Table 1

Specific interventions, alarm system generation and timing for each intervention

Category of interventionSpecific interventionsAlarm system generationTiming
New technologyVoalte implementation with Connexall integration2October 2014
Airstrip go-live2December 2014
New monitor system go-live 3January 2017
Airstrip discontinuation3January 2017
Alarm logicProgressive increase of low SpO2 alarm delays
  • Step 1 delay:

+5 s for all alarms except SpO2<60%
2October 2015
  • Step 2 additional delay:

+15 s for 80%<SpO2<100%
+10 s for 70%<SpO2<79%
+5 s for 60%<SpO2<69%
2April 2016
  • Step 3 additional delay:

+40 s for 80%<SpO2<100%
+15 s for 70%<SpO2<79%
+5 s for 60%<SpO2<69%
3February 2017
Progressive increase of high SpO2 alarm delays, if parameter set
  • Step 1 delay: +60 s for SpO2>90%

2June 2015
  • Step 2 delay: +300 s for SpO2>90%

2April 2016
Progressive increase in amount of ventricular ectopy per minute needed to trigger alarm
  • Ventricular couplets >5 per minute

2January 2015
  • PVCs >30 per minute

3February 2017
Deactivation of 20 system-level alarms 2February 2015
Addition of high heart rate alarm delay (if rate <220 bpm), +15 s2April 2016
Addition of low heart rate and respiratory rate alarm delay, +15 s3February 2017
Delay of remaining system-level alarms, +120 s3February 2017
Process changesDecrease initial and secondary notifications of alarms to nursing via escalation algorithms
  • Algorithm 1: Secondary notifications resent to primary and charge nurse after 20 s delay

2March 2015
  • Algorithm 2: +40 s to delay for secondary notification; charge nurse removed from initial notifications for low and medium acuity alarms, buddy nurse added to initial and secondary notification for medium acuity alarms and instead of charge nurse for secondary notification of low-acuity alarms; all staff received secondary notification of high-acuity alarms; tertiary notification to all staff added for low and medium-acuity alarms after additional 60 s delay

2June 2016
  • Algorithm 3: Only primary nurse receives initial notification for low and medium-acuity alarms, only primary nurse and buddy nurse receive secondary notifications; tertiary notifications sent to specific staff based on acuity

3March 2017
Turn off in-room alarm volume 2November 2015
Improve per cent of leads changed every 24 hours to >80%2January 2016
Condition-specific vital sign alarm parameters3January 2017
  • Bold indicates key interventions annotated on statistical process control charts.

  • PVC, premature ventricular contraction; SpO2, pulse oxygenation level.