AACN Roadmap for Implementing Change: Alarm Fatigue
Change is a fact of life, and that can be a good thing. Taking something we’ve learned—such as new evidence-based care practices—and introducing
it in our workplace to enhance patient care and to improve outcomes is a change for the better. However, change is often a difficult process. The
AACN Roadmap for Implementing Change is a tool intended to assist you in sharing and implementing new learning and practices in your unit and
hospital. This Roadmap serves as a guide to assess your unit’s level of readiness for change and to identify strategies for implementation. It is best
used once you and your team have determined a specific practice or area to change.
Action Steps
Supporting Resources
Key Stakeholders
Unit and Staff Assessment
 Change Readiness Assessment
Assess your unit’s structure and readiness to
support change.
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Schedule a meeting of key stakeholders.
Discuss the reason for the assessment.
Distribute the Assessment tool—set a
completion date for one week.
Schedule a follow-up meeting to discuss
the results and to determine the level of
engagement.
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 Administrative sponsor(s) (e.g., Chief
Nursing Officer, Director of Nursing,
Vice President of Quality)
 Key medical staff member(s) (e.g., Unit
Medical Director, Lead Intensivist)
 Patient Safety Officer/Risk Manager
 Nurse Manager
 Clinical Nurse Specialist
 Nurse Educator
 Direct care frontline staff nurses
 Monitor/telemetry technicians
 Clinical (biomedical) engineering staff
member(s)
 Information technology staff member(s)
 Others as identified or needed
Action Steps
Supporting Resources
Assess current knowledge of alarm fatigue and
alarm safety.
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Schedule a meeting of identified
stakeholders (3 or 4).
Discuss the reason for completing the Gap
Analysis (e.g., What is the problem we are
trying to solve?).
Distribute the Analysis tool—set the
completion date for one week.
Schedule a follow-up meeting to discuss
results, determine practice gaps, and
identify the high-priority needs.
Discuss the journal article on alarm fatigue
from AJCC.
Evaluate results of assessments.
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Formulate the team.
Gather all assessments, and determine
change readiness and areas targeted for
change.
Identify change strategies based on the
assessments.
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Unit Gap Analysis
Survey Monkey survey
Informal discussion
Performance improvement (PI) data
Discuss at journal club:
Graham K, Cvach M. Monitor alarm
fatigue: standardizing use of
physiological monitors and
decreasing nuisance alarms.
Am J Crit Care 2010; 19(1):28-34;
quiz 35. Doi:10.4037/ajcc2010651
 Discussion at unit council meeting
 Discussion with unit leadership (Nurse
Manager, Clinical Nurse Specialist,
Physician Director)
 Engaging PI or Quality, Risk, and Clinical
Engineering departments
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Key Stakeholders
 Administrative sponsor(s) (e.g., Chief
Nursing Officer, Director of Nursing,
Vice President of Quality)
 Key medical staff member(s) (e.g., Unit
Medical Director, Lead Intensivist)
 Patient Safety Officer/Risk Manager
 Nurse Manager
 Clinical Nurse Specialist
 Nurse Educator
 Direct care frontline staff nurses
 Monitor/telemetry technicians
 Clinical (biomedical) engineering staff
member(s)
 Information technology staff member(s)
 Others as identified or needed
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Direct care frontline staff nurses
Nurse Manager
Clinical Nurse Specialist
Nurse Practitioner(s)
Quality improvement teams
Risk management staff member(s)
Clinical (biomedical) engineering staff
member(s)
 Physician(s)
 Other members of the multidisciplinary
team (as determined by the change
initiative)
Action Steps
Supporting Resources
Key Stakeholders
Determine Change Strategies
Readiness Level: Low
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Raise awareness, advocacy.
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Readiness Level: Medium
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Provide education.
