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Sorting Sounds: Boston Medical Center Fights Alarm Fatigue

Boston Medical Center won the 2014 Gage Award for quality.

Boston Medical Center (BMC) tackled one of hospital care’s toughest problems—alarm fatigue—through education, equipment calibration, and other changes that sharply reduced clinically insignificant alarms, lowered noise levels, and improved patient and nurse satisfaction.

Alarm fatigue refers to the harm that comes from excessive alarms in hospitals, the volume and frequency of which can lead to them being turned off, ignored, or missed, potentially causing patient harm. Alarm fatigue may also intensify patient anxiety, detract from the healing environment, and affect patient satisfaction.

Responding to alarm-related events at other institutions and the exploding growth nationally of inpatient cardiac monitoring, BMC convened a multidisciplinary telemetry task force (TTF) in October 2011 to examine alarm fatigue. The team developed the Alarm Management Quality Improvement Project to identify methods to reduce alarm fatigue by safely reducing the number of clinically insignificant audible alarms.

Foundation for Change

One of the TTF’s first tasks was understanding current medical alarm use at the hospital. BMC’s use of a single vendor for all of its medical equipment with alarms allowed it to rapidly capture comprehensive data to develop a baseline. The hospital found that the cardiology medical unit chosen as the project’s pilot site experienced more than 12,500 audible alarms daily among its 28 monitored patients, or 87,870 alarms weekly.

With baseline alarm frequency and decibel levels in hand, the TTF developed a 15-step plan to improve cardiac alarm management. It included these steps and others:

  • surveying staff about alarm volume and frequency
  • identifying clinically significant alarms in collaboration with clinician stakeholders
  • standardizing alarm defaults when possible
  • altering alarm settings to remove audible notification for clinically insignificant alarms
  • requiring staff to respond to all clinically significant alarms

These changes helped the hospital raise awareness among BMC nurses about the dangers of alarm fatigue and engage and educate patients about alarm fatigue and the project.

Alarms Drop, Satisfaction Rises

The strategy helped BMC reduce audible alarms per week by 89 percent in the pilot unit and reduce noise levels from 90 decibels to 72 decibels. No incident reports involving cardiac alarms occurred after the project’s implementation.

Meanwhile, nursing staff surveys showed that the percent of respondents who viewed the unit’s noise level as “acceptable” increased from zero to 64 percent. Also, as the noise level fell, nursing staff reported feeling less fatigued at the end of shifts, consistent with research showing that nurses and other health care staff are affected by high noise levels and tend to report increased stress and exhaustion in such environments.

Winning Recognition, Support

BMC’s effort broke new ground. James Keller, vice president of health at the Emergency Care Research Institute (ECRI), noted: “The work that the [TTF] initiated, piloted and implemented at BMC has the potential to markedly change the way that telemetry monitoring is performed nationwide.” ECRI has identified alarm hazards and alarm fatigue as the top health technology hazard of 2013.

The pilot’s success also spurred the hospital to carry out similar initiatives in all 10 of the hospital’s inpatient medical-surgical units. Further, because the project so impressed Joint Commission surveyors, the commission made BMC its featured hospital for a May 2013 webinar on alarm fatigue.

Caveats

The TTF advises that while its work is replicable at other institutions, data collection processes might take longer at hospitals that work with multiple hardware vendors and adjustments to default equipment settings might vary.

To learn more about the BMC Alarm Management Quality Improvement Project, please contact:

Deborah Whalen, MSN, MBA, APRN-BC
Clinical Service Manager, Cardiology
deborah.whalen@bmc.org

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