Monitor adjustments reduce alarm fatigue at Boston hospital

In an effort to combat alarm fatigue, Boston Medical Center reduced its weekly audible cardiac alarm rate by 89 percent, increasing both patient and staff satisfaction, according to a new study in the Journal of Cardiovascular Nursing.

With reports of alarm fatigue plaguing nursing staff, and noise levels contributing to patient anxiety, or worse, death, researchers set out to determine variables that would safely reduce noncritical telemetry and monitor alarms on a general medical-surgical unit where there were excessive audible alarms, according to the study.

Researchers, led by Deborah A. Whalen of Boston Medical Center, changed alarms for bradycardia, tachycardia and heart rate limits to "crisis," which meant nursing staff had to view and act on the alarm each time it sounded, altogether eliminating self-resetting alarms.

During the pilot study, daily audible alarm averages dropped from 12,546 to 1,424, according to an announcement from Boston Medical Center. Before the pilot, the unit averaged 87,823 weekly audible alarms. But alarm averages dropped to 9,967 weekly audible alarms, with the largest decrease resulting from the changes to monitors for bradycardia, tachycardia and heart rate parameter limits, which fell from 62,793 to 3,970. 

Researchers determined alarms with self-reset capabilities may result in an excess number of audible alarms and clinical alarm fatigue, and that by eliminating them, hospitals can significantly reduce the volume of calls without requiring additional resources or compromising patient safety. There were no adverse events related to missed cardiac monitoring events and Code Blue incidents decreased by 50 percent, according to the study abstract.

"While some hospitals are looking to add technology to combat this issue, BMC's approach demonstrates the opportunity for clinicians to interact with current alarm systems more effectively to decrease clinical alarm fatigue while simultaneously capturing and displaying all important alarms," said James Piepenbrink, director of clinical engineering at BMC and a study co-author.

The Joint Commission issued a new two-phase National Patient Safety Goal (NPSG) last year, that aims to combat alarm fatigue, FierceHealthcare previously reported. The first phase, which took effect Jan. 1, looks to heighten awareness of the potential risks associated with clinical alarms, such as cardiac monitors, IV machines and ventilators. The second phase, which will begin Jan. 1, 2016, introduces requirements to mitigate those risks.

 To learn more:
- here's the study
- check out the announcement