Running head: ALARM FATIGUE MANAGEMENT
Knowledge and Management of Alarm Fatigue on a Medical Intermediate Care Unit
Kathleen A. Williams
The Pennsylvania State University
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ALARM FATIGUE MANAGEMENT
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Abstract
An educational assessment and intervention on the concept and management of alarm fatigue
was performed on the Medical Intermediate Care Unit at the Penn State Milton S. Hershey
Medical Center. Nurses were surveyed to determine their current understanding of the overall
nature of the problem of alarm fatigue as well as the implications of alarm fatigue on their
individual level of practice, the function of the unit as a whole, and on outcomes for patients.
Knowledge and practice deficits were determined from survey results. A review of literature
was then conducted for current best evidence for methods of alarm management. Specific
recommendations include proper skin preparation and electrode placement as well as daily
replacement of electrodes; customization of alarm parameters based on patient need; review and
consideration of change of default threshold settings and implementation of alarm delays;
appropriate monitoring and discontinuation of patients based on indication; and establishment of
an interdisciplinary team approach to alarm management including development of policy and
procedures as well as initial and ongoing training about devices with alarms.
These findings were then communicated verbally and nonverbally in the form of an educational
flyer and other supportive written material to nursing staff. Staff signed off as to their
participation in this educational event as well as their commitment to future practice and nursing
actions aimed at reducing alarm fatigue to ensure positive outcomes for patients.
Keywords: alarm fatigue, alarm management
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Methods of Alarm Management to Reduce Alarm Fatigue
Today there are potentially up to 40 unique alarm sounds that nurses have to distinguish
between (Kerr and Hayes, 1983; Borowski, Gorges, Fried, Such, Wrede, and Imhoff, 2011). The
result is massive sensory overload leading to overwhelming alarm fatigue. Alarm fatigue
happens when nurses become desensitized to the constant barrage of noise created by all of the
various alarms they encounter on a daily basis like ECG monitoring, infusion pumps, ventilators,
and bed alarms to name just a few. What’s worse is that the majority of these alarms are false
and do not require the nurse to intervene. In fact, research shows that anywhere from 85 to 99
percent of ECG monitor alarms are false or clinically insignificant (Walsh-Irwin & Jurgens,
2015).
Significance
The costs associated with ignoring or silencing alarms or even making adjustments
outside safe zones are increasing to dangerous levels. The Joint Commission reported in their
Sentinel Event database that out of 98 alarm events recorded between 2009 and 2012 that 80
resulted in death (Joint Commission, 2013). The Food and Drug Administration (FDA) reported
566 alarm-related patient deaths between 2005 and 2008 (Weil, 2009). As a result, effective
January 1, 2014 the Joint Commission issued a National Patient Safety Goal (NPSG) consisting
of two phases to tackle the issue of alarm safety. Phase I required that in 2014 hospitals must
identify which alarms are the most important in terms of needing review and management. By
January 1, 2016 policies and procedures for managing those alarms need to be in place. The
ultimate goal is that by 2017 no patient should be harmed by false alarms (Joint Commission,
2013).
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Problem Statement
The Medical Intermediate Care Unit (MIMCU) at the Penn State Milton S. Hershey
Medical Center is a 20-bed state-of-the-art multidisciplinary unit specializing in care of patients
who require an intermediate level of care. There are currently 48 licensed registered nurses
employed on the floor including a nurse manager and two clinical head nurses. The patient-tonurse ratio is 3:1.
Because of the urgency surrounding the issuance of the NPSG and the deadline of
January 1, 2016 for policies and procedures to be in place for alarm safety, the author was
approached by her preceptor and one of the clinical head nurses to gain more insight into the
problem and effects of alarm fatigue on this unit. Once the nature and extent of the problem was
identified the goal was to determine potential solutions to address the issue.
The author distributed a survey via Survey Monkey to each of the 48 nurses (see
Appendix A). Thirty responses were received representing a response rate of 62.5%. The first
question surveyed how disruptive false or nuisance alarms were to daily workflow with (1) being
not disruptive at all and (10) being constantly disruptive. The average of the responses was (8.1)
indicating that noncritical alarms cause a serious disruption in daily workflow. Additionally,
90% of respondents stated within the past year they witnessed a delay in response (from a nurse,
technician, or other staff) to an urgent situation due to alarm fatigue. Most concerning was that
almost half of respondents (46.7%) stated they witnessed patient harm as a result of alarm fatigue
within the last year. Recently a ventilated patient came off the ventilator and the alarm was
sounding for 7 minutes before action was taken. The patient was not harmed in this instance but
it served as a wake-up call for the entire unit and the impetus for this project.
