Reduction of Cardiopulmonary Monitor Alarms in the Special Care Nursery

Abstract

Background: Health care technology has added benefits for monitoring patients, but many of these devices are associated with alarms and alerts to notify staff when a patient’s physiological limits fall outside of set parameters or when there is a machine malfunction. Alarm fatigue occurs when a person is exposed to so many clinical alarms, they eventually become immune to the sound, thus having no or slow responses to alarms. In addition to desensitization, staff exposed to these repetitive sounds may react by silencing alarms, turning them off or changing the parameters to unsafe ranges. These actions, and staff missing clinically relevant alarms, have resulted in adverse patient events and deaths in hospitals nationwide. While the issues surrounding alarm safety are multifaceted, many experts focus on strategies to decrease false or non-actionable alarms. False or non-actionable alarms are alarms that do not require any clinical intervention by staff. Evidence suggests that by changing alarm parameters to fit patient needs, false alarms are minimized, therefore decreasing alarm fatigue. Purpose: The purpose of this project is to decrease alarm fatigue in the Special Care Nursery, a step-down nursery, at a large academic medical center. In order to achieve this goal, the project aimed to decrease the number of cardiopulmonary alarms that sound throughout the unit by individualizing each patient’s alarms to their personal baseline. Methods: A quality improvement project was completed in the Special Care Nursery in which nurses were instructed on how to change alarm parameters to fit their patient’s baseline cardiopulmonary needs. Oxygen saturation was excluded from the project due to the narrow margin of acceptability for a neonate’s oxygenation status. During the one week intervention, staff were reminded of the importance of alarm parameter changes and the impact of alarm fatigue twice daily before starting their shift. In accordance with current hospital standards, prior to alarm parameter changes, a physician order was required. A job aid on how to change alarm parameters was provided to staff and available on the unit at all times. Results: Utilizing the Mann Whitney U for analysis, there was no statistically significant difference in the number of alarms that sounded prior to the intervention and following the intervention. No orders were placed for alarm parameter changes following the intervention period. Discussion: Although the intervention in this project did not result in a statistically significant change (p value=0.974) in cardiopulmonary alarms, the project brought to the forefront the discussion of alarm fatigue within the unit. Further focused work on this unit should involve analysis of current baseline settings to determine if changes can result in decreased nuisance cardiopulmonary alarms. Additional work should focus on achieving support from the front line staff on the criticality of alarm fatigue on patient safety and the role of the nursing staff in decreasing false alarms and alarm fatigue.