Mitigating Alarm Fatigue and Improving the Bedside Experience by Reducing Nonactionable Alarms

Abstract

Objective: To assess whether conditional bedside alarm triggers can reduce the frequency of nonactionable alarms without compromising patient safety and enhance nursing and family satisfaction.

Study design: Single-center, quality improvement initiative in an acute care cardiac unit and pediatric intensive care unit. Following the 4-week preintervention baseline period, bedside monitors were programmed with hierarchical time delay and conditional alarm triggers. Bedside alarms were tallied for 4 weeks each in the immediate postintervention period and 2-year follow-up. The primary outcome was alarms per monitored patient day. Nurses and families were surveyed preintervention and postintervention.

Results: A total of 1509 patients contributed to 2034, 1968, and 2043 monitored patient days which were evaluated in the baseline, follow-up, and 2-year follow-up periods, respectively. The median number of alarms per monitored patient day decreased by 75% in the pediatric intensive care unit (P < .001) and 82% in the acute care cardiac unit (P < .001) with sustained effect at the 2-year follow-up. No increase of rapid response calls, emergent transfers, or code events occurred in either unit. Nursing surveys reported an improved capacity to respond to alarms and fewer perceived nonactionable alarms. Family surveys, however, did not demonstrate improved sleep quality.

Conclusions: Implemented changes to bedside monitor alarms decreased total alarm frequency in both the acute care cardiac unit and pediatric intensive care unit, improving the care provider experience without compromising safety.

Keywords: alarm fatigue; conditional alarm triggers; healthcare quality improvement; pediatric cardiology; pediatric critical care.