Using Data, Serial Observations and Empowering Frontline Staff Were the Keys to Our Success

The Clinical Alarm Management Group is a subgroup of Boston Medical Center’s institutional wide multidisciplinary Telemetry Task Force that spearheaded a quality improvement initiative targeted at eliminating the clinical alarm fatigue driven by cardiac monitor alarms at Boston Medical Center. This group was co-led by Deborah Whalen MSN, APRN, ANP-BC, FAHA, the Clinical Service Manager for Cardiology at BMC and a DOM faculty member with two non-faculty members BMC leaders Patricia Covelle MMHC, RN Director of Critical Care Nursing and James Pipenbrink BSBME Director of Clinical Engineering. Eric Awtry MD the Director of BMC’s Inpatient Cardiology Service and a DOM faculty member,as well as two non- faculty BMC staff Karen Villanova BS , RN and Charlotte Cuneo MSN, RN participated as members of this Clinical Alarm Management Work Group.

This group achieved stunning reduction in audible alarms first on the pilot unit (89% ) and subsequently on all BMC inpatient medical surgical units (60% overall reduction) without additional costs or technology. Dr Benjamin’s letter to you details how this was achieved and the further outcomes it achieved such as improved staff and patient satisfaction. For its work, the Clinical Alarm Management Group has been recognized by the Joint Commission and was featured May 2013 in its webinar introducing the new 2014 National Patient Safety Goal (NPSG) for alarm management to hospitals.

Our approach to this quality initiative was to use actual data from our alarm systems combined with serial observations of staff interactions with alarms to identify where opportunities for safelyreducing audible alarms existed while insuring staff response to all clinically significant alarms. We saw the opportunityto eliminate the audible Warning Alarms. These alarms self- reset when alarm condition no longer met.Because of their self-reset feature, they were often not viewed in real time by staff involved in other important patient care activities. Their settings were thus not adjusted contributing to endless alarms needlessly occurring. Today through this quality improvement initiative all clinically significant heart rate and clinically significant arrhythmia alarms at BMC are alarmed asCrisis Alarms. These do not self- reset and require staff to immediately view and respondto the alarm in real time leading.We also empowered two RNs together to adjust the parameter settings in real time if the crisis alarm were false thus better individualizing the alarms to specific patient for meaningful activation of the alarm. These have all contributed to the audible alarm reduction we achieve , improved patient safety for our patients and the elimination of the clinical alarm fatigue from cardiac monitors at Boston Medical Center and why we are a national model for all hospitals addressing the Joint Commissions new NPSG.

Using data, serial observations and empowering frontline staff were the keys to our success.

Deborah Whalen and Eric Awtry