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‘Alarm Fatigue’ Cured by Reducing Unnecessary Cardiac Monitor Warnings

CINCINNATI – If monitor beeps are so ubiquitous at your facility that you hardly hear them anymore, you may be suffering from “alarm fatigue.”

That was the problem at Cincinnati Children’s Hospital Medical Center, where researchers developed a standardized, team-based approach to reduce the ubiquitous beeping of cardiac monitor alarms. When the median number of daily cardiac alarms dropped from 180 to 40, caregiver compliance with the process shot up from 38% to 95%.

An article on the process developed at the 24-bed, pediatric bone marrow transplant unit at Cincinnati Children's was published online recently by the journal Pediatrics.

"Cardiac monitors constitute the majority of alarms throughout the hospital," said lead author Christopher Dandoy, MD, of the Cancer and Blood Diseases Institute at Cincinnati Children's. "We think our approach to reducing monitor alarms can serve as a model for other hospitals throughout the country."

That is important because, according to The Joint Commission, 80 patients died from hospital alarm-related errors nationwide between January 2009 and January 2012.

The process to standardized cardiac monitoring included:

  • initial ordering of monitor parameters based on age-appropriate standards,
  • daily replacement of electrodes in a manner that was pain-free for patients,
  • individualized daily assessment of cardiac monitor parameters and
  • developing a reliable method for appropriate discontinuation of the monitors.

After testing and adaptation, the team then added some additional innovations, including family/patient engagement in the process; creation of a monitor care log to document parameters, lead changes, and discontinuation; further development of a pain-free process for electrode removal; and customized monitor delay and customized threshold parameters.

From January to November 2013, compliance with each of the four components of the new cardiac monitor care process increased steadily, according to the report.

“Implementation of the standardized CMCP resulted in a significant decrease in cardiac monitor alarms per patient day,” the authors write. “We recommend a team-based approach to monitor care, including individualized assessment of monitor parameters, daily lead change, and proper discontinuation of the monitors.”

The process was not unique to a pediatric unit, the authors emphasize.

"With fewer false alarms, the staff can address significant alarms more promptly," Dandoy pointed out. "We believe the roles and responsibilities entailed in this process can be applied to most units with cardiac monitor care."