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Time series evaluation of improvement interventions to reduce alarm notifications in a paediatric hospital
  1. Colleen M Pater1,
  2. Tina K Sosa2,
  3. Jacquelyn Boyer3,
  4. Rhonda Cable4,
  5. Melinda Egan5,
  6. Timothy K Knilans1,6,
  7. Amanda C Schondelmeyer2,6,7,
  8. Christine L Schuler2,6,
  9. Nicolas L Madsen1,6
  1. 1The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  2. 2Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  3. 3Facilities Management, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  4. 4Strategic Projects, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  5. 5Information Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  6. 6Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
  7. 7Division of Hospital Medicine, James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  1. Correspondence to Dr Colleen M Pater, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA; colleen.pater{at}cchmc.org

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.

  • alarm reduction
  • quality improvement
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Footnotes

  • Contributors JB, RC, ME, TKS, ACS and NLM were involved in the study conception and design. CMP, JB, RC, ME and NLM were involved in the study testing and implementation. CMP, TKS, JB, RC, ME, ACS and NLM were involved in the data analysis and interpretation of results. CMP, TKS, ACS, CLS and NM were involved in final data analysis and manuscript drafting. All the authors critically revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This improvement work fell within the institutional review board’s guidance for quality improvement projects that did not constitute human subjects research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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