BACKGROUND AND OBJECTIVES: Excessive cardiac monitor alarms lead to desensitization and alarm fatigue. We created and implemented a standardized cardiac monitor care process (CMCP) on a 24-bed pediatric bone marrow transplant unit. The aim of this project was to decrease monitor alarms through the use of team-based standardized care and processes.METHODS: Using small tests of change, we developed and implemented a standardized CMCP that included: (1) a process for initial ordering of monitor parameters based on age-appropriate standards; (2) pain-free daily replacement of electrodes; (3) daily individualized assessment of cardiac monitor parameters; and (4) a reliable method for appropriate discontinuation of monitor. The Model for Improvement was used to design, test, and implement changes. The changes that were implemented after testing and adaptation were: family/patient engagement in the CMCP; creation of a monitor care log to address parameters, lead changes, and discontinuation; development of a painfree process for electrode removal; and customized monitor delay and customized threshold parameters. RESULTS:From January to November 2013, percent compliance with each of the 4 components of the CMCP increased. Overall compliance with the CMCP increased from a median of 38% to 95%. During this time, the median number of alarms per patient-day decreased from 180 to 40.CONCLUSIONS: Implementation of the standardized CMCP resulted in a significant decrease in cardiac monitor alarms per patient day. We recommend a team-based approach to monitor care, including individualized assessment of monitor parameters, daily lead change, and proper discontinuation of the monitors. Pediatrics 2014;134:e1686-e1694 2 Providers feel overwhelmed as they differentiate between the large amount of alarms, and they may become desensitized. 3 Desensitization to alarms, or "alarm fatigue," leads to a lack of response to the alarms due to sensory overload.In January 2010, excessive alarms reached national headlines when a patient' s death was directly related to alarm fatigue. 4,5 However, the dangers from excessive alarms are more than an isolated case. From 2005 to 2010, the Emergency Care Research Institute reported 216 physiologic monitor-related deaths. 6 The institute publishes an annual top 10 technology list, and "Alarm Hazards" has been at the top of the list for the last several years. [6][7][8] In April 2013, the Joint Commission announced a Sentinel Event Alert to all hospitals based on alarm fatigue and cardiac monitor device care. 9 They reported 80 alarm-related deaths between January 2009 and June 2012, all traced back to alarm-related issues. The major factors reported in these deaths were from alarm fatigue, alarm parameters not customized to the patient, and inadequate staff training on the functioning of the monitors.The present improvement project was performed in the bone marrow transplant (BMT) unit at Cincinnati Children' s Hospital Medical Center (CCHMC). Hospital guidelines recommend cardiopulmonary ...

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Act (PDSA) testing we created a standardized ADL process that involved all providers. Interventions included addressing 1-2-3 compliance during rounds, creating accountability in care delivery, creation of an algorithm and order set for oral care, daily text message reminders, and physician intervention with non-compliant and high-risk patients. Findings & Interpretation: Our baseline compliance with the 1-2-3 initiative was 25%. With our interventions we increased our median compliance to 66% in 90 days. The greatest impact on compliance was seen with text message reminders to staff to complete the 1-2-3 components, designated roles and responsibilities, and physician discussion with noncompliant and high-risk patients. Discussion & Implications: Oral care algorithm and order set, daily text message reminders, and physician intervention with non-compliant and high-risk patients could all be adaptive to other units. Units where compliance with ADL participation is low would be an ideal environment to incorporate the ADL 1-2-3 initiative.