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These results clearly indicate the need for educational intervention aimed at the problem
of alarm fatigue. The purpose of this capstone project is to create and promote an educational
event for the nurses of the MIMCU to include verbal detailing of findings at shift changes as
well as provision of supportive written materials in the form of a flyer and additional handouts.
In doing so, the author seeks to answer the question, “What is the impact of an educational
intervention on nurses’ knowledge of alarm fatigue?” The objective is that through this
educational intervention nurses will have a direct role in reducing alarm fatigue which will not
only benefit them, but will ultimately improve patient outcomes and ensure compliance with
Joint Commission safety goals.
Literature Review
A computerized search for literature was done by accessing the PubMed database using
an advanced search for journals published from 2010 to the present and incorporating the term
“alarm fatigue.” The search returned a total of 108 articles. Key articles of evidence were
selected and reviewed focusing on relevance to the topic of alarm management and interventions
to reduce alarm fatigue. Supporting evidence was also obtained from references cited within the
key articles.
ECG Electrode Management
Walsh-Irwin and Jurgens (2015) found that proper skin preparation and electrode
replacement significantly decreased alarms by 44%. Proper skin preparation included clipping
hair if needed, washing the skin with warm soap and water, and drying the skin with a washcloth.
Correct placement involved attaching the electrodes to leads and placing the electrodes correctly
on the body (see Appendix B) (Walsh-Irwin & Jurgens, 2015).
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It is also believed that conductivity is decreased when electrodes are left on too long
resulting in lost signals that contribute to unnecessary alarms. Dandoy et al. (2014) evaluated
replacing electrodes at daily bath time. The authors concluded that there was a 25% to 30%
increase in alarms with each added day that leads went unchanged (Dandoy et al., 2014). Cvach,
Biggs, Rothwell and Charles-Hudson (2013) also examined the effect of daily electrode change.
They were able to show a reduction of 46% in average alarms per bed per day on the two units
that were part of the project (Cvach, Biggs, Rothwell & Charles-Hudson, 2013).
Alarm Parameter Customization
In a study by Graham and Cvach (2010) nurses on a medical progressive care unit were
educated about customizing alarm parameters based on individual patient need. This was the
first test of change in a series of changes that were implemented. A survey before the education
determined that 83% of nurses changed alarm parameters when a patient’s vital signs changed
and 78% changed parameters at the beginning of their shift. After the educational intervention
improvements was seen as 94% of nurses changed alarm parameters both in response to changes
in vital signs and at the beginning of their shift (Graham & Cvach, 2010). It was concluded that
this educational intervention when combined with other alarm interventions contributed to an
overall 43% reduction in alarms (Graham & Cvach, 2010).
Dandoy et al. (2014) performed daily assessment of alarm parameters. Nurses were
required to fill out a cardiac monitor log, of which one component was alarm parameters. Each
day the charge nurses reviewed the log with the providers. Parameters were analyzed against
vital signs and actual need. Any excessive alarms that were deemed false were resolved using a
defined troubleshooting process (Dandoy et al., 2014).
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Adjustment of Default Threshold Settings
The literature suggests that adjustment of threshold settings reduces noncritical alarms.
In a study by Whalen and colleagues (2014) an overall 89% reduction in total mean weekly
audible alarms was achieved when the alarms for bradycardia, tachycardia, and HR limits were
changed to “crisis,” requiring nursing staff to view and act on the alarm each time it sounded.
The limits for HR were HR low of 45 bpm and HR high of 130 bpm. There were no adverse
events related to missed cardiac monitoring events, and the incidence of code blues was
decreased by 50% (Whalen, Covelle, Piepenbrink, Villanova, Cuneo, & Awtry, 2014).
Similarly, in a medical-surgical unit with telemetry monitoring, Gross, Dahl, and Nielsen
(2011) determined that changing the high heart rate alarm from 120 beats per minute (bpm) to
130 bpm resulted in a 50% decrease in the number of alarms. Changing the SpO(2) limit from
90% to 85% or 80% reduced the alarm load by 36% or 65%, respectively (Gross, Dahl, &
Nielsen, 2011). Welch (2011) also showed how pulse oximetry alarms contribute to nuisance
alarms. By decreasing the threshold on the SpO(2) from 90% to 88% overall alarms decreased
by 45% (Welch, 2011).
