Sound the alarm: a multidisciplinary approach to reducing alarm burden in a pediatric icu

Introduction: The impact of alarm burden on outcomes was highlighted in the 2013 Joint Commission Sentinel Event Alert Issue: “Medical Device Alarm Safety in Hospitals.” In March 2021, the Patient Monitoring Taskforce (PMT) was created with the goal of reducing non-actionable alarms by 10% over 1 year. Methods: The PMT is a multidisciplinary taskforce leveraging QI and Human Factors methodology to re-design enterprise approach to alarm management. The PMT partnered with an internal research learning lab to: 1. perform a systematic review; 2: analyze pre-intervention data to define sources of non-actionable alarms and model impact of potential changes; and 3: perform a pre- and post-intervention survey of nurse experience of alarm notification. In October 2021, standardized alarm defaults with widened alarm limits and delays were piloted in a 24-bed cohort in the PICU. Results: Following intervention, a 66% reduction in alarm notifications was seen. The top 3 alarm categories had large reductions in alarms: O2 saturation (38.2 to 17.9 alarms/bed/24 hours, 53% reduction); apnea and respiratory rate (20.1 to 4.3 alarms/bed/24 hours, 79%); and tachycardia (21.3 to 4.1 alarms/bed/24 hours, 81%). There was no decrease in critical alarm notifications (ie, asystole, vtach) and no significant patient safety events. The changes were then implemented across all 74 PICU beds. A pre-implementation survey (63 respondents; 27% response rate) and post intervention survey (46 respondents; 16% response rate) were performed. For the question “In the past month, I experienced non-actionable alarms while delivering patient care,” there was a 7% reduction in nurses who answered “Always (every shift)/Often” (55/63 to 37/46). Specifically related to secondary notifications, “In the past month, I felt overwhelmed with the number of alarm messages received on my phone” the percentage of nurses who answered “Always (every shift)/Often” reduced by 32% (42/63 to 16/46). Conclusions: Leveraging an evidence-based approach based on best practice standards, internal alarm data, and simulation, the intervention resulted in reduction in non-actionable alarm notifications and improved RN experience of alarms. After the success of these interventions in the PICU, the changes were rolled out enterprise-wide.