Information sharing
Email blast (see sample)
Posting flyers
Journal club article and discussion
questions (see sample)
Huddle (see sample script)
Newsletter write-up (see sample)
AACN Practice Alert™
Telling peers
 All “Low” level resources
 PowerPoint teaching presentation (see
sample)
 “Lunch & Learn”
 Staff meeting
 Poster presentation
 Competency Day
 Compliance audit
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Copyright © 2013 American Association of Critical-Care Nurses
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Direct care frontline staff nurses
Clinical Nurse Specialist
Nurse Educator
Physician(s)
Nurse Manager
Clinical (biomedical) engineering staff
member(s)
 Risk management staff members
 Quality improvement teams
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Nurse Educator
Advanced Practice Nurse(s)
Nurse Manager
Direct care frontline staff nurses
Physician(s)
Clinical (biomedical) engineering staff
member(s)
Action Steps
Supporting Resources
 All “Low” and “Medium” level resources
 Forming or participating on a
committee
 Evidence-based project initiation
 Identification of a leadership champion
 Interprofessional taskforce
 Sample Improvement Plan: Alarm Safety
Readiness Level: High
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Implement the change initiative.
Key Stakeholders
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Administrative sponsor(s)
Key medical staff member(s)
Patient Safety Officer/Risk Manager
Nurse Manager
Clinical Nurse Specialist
Nurse Educator
Direct care frontline staff nurses
Monitor/telemetry technicians
Clinical (biomedical) engineering staff
member(s)
 Information technology staff member(s)
Measure Success
Evaluate efforts: Awareness and advocacy level.
 Monitoring dialogue
 Discussion at a future staff meeting or
huddle
 Unit Quality Improvement Team
 Direct care frontline staff nurses
Evaluate efforts: Education level.
 Knowledge checks
 Competency validation
 Assessment of the use of audit tools
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Unit Quality Improvement Team
Nurse Manager
Clinical Nurse Specialist
Nurse Educator
Action Steps
Supporting Resources
Key Stakeholders
Evaluate efforts: Implementing change level.
 Compliance audits
 Quality indicators (i.e., patient
outcomes)
 Satisfaction: staff, patient, team
 Length of stay
 Cost
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Evaluate efforts: Sustained change over time.
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Regular monitoring of outcomes
Reporting outcomes to unit leadership
Continually auditing for compliance
Re-educating, as needed
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Administrative sponsor(s)
Key medical staff member(s)
Patient Safety Officer/Risk Manager
Nurse Manager
Clinical Nurse Specialist
Nurse Educator
Direct care frontline staff nurses
Monitor/telemetry technicians
Clinical (biomedical) engineering staff
member(s)
 Information technology staff member(s)
Administrative sponsor(s)
Key medical staff member(s)
Patient Safety Officer/Risk Manager
Nurse Manager
Clinical Nurse Specialist
Nurse Educator
Direct care frontline staff nurses
Monitor/telemetry technicians
Clinical (biomedical) engineering staff
member(s)
 Information technology staff member(s)
Action Steps
Supporting Resources
Key Stakeholders
Disseminate Findings
Share learning.
 Discussion at organizational acute and
critical care team meetings
 Sharing with other units and/or
organizational practice councils
 Hospital newsletter
 Poster presentation or educational
session at local or national professional
meetings
 Submission of findings for publication
 Sharing with others on the NTI
Network’s NTI ActionPak discussion
group
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Administrative sponsor(s)
Key medical staff member(s)
Patient Safety Officer/Risk Manager
Nurse Manager
Clinical Nurse Specialist
Nurse Educator
Direct care frontline staff nurses
Monitor/telemetry technicians
Clinical (biomedical) engineering staff
member(s)
Information technology staff member(s)
Celebrate Success
Determine meaningful recognition.
 Scaling the recognition for the level of
success
 Evaluating recognition mechanisms
 Involving staff in selecting recognition
methods
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Copyright © 2013 American Association of Critical-Care Nurses
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Administrative sponsor(s)
Key medical staff member(s)
Patient Safety Officer/Risk Manager
Nurse Manager
Clinical Nurse Specialist
Nurse Educator
Direct care frontline staff nurses
Monitor/telemetry technicians
Clinical (biomedical) engineering staff
member(s)
 Information technology staff member(s)
Action Steps
Tell AACN your story.
Supporting Resources
 Submitting a poster or abstract for
presentation at NTI
 Submitting a manuscript for publication
to Critical Care Nurse or AJCC
 Sending an email to practice@aacn.org
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Key Stakeholders
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Administrative sponsor(s)
Key medical staff member(s)
Patient Safety Officer/Risk Manager
Nurse Manager
Clinical Nurse Specialist
Nurse Educator
Direct care frontline staff nurses
Monitor/telemetry technicians
Clinical (biomedical) engineering staff
member(s)
 Information technology staff member(s)