Effect of a Nurse-Managed Telemetry Discontinuation Protocol on Monitoring Duration, Alarm Frequency, and Adverse Patient Events

Perrin, Keisha; Ernst, Neysa; Nelson, Terry; Sawyer, Melinda; Pfoh, Elizabeth R.; Cvach, Maria

doi:10.1097/ncq.0000000000000230

Cited by 9 publications

(13 citation statements)

References 12 publications

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“…Alarm fatigue has a large impact on nurses and their daily workflow. Researchers have shown that there is improved nurse and patient satisfaction with education of nurses regarding alarm safety (Perrin et al, 2017). In providing clinical interventions for management of alarm fatigue, research shows a minimization of nuisance and false alarms (Sendelbach et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…Benjamin et al (2013), also estimated that with a 35% rate of non-indicated telemetry days there is an excess cost of $ 250,000 per year. Perrin et al (2017), completed a quality improvement project utilizing a nurse driven telemetry monitoring discontinuation protocol. The pre-post study was completed on a 15-bed medical care unit in a hospital.…”

Section: Impacts Of Over-monitoring On Alarm Fatiguementioning

confidence: 99%

“…Overall, results revealed that nurses and physicians can work together to decrease the number of patients maintained on telemetry monitoring without affecting patient safety. With a decreased number of patients being monitored there is a decrease in the number of false and nuisance alarms, which decreases the occurrence of alarm fatigue (Perrin et al, 2017).…”

Section: Impacts Of Over-monitoring On Alarm Fatiguementioning

confidence: 99%

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Telemetry Nurses Knowledge of Alarm Fatigue and Interventions for Change: An Education Program Development

Cruz¹

2018

Preprint

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Alarm fatigue is known to be one of the top safety concerns in the healthcare setting. The Joint Commission recognized Alarm safety as one of the 2017 National Patient Safety Goals. Alarm fatigue occurs when a healthcare worker becomes overwhelmed and often desensitized to patient monitor alarms. It has been established that interventions including ECG daily electrode and battery changes, skin prep for electrode placement, and adjusting alarm parameters to fit patient needs can lead to a reduction in false or nuisance alarms. In order for these interventions to be carried out successfully, education of nurses regarding alarm fatigue and interventions for change needs to be completed. Education is one of the most important phases of creating change. The purpose of this program development project was to determine the effectiveness of an educational program on alarm fatigue awareness for telemetry unit nurses. A program development project was developed utilizing a pre-test, educational intervention, and a post-test design. Tests were used to evaluate the nurses’ knowledge improvement related to the educational intervention. Sixteen out of a possible 60 telemetry nurses completed the pretest portion of this quality improvement project. (N=16, 26.6%). Fourteen of a possible 60 nurses attended the educational session and completed the post-test portion of this quality improvement project. (N=14, 23%). For the purpose of presenting the first four questions, only those tests with matching pre-and-post responses were utilized, (N=14). The mean scores from pre-tests were 51.2% and mean post-test scores were 92% which revealed an increase by 40.8% after an educational intervention. The APRN can assist in establishing and implementing an educational program. This educational program can help to implement interventions and provide evidenced based research to support the prevention of alarm fatigue.

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Section: Discussionmentioning

confidence: 99%

Section: Impacts Of Over-monitoring On Alarm Fatiguementioning

confidence: 99%

Section: Impacts Of Over-monitoring On Alarm Fatiguementioning

confidence: 99%

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Telemetry Nurses Knowledge of Alarm Fatigue and Interventions for Change: An Education Program Development

Cruz¹

2018

Preprint

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“…The current literature predominantly uses stand‐alone educational interventions rather than system or workflow changes, and thus the impact may not be sustained. In addition, few studies have examined the impact of nursing‐driven initiatives to limit telemetry use 18 …”

Section: Introductionmentioning

confidence: 99%

Empowering nurses and residents to improve telemetry stewardship in the academic care setting

