Title : Decreasing the Incidence of Non-Actionable ECG Monitor Alarms
Problem: Excessive non-actionable ECG monitor alarm alerts lead nurses to become desensitized or alarm fatigued, causing caregivers to be less responsive for alarms that need immediate attention. Studies show that 80-99% of the alarms are non-actionable or clinically insignificant, which can cause a decrease in nurse’s response known as a “cry wolf” effect. The aim is to decrease the number of non-actionable alarms to heighten the nurse’s awareness to respond to actionable bedside alarms as well as enhance patient safety. This quality improvement project will address the following PICOT question: For the nursing staff on the Cardio-vascular Intensive Care Unit (CVICU), will implementing the bundled approach alarm management protocol decrease the incidence of non-actionable ECG central monitor alarms in 8-10 weeks?
Methods: A 20-30 minute interactive rapid improvement workshop was provided to the CVICU nurses (n=26) regarding the following bundled evidence-based protocols: 1) Customizing alarms; 2) Assessing ECG tracing size and rhythm; 3) Assuring proper placement of ECG electrodes; 4) Verifying that ECG electrodes are timed, dated, and initialed; and 5) Changing ECG electrodes daily. Post workshop, accountability audits were provided to assist CVICU nurses which enhanced the sustainability of the practice protocols. For measurement, the total number of alarms were counted for two weeks pre-education workshop and for two weeks post-intervention. The General Electric Healthcare (GEH) alarm reporting tool (ART) was utilized on the CVICU’s Solar 8000iV4 central monitors to collect the alarm count data.
Results: The median number of ECG alarm alerts per patient, per day, prior to the intervention was 594.95 compared to the post-intervention of 177.63 alarm alerts or a 70.1% reduction. When comparing pre- and post-intervention number of alerts, the Wilcoxon sum rank method was utilized to find a p value of < 0.001 or highly significant. The bundled approach to managing alarms decreased the mean number of alarm alerts.
Nursing Implications: Decreasing the number of alarms can improve patient safety, patient satisfaction, nursing satisfaction, and cost effectiveness for the organization as well as satisfy The Joint Commission’s requirements.
Opportunities/Considerations: The following is a list of opportunities that can be explored to further reduce the amount of non-actionable alarms: Consider alarm management training at orientation and required annually; Collaborate with biomedical engineering and General Electric to assure default alarms are standardized; Initiate periodic audits (peer-audits) to assure alarm management is being practiced properly, and; Continue to maintain a culture of safety with staff involvement with addressing quality concerns.