Time series evaluation of improvement interventions to reduce alarm notifications in a paediatric hospital

Colleen M. Pater, Tina K. Sosa, Jacquelyn Boyer, Rhonda Cable, Melinda Egan, Timothy K. Knilans, Amanda C. Schondelmeyer, Christine L. Schuler, Nicolas L. Madsen

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background10 The Joint Commission identified inpatient alarm reduction as an opportunity to improve patient safety; enhance patient, family and nursing satisfaction; and optimise workflow. We used quality improvement (QI) methods to safely decrease non-actionable alarm notifications to bedside providers. Methods In a paediatric tertiary care centre, we convened a multidisciplinary team to address alarm notifications in our acute care cardiology unit. Alarm notification was defined as any alert to bedside providers for each patient-triggered monitor alarm. Our aim was to decrease alarm notifications per monitored bed per day by 60%. Plan-Do-Study-Act testing cycles included updating notification technology, establishing alarm logic and modifying bedside workflow processes, including silencing the volume on all bedside monitors. Our secondary outcome measure was nursing satisfaction. Balancing safety measures included floor to intensive care unit transfers and patient acuity level. Results At baseline, there was an average of 71 initial alarm notifications per monitored bed per day. Over a 3.5-year improvement period (2014-2017), the rate decreased by 68% to 22 initial alarm notifications per monitored bed per day. The proportion of initial to total alarm notifications remained stable, decreasing slightly from 51% to 40%. There was a significant improvement in subjective nursing satisfaction. At baseline, 32% of nurses agreed they were able to respond to alarms appropriately and quickly. Following interventions, agreement increased to 76% (p<0.001). We sustained these improvements over a year without a change in monitored balancing measures. Conclusion We successfully reduced alarm notifications while preserving patient safety over a 4-year period in a complex paediatric patient population using technological advances and QI methodology. Continued efforts are needed to further optimise monitor use across paediatric hospital units.

Original languageEnglish (US)
Pages (from-to)717-726
Number of pages10
JournalBMJ Quality and Safety
Volume29
Issue number9
DOIs
StatePublished - Sep 1 2020
Externally publishedYes

Keywords

  • alarm reduction
  • quality improvement

ASJC Scopus subject areas

  • Health Policy

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