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Excessive alarms create desensitization and alarm fatigue. The Joint Commission declared a sentinel event alert regarding improper alarm monitoring. We recently reported our work creating and implementing a standardized cardiac monitor care process (CMCP) on a large bone marrow transplant (BMT) unit using the Model of Improvement (Pediatrics). We now report on the sustainability of this process.
Methods, Intervention, & Analysis
The standardized CMCP has been sustained for over a year and a half on a 36 bed BMT unit. The CMCP included: 1) process of initial ordering and monitor settings based on age appropriate standards; 2) pain free daily replacement of electrodes; 3) daily individualized assessment of cardiac monitor settings; 4) reliable process for appropriate discontinuation of monitor. We have sustained compliance with the CMCP through standardization of practice and highly reliable interventions including: regular evaluation and mitigation of alarms; scheduled education for the nursing staff on CMCP; clearly defined roles and responsibilities in the execution of the CMCP; and redundancy in the delivery system to ensure compliance. Families are educated on alarm care and encouraged to voice concerns with alarm issues in daily rounds. Compliance and failures with the process are reviewed regularly with staff.
Findings & Interpretation
From January 2013 – July 2014, percent compliance with the CMCP increased from 30% to >98% compliance (median=87%). Number of alarms per patient day decreased from 180 to 20 (median=26) alarms/day during this time period. The CMCP has sustained low numbers of alarms per monitored patient day.
Discussion & Implications
The results of the CMCP have not only been sustained, but improved with time. The process has been integrated into the daily workflow of the BMT staff. With the number of false alarms down there is an improved work environment and re-sensitization to cardiac monitor alarms.
