testing and data analysis to validate improvements.

Recommendations and results^*

27 opportunities for improving the alarm management processes, protocols, and policies were identified and recommended to the hospital leadership for consideration. The top recommendations included:

Implementation of an alarm governance committee to ensure continuous quality improvement, while aligning with existing site committee initiatives
Removing the default of selected medium priority arrhythmia alarms per published leading practices as retrospective data demonstrated a potential reduction of over 60% of non-actionable alarms for telemetry and critical care if these defaults had been in place^*
Revision of the existing policy to reflect current best practice industry guidelines, while standardizing and aligning with hospital protocols to improve patient safety and staff compliance
Consideration of implementing a 24-48-hour review process for the continuation or discontinuation of telemetry, utilizing the ACA/AHA 2017 Guidelines
Revising protocols for telemetry device tracking to avoid discharge delays due to unknown device location

The consultants identified additional areas of change opportunities which included:

Standardization of onboarding education
Telemetry utilization bottlenecks
Policy discrepancies
Staff satisfaction
Overall environmental noise

The hospital leadership team appreciated the insights and guidance received and plan on implementing several of the recommendations in the short term and establishing an alarm management roadmap for implementing the other changes over time. They expect to achieve significant and sustainable reductions in non-actionable alarms in the long-term.

^*Results are specific to the institution where they were obtained and may not reflect the results achievable at other institutions.

Meet our team

Lisa Pahl, RN, BSN, MSN

Principal and Practice Operations Lead

Lisa is a recognized expert in alarm fatigue and alarm management. She is a member of the AAMI Healthcare Technology Safety Institute’s national Clinical Alarms Steering Committee and often presents on alarm management.

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John Davanzo, MBA, BSN, RN, CEN, EMT-P, NEA-BC, FACHE

Consulting Manager

John brings expertise in hospital operations, workflow, and process redesign. He is a regular regional and national presenter on healthcare topics including process and resource efficiency as well as use of simulation in healthcare. He is a Fellow in the American College of Healthcare Executives. His clinical expertise includes emergency care, pre-hospital care, and pediatric and adult ICU.