September 18, 201712pm to 1pm

From the National Coalition for Alarm Management Safety

A JOURNEY TO REDUCE ALARM FATIGUE: Tips on What Not to Do

Peggy Bartholomew, MHSM, RN, PMPProject Manager

Quality Project ManagementUT Southwestern Medical Center

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Speaker Introduction

Peggy Bartholomew, MHSM, RN, PMP

Project ManagerQuality Project Management

UT Southwestern Medical Center

A JOURNEY TO REDUCE ALARM FATIGUE: Tips on What Not to Do

Conflict of Interest Disclosure

• I have no actual or potential conflict of interest in relation to this presentation.

Who is UT Southwestern?

Zale Lipshy University Hospital William P. Clements University Hospital

Charting a CourseOperational Barriers to Impacting Alarm Reduction

Know the Destination

• Navigating uncharted territory

How many people does it take to create a project team? 

Logistical Challenge

• Two hospitals• In 1989, Zale Lipshy opened

as the first University Hospital

• In 2000, St. Paul Hospital joined with Zale Lipshy Hospital

Creation of a new policy

Move to a New Facility

Redirecting the CourseDetermining When to Ask for Help

Post‐Move Observations

Diminished sense of

urgency to reduce alarm

fatigue

Generalized policy and

limited expectations on managing

alarms

Lack of empowerment

to manage alarms

Delay in embracing

new technology

Increased alarm load Alarm Fatigue

Redirecting the CourseBarriers to Impacting Alarm Reduction

• High occurrence of non-actionable alarms

• Lack of awareness of default settings

• Gaps in our customization processes and practices

• Gap in understanding and use of our technology

• Identified policy gaps

Nurses

Providers

Ancillary Staff

Hope on the HorizonOne Approach to Reduce Non-Actionable Alarms

Top 10 Alarms

ECG Leads Off Alarm

High Arrhythmia Medium Arrhythmia High Parameter Medium Parameter Low/Technical

CVICU• Piloted

arrhythmia default setting changes

MICU• Piloted alarm

parameter default setting changes

NSICU• Piloted

manual customization of all alarm settings

SBAR Communication

• Shared with providers and nursing

• Modified event reporting system to include clinical alarms

• Encouraged staff to submit event reports or notify Nursing manager to ensure patient safety

Arrival to DestinationAchieving the Goal

Pre/Post Full ImplementationTotal Alarms

(Pre/Post Full Implementation)

% Change in Total Alarms

(Pre/Post Implementation)

Total Alarms Per Bed/Per Day

(Pre/PostImplementation)

% Change in Total Alarms

Per Bed/Per Day(Pre/Post

Implementation)

MICU 118,576/56,422

- 48% 173/79 - 46%

CVICU 152,043/77,933

- 51% 216/116 - 46%

NSICU 68,526/43,462

- 37% 120/74 - 38%

SICU 54,433/45,843

- 16% 81/68 - 16%

ED 79,710/49,331

- 38% 71/44 - 38%

Four weeks pre-intervention – Jan 2017Four weeks post-intervention – dates variable

