Temple Health – Temple University Health System

Mark Meyers

Alarm fatigue is a multifaceted problem that can lead to patient injury up to and including death. Reducing the number of nonactionable alarms improves opportunities for clinicians to respond to true actionable alarms. Nursing leaders should work to provide care environments that produce meaningful information for monitor technicians to provide safe care. Careful consideration to reduce alarms to make them meaningful is the key to success to provide a safe and effective care environment.

Patient safety literature supports that alarm management deficiencies are mostly caused by human errors that relate to system complexities. The circumstances of alarm management systems are usually institutionally unique and are influenced by organizational culture, equipment and styles of alarm management. Variability across care systems and within department units contributes to troubling problems that cannot be solved with a single, broad approach. Telemetry rooms can be an effective strategy to combat alarm management challenges; however, the design and set up of these rooms can expose telemetry technicians, also known as monitor watchers, to a barrage of alarms that may be overwhelming and lead to patient safety events.

A good portion of the available research discusses the utilization of several techniques to reduce alarm burden that leads to alarm fatigue. These techniques such as, proper lead placement and maintenance or customizing alarm limits to meet a patient’s clinical condition. While all of these methods have proven to reduce alarms fatigue and decrease nonactionable alarms, they all rely on end user intervention.

Eliminating premature ventricular contractions (PVC) alarms from telemetry monitoring reduces nonactionable alarms and requires no end user intervention. The PVC alarms are nonactionable alarms that were addressed in the early days of physiologic monitoring, but have little to no value in today’s telemetry monitoring. These alerts are frequent and intrusive to being able to hear actionable alarms.

Biomedical engineering removed the three PVC alarms (Multiform PVC, Pair PVC and Run PVC). Eliminating the aforementioned PVC alarms showed an overall decrease in the number of alarms and an increase in the percentage of actionable alarms to which telemetry technicians are exposed. This reduction in overall alarms begins to promote an environment that will have less alarms not only for telemetry, but for each of the clinical floors that the telemetry rooms support. Continual work to reduce nonactionable alarms will provide clinicians with the ability to appropriately respond and promote a safer and quieter patient environment.

Turning off the non-actionable multiform PVC, pair PVC, and run PVC alarms, eliminated the need for the telemetry technicians or nurses to do anything. The alarms are off. Other interventions, such as proper lead placement and maintenance, customizing alarm limits to meet a patient’s clinical condition, take many nurses or telemetry technicians to perform a similar task regularly to ensure that alarms are reduced. This is not to say that these interventions are not good ideas, but two clinicians could have different views about how to modify alarms settings, even after they receive the same education. Eliminating the PVC alarms did not need to have any workflow changes for the telemetry technicians or nurses and was consistent.

The change was effective in reducing the overall number of alarms in the telemetry room. While the number of actionable alarms increased, it was not at a statistically significant level. Feeling of the telemetry technician’s attitude toward their ability to respond to alarms improved during this process. This type of project should be considered as a primary method of alarm management because of the ease of implementation and that there is no impact to the workflow of the telemetry technicians.