Johns Hopkins reports that it has reduced bedside alarms up to 74% in some units

A group of Johns Hopkins nurses, physicians, and engineers have significantly reduced the number of distracting, non-critical bedside alarms in some of the hospital’s noisiest areas — up to 74% in some cases — in an improvement that has been linked to patient safety.

ECRI Institute, an independent, nonprofit institute that conducts research about and assesses best practices in patient safety and quality, has called clinical alarms the number one health technology hazard of the year. For its efforts in reducing bedside alarms, the group recently awarded The Johns Hopkins Hospital its Health Devices Achievement Award for 2012.

The effort is an example for how a methodical and carefully analyzed research process can be applied to alarm management and result in a significant improvement in patient care, says Maria Cvach, MSN, RN, CCRN, assistant director of nursing clinical standards at Johns Hopkins and leader of the hospital’s alarm improvement efforts since 2006.

“This project came about because, like a lot of healthcare organizations, we were concerned about how to improve safety with clinical alarms,” she says. “One of the top reasons for missing an alarm is alarm fatigue. There are too many alarms, and people are just desensitized to the amount of noise. They either hear it and ignore it, or they don’t hear it and don’t take action.”

Ironically, improvements in monitoring have led to the need to reduce the number of alarms, Cvach explains. “In healthcare we have created the perfect storm with all of these monitoring devices,” Cvach says. “Monitor alarm systems are set to be very sensitive and unlikely to miss a true event but result in too many false positives.”

Baseline measures revealed the scope of the challenge for Johns Hopkins’ Alarms Management Committee: One 12-day alarm system analysis registered 58,764 alarms, an average of 350 per patient per day. That rate was doubled on the noisiest unit, and analysis revealed a 90% false-positive rate among alarms in the pediatric intensive care unit set on monitors for apnea, a breathing lapse.

In addition to noise reduction, the quality-improvement project sought to prevent “alarm fatigue,” potentially hazardous conditions that arise when nurses and other caregivers become so desensitized by frequent, unnecessary crisis alarms that they become less likely to respond. “Frequent alarming can cause a ‘cry-wolf’ effect,” Cvach explains.

By collecting baseline measurements, defining and validating appropriate alarm settings, and working with each unit to develop an alarms improvement plan, the multidisciplinary team safely reduced the cacophony from monitors, infusion pumps, ventilators, bed exit systems, and other bedside devices hospitalwide. Reductions ranged from 24% to 74% across six units.

In another pilot study, the researchers cut in half the total number of alarms by asking nurses to change patients’ monitor electrodes daily, explains Andrew Currie, MS, CBET, Hopkins’ director of clinical engineering. He co-chairs the alarms committee with Cvach and Adam Sapirstein, MD, associate professor in the Department of Anesthesiology/Critical Care Medicine in The Johns Hopkins School of Medicine and also a faculty member in the Johns Hopkins Armstrong Institute for Patient Safety and Quality.

“Patients and staff need a quiet environment,” Currie says. “We are trying to reserve noisy alarms for the most important, actionable events. In some cases, units switched some lower-priority alarms to visual rather than auditory notifications.”

Cvach and Sapirstein say that partnering with leaders on each unit was essential to their success, because improvements needed to be tailored to individual settings. “A one-size-fits-all approach would not have received the kind of support we needed to address this problem,” Currie says.

Before setting out to alter alarm settings, the committee analyzed and rated each alarm based on importance and risk to ensure back-up notification systems were in place for the most critical alarms. Cvach says, “For high-priority alarm conditions, redundancy is important. Our units need multiple ways to ensure audibility of alarm signals and patient safety.”

The group’s other efforts include testing new equipment, assessing alarm management alternatives, developing new policies, creating and assessing training efforts, and considering new alarm technologies.

A current pilot study is testing a system that sends messages about priority alarms to cell phones and pagers carried by nurses, who, with the press of a button, can call for back-up if they’re unable to respond. Another initiative that Sapirstein is leading will look into “smart alarm” systems that integrate data from multiple machines and predict problems before they occur.

Sources:

  • Andrew Currie, MS, CBET, Director, Clinical Engineering Services, The Johns Hopkins Hospital, Baltimore, MD. Telephone: (410) 955-9859. Email: andcur@jhmi.edu.
  • Maria Cvach, MSN, RN, CCRN, Assistant Director of Nursing Clinical Standards, The Johns Hopkins Hospital. Telephone: (410) 955-0782. Email: mcvach1@jhmi.edu.