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At a facility in Ohio, changes in how cardiac monitors are used on pediatric patients resulted in an 80% reduction in alarms, which reduced the likelihood of the alarm fatigue known to threaten patient safety.
Clinicians at Cincinnati (OH) Children’s Hospital Medical Center (CCHMC) were concerned that excessive cardiac monitor alarms were leading to desensitization and alarm fatigue, says Christopher E. Dandoy, MD, MSc, instructor of pediatrics in the bone marrow transplant (BMT) unit. In response, they created a standardized Cardiac Monitor Care Process (CMCP) on a 24-bed pediatric BMT unit. CCHMC is a large, urban pediatric medical center, and the BMT team performs 100 to 110 transplants per year.
The BMT unit has 24 beds. About 70% of patients on the floor are on cardiac monitors, which include pulse oxygen saturation (SpO2) monitoring as well as cardiopulmonary monitoring, Dandoy explains. Patients admitted to the BMT unit often are hospitalized for up to 40 days, and they can be on monitors for 60% of their hospitalization.
Dandoy and his colleagues developed a standardized CMCP that included family/patient engagement in the CMCP; creation of a monitor care log to address parameters, daily lead changes, and discontinuation; development of a pain-free process for electrode removal; and customized monitor delay and customized threshold parameters. (See the story on p. 9 for more information about the changes.)
Much of the effort involved using the cardiac monitors appropriately for children, rather than adults, Dandoy explains. The parameters for triggering an alarm are different, for example, but many hospitals neglect the need to adjust the settings. Even with pediatrics, not all settings are the same.
"We would have infants come in and placed on a monitor, with default settings. That might mean we have an infant using monitor parameters for a 12-year-old," Dandoy says. "The infant’s heart rate will be 130 or 140, whereas the 12-year-old’s heart rate is about 90. The alarm is going off all the time. That bring us to the risk of alarm fatigue, and it could threaten the patient’s care if the monitor isn’t alerting nurses at the right time."
Members of the CCHMC team determined appropriate settings based on clinical evidence so that they could be trusted to signal when appropriate, he says. Determining the correct parameters is better than simply choosing "better- safe-than-sorry" alarm triggers that are too sensitive, Dandoy says.
"That’s when you get into alarm fatigue," he explains. "Your nurses and everyone needs to know that the alarms are set properly so they can trust that when the alarm sounds, the patient really does need attention. If they understand that you set the parameters too loosely, you can have exactly the opposite effect with alarm fatigue."
From January to November 2013, 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. Dandoy and his colleagues concluded that the standardized CMCP resulted in a significant decrease in cardiac monitor alarms per patient day.
The CCHMC team published their results in the journal Pediatrics. An abstract of the study and links to the full report are available online at http://tinyurl.com/pxymlje.
Christopher E. Dando, MD, MSc, Instructor of Pediatrics, Bone Marrow Transplant Center, Cincinnati (OH) Children’s Hospital Medical Center. Telephone: (513) 636-7287. Email: firstname.lastname@example.org.