Doctor of Nursing Practice
Rosemary Johnson DNP, APRN, ANP-BC
Ashely D’Agostino MSN, RN, WCC
Second Practice Mentor
Eduard Valente, MSN, RN, CCRN
Significance and Background: In the critical care setting, frequent false alarms can lead to sensory overload and delayed reactions to alarms (aka, alarm fatigue). Patients are at risk because overtime staff may ignore or become desensitized to all alarm sounds, even true ones.
Purpose: The purpose of this QI project is to establish alarm management protocol in a 14-bed ICU. The goals were to reduce alarm fatigue and create a safe environment for patients and clinical staff.
Methods: The Model of Improvement (IHI, 2023) with cycles of the Plan-Do-Study-Act (PDSA) was used to implement an alarm bundle checklist that included daily skin cleansing with soap, water and change of ECG electrodes. The QI project occurred over 12 weeks. Outcome measures were to see a decrease in false alarms, track adherence to the alarm bundle checklist, and see improvement in nursing perception of alarm fatigue in the ICU.
Outcome: A total 1,544 cardiac rhythms were recorded based on atrial, ventricular, and false rhythms. The occurrence of false alarms prior to the alarm bundle checklist (weeks 1-6) was 44.3% (2) with a 2.3% reduction after the implementation of the alarm bundle checklist (weeks 7-12) at 42% (1). The alarm bundle adherence showed >90% completion rate except for last week of the study, which decreased to 86%. Responses (n=24) to the 11-question nursing survey showed >10% improvement by week 12 except for the question that directly asked about the occurrence of nuisance alarms, which did not change from baseline to end of study.
Discussion: There was a reduction in cardiac false alarm rhythms after using the alarm management protocol. Having more PSDA cycles may lead to larger reduction and improve sustainability of the alarm management protocol.
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Petitti, B. (2023). Use of an alarm bundle to reduce alarm fatigue in the ICU: A quality improvement project [Unpublished DNP project]. Sacred Heart University.