Education Program for Nurses Helps Reduce Nuisance Alarms

Posted February 21, 2017

Over a four-month period in 2014, nurses at Palomar Health in California were faced with more than 43,000 infusion pump alarms. Based on previous research conducted primarily with physiologic monitors, 85–99% of alerts do not require any type of clinical intervention, but they do contribute to a leading patient safety hazard in hospitals—alarm fatigue.

“Clinical devices cause hundreds of alarms per patient per day, creating an environment that can overwhelm, distract, and desensitize health workers,” said Diana Schultz, Palomar’s manager of medication safety, during an infusion safety seminar presented by the AAMI Foundation and the National Association of Clinical Nurse Specialists. "Caregivers with alarm fatigue are more likely to ignore or have trouble prioritizing and managing various alarms, which can lead to delayed treatment and patient harm.”

To help its nurses better understand why so-called nuisance alarms were occurring and learn how to manage them, a team that included Schultz; Carol Suarez, a clinical nurse specialist at Palomar Health; and LaQuoia Johnson, a pharmacy supervisor who now works at Novant Health, piloted a standardized education plan that targeted the health system’s main types of infusion pump alarms—patient-side occlusion and air in the infusion line.

During an all-day training session, 1,200 nurses learned about IV site placement and pressure sensors, among other topics, to help reduce patient-side occlusion alarms. They also received instruction on line priming and how to use an anti-siphon valve when administering highly gaseous medications.

This “back to basics” training helped nurses feel more in control of infusion pump alarms, according to Schultz. “When nurses understand why alarms are occurring, they can react and resolve them more quickly, and they can alleviate patient anxiety when they do occur,” she said. “All of this has led to increased patient safety and reduced the risk of nuisance alarms at Palomar Health.”

In fact, alarms decreased by nearly 30%, from 10,570 total infusion alarms in April 2014 to 7,564 in April 2015.

Since concluding the pilot, Palomar has continued to provide ongoing training related to infusion pump alarms during nursing orientation sessions and through targeted re-education programs in order to help maintain these improvements. “We continue to sustain our gains,” Schultz said. “This study has been invaluable for Palomar Health and to the understanding of alarms with infusion pumps and our ability to manage them.”

The next seminar in this series will be held March 6 and will focus on integrating smart pumps with electronic health records. Recordings from previous seminars are available for free on the AAMI Foundation’s website.