Boston Medical Center (BMC) reports that it has successfully reduced audible alarms as a way to combat alarm fatigue – a condition when providers become desensitized to the constant beeps from monitors. This sort of fatigue could result in a failure to respond (or failure to respond quickly enough) to alarms indicative of a potential life-threatening condition.
To reduce alarm fatigue and increase patient safety, BMC implemented a six-week pilot program to reduce the decibel level in audible alarms. According to results of the pilot study, which were published online in the Journal of Cardiovascular Nursing, BMC reduced audible cardiac monitor and telemetry alarms by 89 percent, dropping daily audible alarm averages from 12,546 to 1,424. Before the pilot, the unit averaged 87,823 weekly audible alarms.
During the pilot, the number dropped significantly to an average of 9,967 weekly audible alarms, with the largest decrease from the changes to monitors for bradycardia, tachycardia, and heart rate parameter limits, which dropped from 62,793 to 3,970. Additionally, daily reviews of incident reports showed that no reports were filed during the pilot for adverse events involving cardiac monitoring.
In addition, BMC data showed that patient status arrhythmia and parameter limit “warning” alarms frequently preceded life-threatening arrhythmic events. During the pilot, these alarms were raised to “crisis.” Crisis alarms are heard in real time and require immediate action, which nurses felt could increase patient safety. Nurses also tailored alarm settings that did not indicate a true crisis based on individual patient health care needs.
Noise levels fell to 72 decibels from 90 decibels pre-pilot. Patient and clinician satisfaction increased and none of the changes made during the pilot required additional technology or financial resources, according to the study. The successful approach has since been expanded to all of the hospital’s inpatient medical surgical units and is being touted as a model for other hospitals working to combat alarm fatigue.
“While some hospitals are looking to add technology to combat this issue, BMC’s approach demonstrates the opportunity for clinicians to interact with current alarm systems more effectively to decrease clinical alarm fatigue while simultaneously capturing and displaying all important alarms,” said James Piepenbrink, BSBME, director of clinical engineering at BMC and a study co-author.
The pilot’s results led BMC to implement changes on inpatient medical/surgical units throughout the hospital. The hospital notes that by January 2013, 310 of 332 beds in the pilot units were operating under the new alarm standards with significant alarm reductions and increases in patient and staff safety and satisfaction.