Graham and Cvach (2010) also changed monitor default settings. HR low setting was
changed from 60 to 50 and HR high was changed from 120 to 150. The HR high and low alarms
recorded as “warning” before the intervention and “message” after the intervention. Bradycardia
and tachycardia were recorded as “advisory” prior to the intervention and “warning” after the
intervention. Couplets were changed from “warning” to “message.” The limit on PVCs per
minute was increased to 10 from 6. Oxygen saturation was changed from 90% to 88% (Graham
& Cvach, 2010).
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Alarm Delay Customization
Gorges, Markewitz, and Westenskow (2009) found that two-thirds of noncritical alarms
could be avoided by introducing a 19-second delay and by automatically detecting suctioning,
repositioning, oral care, and washing that the number of ineffective and ignored alarms can be
reduced by 50% (Gorges, Markewitz, & Westnskow, 2009). Welch (2011) reported on the
impact of 5, 10, and 15-second delays on the number of alarms at a low SpO(2) threshold of
90%. An alarm delay of 5 seconds reduced nuisance alarms by 32% and a delay of 10 seconds
decreased alarms by 57%. An alarm delay of 15 seconds reduced alarm frequency by 70%.
Furthermore, Welch demonstrated that when both a 15-second delay and an alarm threshold of
88% were applied, a “six-fold reduction” was demonstrated in the number of SpO(2) alarms
(Welch, 2011).
Indications for Patient Monitoring
Funk et al. (2010) evaluated information from the PULSE (Practical Use of the Latest
Standards for Electrocardiography) trial and found that 85% of patients with no indication for
cardiac monitoring were being monitored anyway. All of this over-monitoring can lead to an
increase in false alarms if patients are left on monitors longer than needed or unnecessarily (Funk
et al., 2010). Dandoy et al. (2014) also addressed appropriate discontinuation of monitoring in
their study. Using the cardiac monitoring log that was discussed earlier, nurses and providers
collaborated on the need for monitoring and this information was then documented in the cardiac
monitor log. The log was reviewed daily by the team. Standardization of this process lead to a
high percentage of patients being discontinued appropriately. And interestingly, the increase in
the time spent completing the log was offset by time saved in not having to address frequent
alarms (Dandoy et al., 2014).
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Alarm System Education
As stated earlier, Graham and Cvach’s (2010) first test of change was the implementation
of a retraining program regarding best practices of alarm management. Nurses were educated on
the importance of customizing alarm parameters and how to troubleshoot common monitor
issues. After receiving education and retraining, nurses were more proactive in individualizing
alarm settings in the beginning instead of adjusting settings after-the-fact in response to repeated
activation of alarms (Graham & Cvach, 2010).
Gazarian, Carrier, Cohen, Schram, and Shiromani (2014) examined how nurses make
decisions with respect to ECG monitoring in their qualitative descriptive study. One of the
significant findings was that educational resources serve as a guide for nurses caring for patients
with ECG monitoring and that having educational posters regarding this topic on the unit are
helpful (Gazarian, Carrier, Cohen, Schram, & Shiromani, 2014).
Interdisciplinary Team Approach
Welsh (2011) described a case study at Dartmouth-Hitchckock Medical Center where a
cross-functional team including nurses, physicians, biomed and IT were able to reduce rapid
response activations and ICU transfers by 68% and 50%, respectively, by using a unique alarm
management protocol system where alarms were connected to the nurse via a dedicated pager.
The success of this study was due to collaboration between the clinicians determining alarm
policies and parameters and the biomed professionals supporting those decisions by providing
technological solutions (Welsh, 2011).
Graham and Cvach (2010) used a Comprehensive Unit-Based Safety Program (CUSP)
team to lead the small tests of change which were implemented on the medical progressive care
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unit. The team consisted of the nurse manager, the unit-based quality improvement and safety
representative, the safety executive, the medical director, and the safety coach. The CUSP team
oversaw the project and approved the changes to be tested with end results being a 43%
reduction in alarms (Graham & Cvach, 2010).
