The risk of alarm fatigue prompted clinicians at Cincinnati (OH) Children’s Hospital Medical Center (CCHMC) to institute processes that reduced cardiac monitoring alarms by 80%. These are the processes implemented at the hospital:
Family engagement: Family members were recruited to help identify barriers to implementation of the Cardiac Monitor Care Process (CMCP) and were made part of the multidisciplinary team. The lead change protocol was discussed with family members on initiation of cardiac monitoring. Family members and patients communicated problems with alarms to the nursing staff, and these issues were addressed directly and documented in the monitor log. Family perception of timely attention to monitors by staff was measured in a satisfaction questionnaire.
Standardized age-appropriate ordering of monitor parameters: To address that pediatric patients need different monitor settings than adults, the team created an age-appropriate order set with baseline parameters in the electronic medical record. Initial monitor parameters were documented on the cardiac monitor log.
Daily lead changes: Prolonged electrode use can result in signal impedance and increased signal noise due to decreased conductivity, which leads to increased false alarms. To avoid that problem, daily lead changes were instituted. To reduce the pain associated with removing the leads, it is done during daily baths.
Daily assessment of monitor parameters: The cardiac monitor log was completed daily by the nursing staff and reviewed daily by the medical team. Excessive false alarms were investigated and corrected by the nursing staff with a monitor troubleshooting algorithm.
Clearly defined roles and responsibilities: Staff were educated through a mandatory computer module and by the CMCP team.
Standardized reliable process for monitor discontinuation: The hospital created intentional redundancy in the assessment of the discontinuation of the monitors. Providers and nurses assessed the need for the cardiac monitors, and this information was documented in the cardiac monitor log.
Customized monitor delay and increased threshold settings: CCHMC increased the oxygen saturation alarm delay from five to 10 seconds because most oxygen saturation alarms self-correct within the delay period set.