VHA National Center for Patient Safety

The Hunter Holmes VA Clinical Alarm Committee has reduced the number of clinical alarms in their facilities. (Photo via Shutterstock)

Background

The health care industry continues to grow, and so does health care workers’ reliability on technology to care for patients. New alarm-enabled equipment is manufactured each year intending to improve patient safety. However, whenever new devices are introduced, potential safety risks are involved. The increased dependency on alarm-enabled equipment can place patients at risk. As clinicians and staff experience alarm fatigue, they become overwhelmed, desensitized or immune to the alarms intended to notify them of potential harm.

Getting Started

In 2014, Hunter Holmes McGuire VA Medical Center’s leadership organized the Clinical Alarm Committee (CAC) to address The Joint Commission’s National Patient Safety Goal (NPSG) 06.01.01 with the goal to improve clinical alarm systems. The core committee included: patient safety manager, biomedical engineering staff, clinical information systems coordinator, telemetry nurse manager, nurse educators and a critical care intensivist. The committee’s initial responsibilities included the following: reviewing the current alarm-enabled equipment, a Clinical Alarms Risk Analysis, identifying equipment with the highest risk of harm to patients, developing a systematic blueprint to manage all clinical alarms in the facility, transcribing organizationwide policies and procedures, and creating an educational plan for current and new nursing staff.
Based on the results from the Clinical Alarms Risk Analysis, the physiologic monitoring system was identified as the equipment with the highest potential of harm to patients throughout the facility.

Reviewing Technology and Gathering Data

After consulting with the biomedical engineering department, the committee determined that the existing physiologic monitoring equipment could not provide the needed data to accurately analyze and make the necessary changes to non-actionable and duplicate alarms. An initial attempt to manually collect the data was limited due to intermittent time periods for data collection, possibilities of human error, limitations of data storage with the existing equipment and staff availability. Additionally, manual data collection gave a limited indication of the actual number of alarms produced. The initial findings were submitted to the organization’s leadership for review. They recognized the need to improve patient safety; therefore, an upgrade to a more robust physiologic monitoring system was approved for purchase. In March 2016, new physiologic monitors and telemetry equipment were installed in the critical care departments, telemetry units and emergency department. Goals after installation were:
• Initial training for the nursing staff and new employees
• Collect baseline data for all alarms in each department and the facility
• Determine the top five alarms in all areas
• Identify non-actionable and duplicate alarms
• Select the first unit to implement the clinical alarm pilot

Utilizing the New Physiologic Monitors

Biomedical Engineering collected baseline data from April to September 2016. Data collection revealed an average of 213,387 total facility alarms per month. The Intensive Care Units had the highest number of clinical alarms totaling 47,377. Based on the findings, the CAC set an initial goal to decrease the nonactionable and duplicate clinical alarms by 30 percent within nine months. After reviewing data, it was decided to address the top five most frequently occurring clinical alarms: premature ventricular contractions (PVCs), pair PVCs, multiform PVCs, heart rate (HR), and oxygen saturation (SpO2).

Implementing Unit Pilot and Subsequent Phased Roll-out

A pilot project was initiated to decrease clinical alarms. Before starting the project and ensuring the nonactionable alarms were turned off, the CAC consulted with physician and nursing leadership to receive approval for the pilot project and ensure staff were educated about the upcoming changes. The pilot project was initiated in the Surgical Intensive Care Unit (SICU) in November 2016. Before initiation, the baseline data for the SICU was approximately 37,764 total clinical alarms per month. The pilot project focused on turning off non-actionable and duplicate PVC alarms. Over a three-month period, the number of clinical alarms in the SICU decreased to 29,562, a 22 percent decrease. These results increased leadership support and the project was expanded throughout the facility. The pilot project evolved into two phases. Phase 1 focused on nonactionable PVC alarms, and phase 2 focused on non-actionable heart rate alarms. Phase 1 was initiated in the medical and coronary intensive care units on March 1, 2017, and phase 2 began on June 1, 2017. Based on the proven success, it was decided to start both, phase 1 and 2 simultaneously in the Medical Telemetry Unit, Oncology Unit, and the Post Anesthesia Care Unit on June 1, 2017. After just one month of the facilitywide project being implemented, the total number of clinical alarms decreased to 90,289, from 213,387, a 55.5 percent decrease, surpassing the original goal of 30 percent.

Sustaining Results

The CAC team contributes the sustained results to employee engagement and continuing education. Education is provided to nursing staff during New Nurse Employee Orientation and unit-specific skills fairs. Education is provided to other health care professionals through the hospital’s electronic education portal. The committee reviews policies and procedures annually to assess the need for updating or implementing new best practices. The team meets regularly to review current data. The effort to sustain these results has proven successful. The most recent data collection shows that facilitywide clinical alarms continue to decrease (85,358 as of May 2018). The slight monthly data variation is attributed to changes in patient census and acuity levels. The project continues to expand throughout the Hunter Holmes VA Medical Center with Phase 1 having been recently initiated in the Emergency Department.

Hunter Holmes McGuire VA Medical Center (Richmond, VA) Clinical Alarm Committee:

Pamela Mahan, MSN/Ed, RN, VHA-CM
Holly Tarta, MSN, RN
Marilyn Mayo, MSN, RN
Tequila Herron-Smith, MSN/Ed, RN, VHA-CM
Lavern Browne, MHSA, BSN, CVN
Mike Czekajlo, MD, PhD
Kimberly Hillmer, MS
Robyn Jones, MSN, BSN, RN, CDN, VHA-CM
Stephen Mosher, BS
Mercy Orikogbo, MSN/Ed, RN, VHA-CM
Kristin Windon, EdD, RN, GCNS-BC

To learn more about how the Hunter Holmes McGuire VAMC reduced the number of clinical alarms throughout their VA Medical Center listen to their podcasts on NCPS' The Patient Safety Huddle Podcast: https://www.patientsafety.va.gov/podcasts.asp.