Safety Innovations Series: Clinical Alarm Management

Fighting Alarm Fatigue with Data-Driven Interventions—The NCH Healthcare Device Eco-System Experience
NCH Healthcare System
At NCH Healthcare System, several initiatives designed to enhance patient monitoring and improve alarm safety were underway prior to The Joint Commission issuing its alarm goal. The health system has been actively operating in an environment of technological innovation that focuses on patient and clinician needs.

Clinical Practice Changes Associated with Alarm Standardization
Boston Medical Center
BMC’s alarm journey began in 2008 with the standardization of all cardiac monitoring equipment across the medical center. In 2011, with increasing focus nationally on alarm fatigue and the report of sentinel events from missed alarms, BMC reconvened its multidisciplinary task force to look at opportunities to decrease the volume of audible alarms particularly on its medical surgical units.

Healthcare Alarm Safety—What We Can Learn from Military Alarm Management Strategies
Lockheed Martin (LM) Advanced Technology Laboratories
Daniel McFarlane, ScD of LM Advanced Technology Laboratories, provides insight on ways to enhance hospital alarm management, reflecting upon innovative alerting systems utilized by the Navy to improve warfighter awareness and capabilities.

Simple Solutions for Improving Patient Safety In Cardiac Monitoring—Eight Critical Elements to Monitor Alarm Competency
University of Pittsburgh Medical Center (UPMC); Presbyterian Hospital
UPMC realized that improving the utilization and management of non–life-threatening arrhythmia alarm conditions could reduce alarm fatigue and preserve patient safety. UPMC Presbyterian launched pilot projects that would result in decreasing alarm ring time, improving staff response to cardiac monitor alarm signals, and decreasing alarm noise within hospital units that contain a high volume of monitoring equipment.

Safeguarding Patients with Surveillance Monitoring
The Dartmouth-Hitchcock Medical Center
A series of adverse events led clinicians and researchers at Dartmouth-Hitchcock Medical Center to a humbling conclusion: Healthcare professionals were handicapped by their limited ability to detect signs of patient deterioration and to predict which patients were at risk for adverse events in the first place. Dartmouth-Hitchcock responded with stopgap measures to safeguard patients, including double checks of opioid administration, smart patient-controlled analgesia (PCA) pumps, and rapid response teams.

Cardiopulmonary Monitors and Clinically Significant Events in Critically Ill Children
Children's National Medical Center
A team of nurses, biomedical engineers, physicians, and biostatisticians were assembled to assess the conditions associated with the generation of cardiopulmonary monitors (CPMs), including false positive alarms signals in critically ill children, and to define alternative alarm parameters that would improve CPM alarm performance.

Plan, Do, Check, Act: Using Action Research to Manage Alarm Systems, Signals, and Responses
The Beth Israel Deaconess Medical Center
In the aftermath of two sentinel events in inpatient rooms at the Beth Israel Deaconess Medical Center in Boston, MA, the hospital’s leadership and its physician, nursing, and clinical engineering staff focused comprehensively on alarmed medical devices.

Recommendations for Alarm Signal Standardization and More Innovation
The Christiana Care Health System
Christiana Care developed a system-wide alarm policy and protocols that defined its alarm management strategy for alarmed medical equipment, including flex monitors, standard cardiac monitors, pulse oximeters, and infusion pumps.

Using Data to Drive Alarm System Improvement Efforts: The Johns Hopkins Hospital Experience
The Johns Hopkins Hospital
The key to reducing alarm signal noise is the collection and analysis of quantitative data to evaluate the applications of alarm system management in hospitals.