Data-Driven Implementation of Alarm Reduction Interventions in a Cardiovascular Surgical ICU

Allan, Sharon H.; Doyle, Peter A.; Sapirstein, Adam; Cvach, Maria

doi:10.1016/j.jcjq.2016.11.004

Cited by 20 publications

(24 citation statements)

References 22 publications

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“…Institute's Health Technology Hazards list [77,78]. The subject of AF has been extensively studied, primarily due to its high prevalence across essentially all health-care settings.…”

Section: Potential Outcomes Of Alarm Fatiguementioning

confidence: 99%

Combating Alarm Fatigue: The Quest for More Accurate and Safer Clinical Monitoring Equipment

Nguyen¹,

Davis²,

Guglielmello³

et al. 2019

Vignettes in Patient Safety - Volume 4 [Working Title]

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As the demand for health-care services continues to increase, clinically efficient and cost-effective patient monitoring takes on a critically important role. Key considerations inherent to this area of concern include patient safety, reliability, ease of use, and cost containment. Unfortunately, even the most modern patient monitoring systems carry significant drawbacks that limit their effectiveness and/or applicability. Major opportunities for improvement in both equipment design and monitor utilization have been identified, including the presence of excessive false and nuisance alarms. When poorly optimized, clinical alarm activity can affect patient safety and may have a negative impact on care providers, leading to inappropriate alarm response time due to the so-called alarm fatigue (AF). Ultimately, consequences of AF include missed alerts of clinical significance, with substantial risk for patient harm and potentially fatal outcomes. Targeted quality improvement initiatives and staff training, as well as the proactive incorporation of technological improvements, are the best approaches to address key barriers to the optimal utilization of clinical alarms, AF reduction, better patient care, and improved provider job satisfaction.

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“…Institute's Health Technology Hazards list [77,78]. The subject of AF has been extensively studied, primarily due to its high prevalence across essentially all health-care settings.…”

Section: Potential Outcomes Of Alarm Fatiguementioning

confidence: 99%

Combating Alarm Fatigue: The Quest for More Accurate and Safer Clinical Monitoring Equipment

Nguyen¹,

Davis²,

Guglielmello³

et al. 2019

Vignettes in Patient Safety - Volume 4 [Working Title]

View full text Add to dashboard Cite

show abstract

“…Prior studies have identified outlier patients for both arrhythmia and other physiologic alarms (e.g. vital signs), a problem described as ‘alarm flood’ (Allan et al, 2017; Drew et al, 2014; Harris et al, 2017; Nguyen et al, 2020; Yeh et al, 2020). To reduce alarm fatigue in this situation targeted alarm strategies (e.g.…”

Section: Discussionmentioning

confidence: 99%

Premature ventricular complexes during continuous electrocardiographic monitoring in the intensive care unit: Occurrence rates and associated patient characteristics

Suba

Hoffmann

Fleischmann

et al. 2022

Journal of Clinical Nursing

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Aims and objectives:This study examined the occurrence rate of specific types of premature ventricular complex (PVC) alarms and whether patient demographic and/ or clinical characteristics were associated with PVC occurrences.Background: Because PVCs can signal myocardial irritability, in-hospital electrocardiographic (ECG) monitors are typically configured to alert nurses when they occur.However, PVC alarms are common and can contribute to alarm fatigue. A better understanding of occurrences of PVCs could help guide alarm management strategies.Design: A secondary quantitative analysis from an alarm study. Methods:The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was followed. Seven PVC alarm types (vendor-specific) were described, and included isolated, couplet, bigeminy, trigeminy, run PVC (i.e. VT >2), R-on-T and PVCs/min. Negative binomial and hurdle regression analyses were computed to examine the association of patient demographic and clinical characteristics with each PVC type.Results: A total of 797,072 PVC alarms (45,271 monitoring hours) occurred in 446 patients, including six who had disproportionately high PVC alarm counts (40% of the total alarms). Isolated PVCs were the most frequent type (81.13%) while R-on-T were the least common (0.29%). Significant predictors associated with higher alarms rates: older age (isolated PVCs, bigeminy and couplets); male sex and presence of PVCs on the 12-lead ECG (isolated PVCs). Hyperkalaemia at ICU admission was associated with a lower R-on-T type PVCs.Conclusions: Only a few distinct demographic and clinical characteristics were associated with the occurrence rate of PVC alarms. Further research is warranted to

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“…Partnering with stakeholders such as clinical leadership, bedside providers and technical staff was critical. Our approach incorporated many evidence-based interventions previously shown to reduce alarm notifications,19 such as implementing alarm delays,20 changing ECG electrodes daily11 and generating algorithms for alarm notification 21 22. Previously, these strategies successfully decreased the number of alarms per patient-day over fourfold without compromising patient safety 11 23.…”

Section: Discussionmentioning

confidence: 99%

Time series evaluation of improvement interventions to reduce alarm notifications in a paediatric hospital

et al. 2020

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Background10The Joint Commission identified inpatient alarm reduction as an opportunity to improve patient safety; enhance patient, family and nursing satisfaction; and optimise workflow. We used quality improvement (QI) methods to safely decrease non-actionable alarm notifications to bedside providers.MethodsIn a paediatric tertiary care centre, we convened a multidisciplinary team to address alarm notifications in our acute care cardiology unit. Alarm notification was defined as any alert to bedside providers for each patient-triggered monitor alarm. Our aim was to decrease alarm notifications per monitored bed per day by 60%. Plan-Do-Study-Act testing cycles included updating notification technology, establishing alarm logic and modifying bedside workflow processes, including silencing the volume on all bedside monitors. Our secondary outcome measure was nursing satisfaction. Balancing safety measures included floor to intensive care unit transfers and patient acuity level.ResultsAt baseline, there was an average of 71 initial alarm notifications per monitored bed per day. Over a 3.5-year improvement period (2014–2017), the rate decreased by 68% to 22 initial alarm notifications per monitored bed per day. The proportion of initial to total alarm notifications remained stable, decreasing slightly from 51% to 40%. There was a significant improvement in subjective nursing satisfaction. At baseline, 32% of nurses agreed they were able to respond to alarms appropriately and quickly. Following interventions, agreement increased to 76% (p<0.001). We sustained these improvements over a year without a change in monitored balancing measures.ConclusionWe successfully reduced alarm notifications while preserving patient safety over a 4-year period in a complex paediatric patient population using technological advances and QI methodology. Continued efforts are needed to further optimise monitor use across paediatric hospital units.

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Data-Driven Implementation of Alarm Reduction Interventions in a Cardiovascular Surgical ICU

Cited by 20 publications

References 22 publications

Combating Alarm Fatigue: The Quest for More Accurate and Safer Clinical Monitoring Equipment

Combating Alarm Fatigue: The Quest for More Accurate and Safer Clinical Monitoring Equipment

Premature ventricular complexes during continuous electrocardiographic monitoring in the intensive care unit: Occurrence rates and associated patient characteristics

Time series evaluation of improvement interventions to reduce alarm notifications in a paediatric hospital

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