Duffy

Niessen

Perrin

et al. 2020

Evaluation Clinical Practice

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Aims and Objectives Inappropriate use of telemetry frequently occurs in the inpatient, non‐intensive care unit setting. Telemetry practice standards have attempted to guide appropriate use and limit the overuse of this important resource with limited success. Clinical‐effectiveness studies have thus far not included care settings in which resident‐physicians are the primary caregivers. Methods We implemented two interventions on general internal medicine units of an academic hospital. The first intervention, or nurse‐discontinuation protocol, allowed nurses to trigger the discontinuation of telemetry once the appropriate duration had passed according to practice standards. The second intervention, or physician‐discontinuation protocol, instituted a best‐practice advisory that notified the resident‐physician via the electronic medical record when the appropriate telemetry duration for each patient had elapsed and suggested termination of telemetry. Data collection spanned 8 months following the implementation of the nurse‐discontinuation protocol and 12 months following the physician‐discontinuation protocol. Results During the control period, the average time spent on telemetry was 86.29 hours/patient/month. During the nurse‐discontinuation protocol, patients spent, on average, 70.86 hours/patient/month on telemetry. During the physician‐discontinuation protocol, patients spent, on average, 81.6 hours/patient/month on telemetry. During the nurse‐discontinuation protocol, there was no significant change in the likelihood that a patient was placed on telemetry throughout their admission when compared with the control period. During the physician‐discontinuation protocol, there was a significant decrease of 56.1% in the likelihood that a patient would be put on telemetry when compared with the control time period. Conclusions These findings expand our understanding of telemetry use in the academic care setting in which trainees serve as the primary caregivers. Furthermore, these findings represent an important addition to the telemetry and patient monitoring literature by demonstrating the impact that nurse‐managed protocols can have on telemetry use and by highlighting effective strategies to improve telemetry use by physicians in training.

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“…To this end, one institution moved to ensure that monitoring of all low-risk patients was discontinued in a timely manner, 12 and another institution implemented a nurse-managed monitor discontinuation process in an inpatient unit. 13 A subset of premature ventricular contraction alarms were disabled in one institution after studies showed that these alarms contribute a large amount of the noise load experienced in an inpatient unit, despite being largely non-actionable. 14 The sound of an alarm is often configured to reflect the acuity of the event, so efforts have been taken to reconfigure the acuity of each alarm type, ensuring that only the most serious events will trigger a high-acuity alarm sound.…”

Section: Introductionmentioning

confidence: 99%

Incorporating Observed Physiological Data to Personalize Pediatric Vital Sign Alarm Thresholds

Poole

Shah

2019

Biomed Inform Insights

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Bedside monitors are intended as a safety net in patient care, but their management in the inpatient setting is a significant patient safety concern. The low precision of vital sign alarm systems leads to clinical staff becoming desensitized to the sound of the alarm, a phenomenon known as alarm fatigue. Alarm fatigue has been shown to increase response time to alarms or result in alarms being ignored altogether and has negative consequences for patient safety. We present methods to establish personalized thresholds for heart rate and respiratory rate alarms. These thresholds are first chosen based on patient characteristics available at the time of admission and are then adapted to incorporate vital signs observed in the first 2 hours of monitoring. We demonstrate that the adapted thresholds are similar to those chosen by clinicians for individual patients and would result in fewer alarms than the currently used age-based thresholds. Personalized vital sign alarm thresholds can help to alleviate the problem of alarm fatigue in an inpatient setting while ensuring that all critical vital signs are detected.

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Effect of a Nurse-Managed Telemetry Discontinuation Protocol on Monitoring Duration, Alarm Frequency, and Adverse Patient Events

Cited by 9 publications

References 12 publications

Telemetry Nurses Knowledge of Alarm Fatigue and Interventions for Change: An Education Program Development

Telemetry Nurses Knowledge of Alarm Fatigue and Interventions for Change: An Education Program Development

Empowering nurses and residents to improve telemetry stewardship in the academic care setting

Incorporating Observed Physiological Data to Personalize Pediatric Vital Sign Alarm Thresholds

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