Dandoy et al.’s (2014) team-based approach established a multidisciplinary alarm
oversight task force consisting of key stakeholders including physicians, nurse practitioners,
nursing leadership, registered nurses, patient care assistants, clinical engineering, and patient
family representatives. The team reviewed the current cardiac monitor care practice, published
recommendations, identified gaps between practice and evidence, and identified areas of
improvement. The team then implemented a standardized cardiac monitor care process that
resulted in the median number of false alarms falling from 95% to 50% (Dandoy et al., 2014).
Gaps in Knowledge/Need for Further Research
The greatest limitation in the literature is that none of the interventions has been
rigorously tested with respect to patient outcomes. The safety of some of the interventions such
as adjustment of threshold settings is therefore questionable. Many of the studies were
conducted at single sites resulting in potential bias, and there are no definitive studies on the
proper settings for alarm default parameter thresholds (Cvach, 2012). Research is needed on the
best way to set monitor limits and there is a gap in knowledge on the risk/benefit of alarm
standardization across like medical devices (Cvach, 2012).
Dandoy et al. (2015) reported the limitation that because implementation of bundled
interventions occurred at nearly the same time it was difficult to know exactly what intervention
made the largest change. Whalen et al. (2014) stated they performed their study of default
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settings using equipment from a single manufacturer and the ability to modify default settings
with the equipment of other manufacturers was not evaluated and may impact the alarm
parameter changes that can be made. Gazarian and colleagues’ (2014) and Funk et al.’s (2010)
studies were limited by the Hawthorne effect because nurses paid more attention to monitoring
because they knew they were being observed.
Implications for Practice
The implications for nursing practice include proper skin preparation and replacement of
ECG leads and electrodes daily as well as adjustment of alarms to patients’ actual needs. Nurses
should be involved in a collaborative effort on when monitoring is appropriately indicated as
well as appropriately discontinued. They should be included as part of an interdisciplinary alarm
management committee that conducts an alarm risk assessment and explores strategies for alarm
reduction as well as the development of monitor policy and protocols (Cvach, 2012). Finally, all
nurses with patients on cardiac monitoring should have initial and ongoing training on monitor
devices.
Action Plan
The initial action plan for this project involved the development of a unit-based quality
improvement project to determine if educational interventions combined with small tests of
change would reduce total daily alarms on the MIMCU. As the project progressed,
technological and time constraint barriers prevented an intervention aimed at a specific reduction
in alarm count over a period of time. The focus of the project turned to an educational
intervention targeted at reducing alarm fatigue. The following is a timeline of events detailing
each step of the overall process:
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10/7/15 – The author was approached by a Clinical Head nurse at a Unit Council
meeting to consider alarm fatigue as the subject for the capstone project. Urgency
surrounding this topic stems from recent issues on the unit where serious alarms were
missed as well as the looming JCAHO NPSG deadline of 1/1/16 to have policies and
procedures in place for alarm management.
10/14/15 – The author presented a sample educational assessment survey to the Nurse
Manager for feedback on relevance and appropriateness of questions. The Nurse
Manager’s approval was solicited for distribution of the survey via email to nursing staff
to ensure the best response rate.
10/17/15 – The author created a survey through SurveyMonkey and emailed it to the
Nurse Manager who then forwarded the survey to the 48 registered nurses on staff of the
unit. The survey was closed to responses on 10/31/15 (see Appendix B for survey
questions and results). Thirty total responses were received for a response rate of 62.5%.
Based upon responses educational interventions were targeted at the definition and scope
of alarm fatigue at all levels of the organization (individual, unit, and hospital) as well as
at the national level. Additional education would be aimed at recommended nursing
practice and actions to reduce alarm fatigue.
10/21/15 – The author consulted with the Nurse Manager on current best evidence
regarding alarm management based on a review of literature. Recommendations included
a combination of educational interventions, adjustment of alarm default settings, and
implementation of alarm delays. In collaboration with the Nurse Manager the author
developed a plan to obtain a count of alarm data over a specified period, implement the
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above interventions and obtain post-intervention alarm data to determine if the
combined interventions were successful.
10/22/15 – The Nurse Manager emailed the Biomedical Engineering technician to
determine the capability of extracting the number of alarms from the central monitor
station over a 24-hour period of time.
