A hospital monitor alarm can save a patient's life, as a single beep or high-pitched wail spurs doctors and nurses into action. However, the chorus of alarms that go off in the typical hospital ward can be mind-numbing to healthcare workers. The constant din of alarms can desensitize them, leading to "alarm fatigue" where audible alerts fail to catch the attention of workers.
According to a study by the Cincinnati Children's Hospital in the journal Pediatrics, a new team-based approach to reducing cardiac care monitors may ease alarm fatigue.
Alarm fatigue is a form of sensory overload that can lead to delayed or missed responses to alarms, and it has become a serious issue in ICUs across the country. Voluntary data submitted to The Joint Commission shows 98 alarm events reported between January 2009 and June 2012. Of these, 80 patients died, 13 suffered permanent loss of function, and five required additional care with an extended hospital stay.
One cause of alarm fatigue is the sheer difficulty of discerning one sound from another. The American Association of Critical-Care Nurses says that humans have a difficult time differentiating between six or more alarm sounds. In 1983, the typical ICU had only six different alarm sounds. By 2011, the average ICU had more than 40 different alarms.
Cardiac monitors make up the majority of alarms in hospitals, and these units can produce false alarms. In fact, 80 to 99 percent of ECG monitor alarms are false or clinically insignificant. This can lead to multiple false alarms per healthcare worker per shift, increasing the risk for alarm fatigue.
To address the problem, researchers at Cincinnati Children's Hospital Medical Center developed a set of standardized, team-based processes that reduce the number of monitor alarms. This standardized cardiac monitor care process (CMCP) included:
- Using age-appropriate standards for the initial ordering of monitors
- Daily replacement of electrodes using pain-free measures
- Daily assessment of cardiac monitor parameters
- A reliable method for discontinuing monitors appropriately
Specific changes included family and patient engagement in CMCP, development of pain-free electrode removal, and use of a monitor care log, detailing parameters, lead changes and discontinuation of monitors. The hospital also instituted customized monitor delays and threshold parameters.
These changes dropped the median number of alarms per patient-day from 180 to 40. Before implementing the changes, overall compliance with the four components of CMCP was only 38 percent. After implementation, compliance leaped to 95 percent.
Christopher Dandoy, M.D., a physician in the Cancer and Blood Diseases Institute at Cincinnati Children's is the lead author of the study. He and his team of researchers developed the standardized CMCP on the 24-bed, pediatric bone marrow transplant unit at Cincinnati Children's.
"With fewer false alarms, the staff can address significant alarms more promptly," Dandoy says. "We believe the roles and responsibilities entailed in this process can be applied to most units with cardiac monitor care."
The researchers recommend a team-based approach to monitor care, individualized assessment of monitor parameters, changing leads daily and proper discontinuation of monitors.