10/23/15 – The Nurse Manager received an email response to the above question from
the Biomedical Engineering technician stating, “Drager does not have the reporting
feature needed to count any specific alarms or range of alarms. However, it is possible
to go in and select each bed and manually go through the Full Disclosure and Event
Disclosure for the information you’re looking for. In Full Disclosure, there is a Reports
tab. It has strip, hour, 24-hour and some other reports options that may be helpful.”
10/25/15 – 11/12/15 – The project was placed on temporary hold due to an unforeseeable
emergency in the author’s family.
11/13/15 – The author emailed the Nurse Manager to obtain a manual count of alarms.
11/17/15 – A manual count of alarms by bed for the 24-hour period from 0800 on
11/16/15 to 0800 on 11/17/15 was performed by the Nurse Manager (see Appendix C).
A significant barrier to obtaining accurate alarm data was that there is no current option
for selecting the time frame. Although the number of alarms by bed could be determined
over certain periods of time, the time periods could not be standardized. Upon analysis
the time periods ranged anywhere from 4 hours to 18 hours with number of alarms per
patient ranging from 2 to >1000. The results, therefore, are possibly so inaccurate as to
be misleading. Further attempts to obtain more accurate data from Biomedical
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Engineering as well as inquiry into implementing alarm delays were met with the
responses, “it can’t be done” or “it requires middleware that we haven’t purchased.”
A decision was made at this time to focus the remainder of this capstone project solely at
the impact of educational interventions at reducing alarm fatigue.
11/18/15 – The author presented an educational intervention utilizing a “Dine and Dash”
approach by detailing nursing staff at day and night shift huddles and as they took
breaks at the nursing station for coffee and donuts provided by the author. An
educational flyer (see Appendix D) was placed next to the coffee and donuts as well as a
copy of the correct anatomical placement of ECG electrodes on the body (Appendix A)
and the current monitor policy (Appendix E). Nurses were educated on the scope and
impact of alarm fatigue nationally and on the unit based on survey results. They were
also instructed on how to access alarm limits by individual patient to customize
parameters based on need (from the central monitor choose “Setup,” and then “Alarm
Limits”). They were also educated on how to obtain a copy of the current monitor
policy via the Infonet (choose “Policies,” then “Nursing,” then “Alarm DefaultsStandardization”). This policy, effective June 2015, describes alarm limits in place for
medical critical care and current procedure for alarm management.
The same information was also posted in the break room with an accompanying signature
page for nurses to initial that they have received education regarding alarm fatigue and
are committed to implementing recommended nursing actions aimed at improving patient
outcomes based on better-quality alarm management. Three days post intervention 25 of
48 signatures were verified. This suggests that the educational impact of this intervention
reached 52% of its targeted audience.
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Summary
This capstone project was a collaboration between the author, her preceptor, the Clinical
Head nurses, the Nurse Manager, and the Biomedical Engineering technician. The project was
aimed at assessing the knowledge of MIMCU nurses regarding the scope and impact of alarm
fatigue, identifying knowledge and practice deficits, and implementing an educational
intervention to address the issue by providing methods of alarm management that seek to reduce
noncritical alarms to decrease alarm fatigue and improve patient outcomes.
Even without a current reliable method of counting total alarms experienced on the
MIMCU in a given 24-hour period, manual counts estimate the average alarm burden to be in the
hundreds per bed per day, with some beds experiencing over 1000 alarms in a given day. This
roughly translates into greater than 4000 alarm signals throughout the unit per day. With 8599% of these alarms not requiring clinical intervention, nurses on the MIMCU have become
increasingly desensitized and overwhelmed by the sheer number of alarms. This can lead to
serious or fatal consequences for patients. In fact, 90% of MIMCU nurses have witnessed a
delay in response to an urgent situation due to alarm fatigue and almost half (47%) have
witnessed patient harm in the past year as a result of alarm fatigue.
In an effort to direct attention to the critical issue of alarm fatigue on the MIMCU, the
author presented an educational intervention focused on the nature and scope of the problem in
general and on the unit, and on recommendations for expected practice and nursing actions.
Both verbal and nonverbal communication methods were used in the intervention. During both
day and night shift huddles the author discussed the results of the survey and educated on
specific practice points that nurses can employ to reduce alarm noise. These suggestions
included providing proper skin preparation for ECG electrodes and daily electrode replacement;
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customization of alarm parameters based on patient need; implementing alarm delays; and
monitoring only those patients with clinical indications for monitoring. The author also provided
handouts in support of these practices including a diagram of proper electrode placement on the
body, a copy of the current alarm monitor policy and how to access it on the organization’s
Infonet, and instructions on how to customize alarm parameters on the central monitoring system
according to patient need. Implementing alarm delays and adjustments to default settings were
recommended to the Nurse Manager, and interdisciplinary discussions with Biomedical
Engineering will be ongoing regarding the potential to investigate these options further.
Ongoing education regarding the Drager central monitoring system and practice points was also
recommended to the Nurse Manager.
Lastly, as a follow-up to this educational intervention, nurses were asked to initial that
they received education regarding alarm fatigue and are committed to expected nursing practice
and actions based on current alarm policy and procedures. The author verified 25 of 48
signatures for an educational impact of 52%. This suggests that ongoing education is needed to
reach a larger percentage of the target audience.
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Appendix A
Correct Electrode Placement
Proper Skin Preparation and Electrode Placement Decreases Alarms on a Telemetry Unit.
Walsh-Irwin, Colleen; DNP, RN; ANP, CCRN; Jurgens, Corrine; PhD, RN; ANP-BC, FAHA
Dimensions of Critical Care Nursing. 34(3):134-139, May/June 2015.
DOI: 10.1097/DCC.0000000000000108
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Appendix B
Nursing Alarm Fatigue Survey
Survey of 48 registered nurses on the Medical Intermediate Care Unit. Responses received from
30 recipients for a response rate of 62.5%
1. How disruptive are false or nuisance alarms clinical alarms to your daily workflow? (1 =
not disruptive at all. 10 = constantly disruptive). Average 8.1
2. Of all the clinical alarms you encounter, estimate the percent that are false or irrelevant
(the patient does not require clinical intervention). Average 65.2%
3. In the past year, have you witnessed a delay in response (from a nurse, technician, or
other staff) to an urgent situation due to alarm fatigue? Yes – 90%; No – 10%
Three comments to this question:
1) Throughout evening O2 was not tracking properly and changed several times; on last
occurrence alarm was giving similar alert, but this time the patient pulled off the
probe as well as his nasal cannula, so it was an emergent situation due to history of
quickly desaturating.
2) There are many times in which serious alarms (spO2<79, Vtach/vfib/asystole) are
ringing-fortunately they are false, but many people don’t respond timely.
3) Red alarms are continuously getting ignored.
4. In the past year, have you witnessed patient harm as a result of alarm fatigue? Yes –
46.7%, No – 53.3%
Two comments to this question:
1) Yes, please refer to previous comment in regards to patient removing O2 and delay in
response time, due to previous recurrent false alarms.
2) Example: trach/vented pt’s ventilator became disconnected and there were several
minutes in which nobody responded.
5. On average, how often do you apply new telemetry ECG electrodes on your patients?
Daily – 70%; Every two days – 6.7%; Every three days – 0%; Only when they wear
out – 13.3%; Other (please specify) – 10%
Three comments to specify “other” response:
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Appendix B
(continued)
1) Depends on each patient, sometimes it can occur multiple times during a 12hr shift.
2) With baths.
3) At least daily, mostly with a bath. Do also change when loose.
6. On average, how often do you change the continuous pulse-oximeter sensor on your
patients? Daily – 46.7%; Every two days – 13.3%; Every three days – 0%; Only
when it wears out – 26.7%; Other (please specify) – 13.3%
Four comments to specify “other” response:
1) Also depends on the particular patient, and their skin condition, usually I change them
when they become an issue or have started to perform improperly.
2) I think night shift replaces the stickers and finger probes.
3) At least daily, sometimes more.
4) At least daily, sometimes a few times a day if it is warranted.
7. When you think a patient no longer needs continuous monitoring, how likely are you to
ask the physician about discontinuing the monitoring? Very likely – 43.4%; Somewhat
likely – 23.3%; Somewhat unlikely – 20%; Very unlikely – 13.3%
8. Your patient is triggering the same ECG or pulse-ox alarm every 5 to 10 minutes. How
likely are you to assess electrodes/sensors and change them if necessary? Very likely –
90%; Somewhat likely – 10%; Somewhat unlikely – 0%; Very unlikely – 0%
9. Your patient is triggering the same ECG or pulse-ox alarm every 5 to 10 minutes but the
electrodes and sensors are detecting a good signal (the alarms are accurate and are not
false alarms). This is being caused by a known medical issue that you are
communicating about with the physician. How likely are you to change the alarm limits
to decrease the alarms while you also address the patient’s nursing and medical needs?
Very likely – 30%; Somewhat likely – 46.7%; Somewhat unlikely – 20%; Very
unlikely – 3.3%
10. You notice another nurse’s patient having an excessive number of alarms and the
situation is causing nurses to ignore the alarms on your unit. How likely are you to
address the problem with the nurse and/or offer to help remedy the situation? Very
likely – 40%; Somewhat unlikely – 53.3%; Somewhat unlikely – 6.7%; Very
unlikely – 0%
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Appendix C
MIMCU Alarm Data
8:00 AM 11/16/15 to 8:00 AM 11/17/15
Room Number
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
Total Alarms: 4422
Average Alarms Per Bed: 260
Median Number of Alarms: 210
Total Alarms
1000
1000
Unoccupied
19
227
210
96
232
2
3
36
489
222
188
312
120
Unoccupied
45
221
Unoccupied
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Appendix D
Educational Flyer
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Appendix E
MIMCU Alarm Monitor Policy
ALARM DEFAULTS, STANDARDIZATION OF
Clinical Practice Manual, Nursing - Hershey Medical Center Policy Number: A-4CPMN
Replaced: August, 2014
Effective: June, 2015
Authorized:
Sherry Kwater, MSM, BSN
Interim Chief Nursing Officer
Approved:
Anna Biser, RN, CCRN
Practice Council Chair 2015
KEYWORDS
Alarm limits, standard defaults, monitor defaults
PURPOSE
Appropriate alarm limit defaults promote safe patient care, avoid duplicative alarms, and
potentially avoid non-actionable alarms which may contribute to alarm fatigue.
POLICY
1. Units will specify standard defaults for alarm parameters for both hardwire and telemetry
monitoring.
a. In clinical areas with both hardwire and telemetry monitoring, the alarm defaults
will be the same for both.
2. Alarm parameters should be adjusted based on specific clinical needs of each patient.
3. Alarm limits will be verified and charted for each patient at the beginning of the shift.
4. Alarm limits will be verified with re-docking.
5. ECG electrodes will be changed daily and prn.
6. See Attached Appendix A for standard alarm areas.
7. See Attached Appendix B for alarm default settings for standard areas.
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Appendix E
(continued)
Medical Critical Care Alarm Limits
ALARM
HR
PVC/MIN
NBP S
NBP D
RESP
ART M
GP1 S
GP1 D
PA S
PA D
CVP
etCO2
SpO2
BT
RRc
ALARM LIMITS
ALARM UPPER LOWER
ON
120
45
ON
15
ON
180
80
ON
95
40
ON
30
5
ON
100
60
ON
160
80
ON
95
40
ON
50
10
ON
20
2
ON
20
2
ON
50
30
ON
100
89
ON
39
34
ON
ALARM
ARCHIVE
STORE
STORE
STORE
STORE
STORE
STORE
STORE
STORE
STORE
STORE
STORE
STORE
STORE
STORE
ASY
VF
VT
RUN
SVT
TACH
BRDY
PAUS
ARRYTHMIA SETUP
ALARM RATE COUNT ARCHIVE
L-T
STR/REC
L-T
STR/REC
L-T
STR/REC
SER
>=110 >=6
STR/REC
SER
>=140 >=8
STR/REC
ON
>=130 >=8
STORE
ADV
<=40
>=8
STORE
SER
2.5s
STR/REC
Telemetry Alarm Limits
Alarm
HR
SpO2
ALARM
ASY
VF
VT
RUN
AIVR
SVT
CPT
BGM
BRDY
PAUS
Alarm
ON
ON
Alarm Limits
Upper Lower
120
45
100
89
Archive
STR/REC
STORE
ARRHYTHMIA SETUP
ALARM RATE COUNT ARCHIVE
L-T
STR/REC
L-T
STR/REC
L-T
>=150 >=6
STR/REC
SER
>=150 >=6
STORE
OFF
<=149 >=3
STORE
SER
>=140 >=8
STORE
ADV
STORE
ADV
STORE
ADV
<=40
>=8
STORE
SER
2.5s
STR/REC
ALARM FATIGUE MANAGEMENT
24
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