Monitoring Plan – CVICU

A X X

0.00

50.00

100.00

150.00

200.00

250.00

300.00

4-Se

p-16

18-S

ep-1

6

2-Oc

t-16

16-O

ct-16

30-O

ct-16

13-N

ov-1

6

27-N

ov-1

6

11-D

ec-1

6

25-D

ec-1

6

8-Ja

n-17

22-Ja

n-17

5-Fe

b-17

19-F

eb-1

7

5-Ma

r-17

19-M

ar-17

2-Ap

r-17

16-A

pr-1

7

30-A

pr-1

7

14-M

ay-1

7

28-M

ay-1

7

11-Ju

n-17

25-Ju

n-17

Indi

vidua

l V

alue

Period

High/Medium/Low Alarms per Bed per DayCVICUI Chart

Arrhythmiadefault changes

Full implementation

Monitoring Plan – MICU

0.00

50.00

100.00

150.00

200.00

250.00

300.00

4-Se

p-16

11-S

ep-1

618

-Sep

-16

25-S

ep-1

62-

Oct-1

69-

Oct-1

616

-Oct-

1623

-Oct-

1630

-Oct-

166-

Nov-1

613

-Nov

-16

20-N

ov-1

627

-Nov

-16

4-De

c-16

11-D

ec-1

618

-Dec

-16

25-D

ec-1

61-

Jan-

178-

Jan-

1715

-Jan-

1722

-Jan-

1729

-Jan-

175-

Feb-

1712

-Feb

-17

19-F

eb-1

726

-Feb

-17

5-Ma

r-17

12-M

ar-17

19-M

ar-17

26-M

ar-17

2-Ap

r-17

9-Ap

r-17

16-A

pr-1

723

-Apr

-17

30-A

pr-1

77-

May-1

714

-May

-17

21-M

ay-1

728

-May

-17

4-Ju

n-17

11-Ju

n-17

18-Ju

n-17

Indi

vidua

l V

alue

Period

High/Medium/Low Alarms per Bed per DayMSICUI Chart

Alarm parameterdefault changes

Full implementation

Monitoring Plan – NSICU

0.00

50.00

100.00

150.00

200.00

4-Se

p-16

11-S

ep-1

618

-Sep

-16

25-S

ep-1

62-

Oct-1

69-

Oct-1

616

-Oct-

1623

-Oct-

1630

-Oct-

166-

Nov-1

613

-Nov

-16

20-N

ov-1

627

-Nov

-16

4-De

c-16

11-D

ec-1

618

-Dec

-16

25-D

ec-1

61-

Jan-

178-

Jan-

1715

-Jan-

1722

-Jan-

1729

-Jan-

175-

Feb-

1712

-Feb

-17

19-F

eb-1

726

-Feb

-17

5-Ma

r-17

12-M

ar-17

19-M

ar-17

26-M

ar-17

2-Ap

r-17

9-Ap

r-17

16-A

pr-1

723

-Apr

-17

30-A

pr-1

77-

May-1

714

-May

-17

21-M

ay-1

728

-May

-17

4-Ju

n-17

11-Ju

n-17

18-Ju

n-17

Indi

vidua

l V

alue

Period

High/Medium/Low Alarms per Bed per DayNSICUI Chart

Full implementation

Manual customization of default changes

Monitoring Plan – SICU

-50

0

50

100

150

200

250

18-D

ec-1

6

25-D

ec-1

6

1-Ja

n-17

8-Ja

n-17

15-Ja

n-17

22-Ja

n-17

29-Ja

n-17

5-Fe

b-17

12-F

eb-1

7

19-F

eb-1

7

26-F

eb-1

7

5-Ma

r-17

12-M

ar-17

19-M

ar-17

26-M

ar-17

2-Ap

r-17

9-Ap

r-17

16-A

pr-1

7

23-A

pr-1

7

30-A

pr-1

7

7-Ma

y-17

14-M

ay-1

7

21-M

ay-1

7

28-M

ay-1

7

4-Ju

n-17

11-Ju

n-17

18-Ju

n-17

Indi

vidua

l V

alue

Period

High/Medium/Low Alarms per Bed per DaySICUI Chart

Full implementation

Monitoring Plan – ED

20

30

40

50

60

70

80

90

100

29-Ja

n-17

5-Fe

b-17

12-F

eb-1

7

19-F

eb-1

7

26-F

eb-1

7

5-Ma

r-17

12-M

ar-17

19-M

ar-17

26-M

ar-17

2-Ap

r-17

9-Ap

r-17

16-A

pr-1

7

23-A

pr-1

7

30-A

pr-1

7

7-Ma

y-17

14-M

ay-1

7

21-M

ay-1

7

28-M

ay-1

7

4-Ju

n-17

11-Ju

n-17

18-Ju

n-17

Indi

vidua

l V

alue

Period

High/Medium/Low Alarms per Bed per DayED

I ChartFull

implementation

Just Do It – Central Monitoring Unit

30

40

50

60

70

80

29-Ja

n-17

5-Fe

b-17

12-F

eb-1

7

19-F

eb-1

7

26-F

eb-1

7

5-Ma

r-17

12-M

ar-17

19-M

ar-17

26-M

ar-17

2-Ap

r-17

9-Ap

r-17

16-A

pr-1

7

23-A

pr-1

7

30-A

pr-1

7

7-Ma

y-17

14-M

ay-1

7

21-M

ay-1

7

28-M

ay-1

7

4-Ju

n-17

11-Ju

n-17

18-Ju

n-17

Indi

vidua

l V

alue

Period

High/Medium/Low Alarms per Bed per DayCUH-Tele

I Chart

Sustaining the Progress & Future 

Plans• Transitioning to a future

Alarm Safety Committee and Process Owner

• Determining the frequency of monitoring

• Developing Standard Operating Procedures

• Sharing the data

• Continuing the progress

Lessons Learned• Determine a governance structure• Organize, structure, and plan efforts

early • Find a process owner sooner rather

than later• Narrow the focus• Understand the workflow and

equipment• Educate early and often• Ask for help if needed; know your

limitations

References

• Alarm & Noise Management – Phase I: Current State Assessment; Healthcare Transformation Services, Lisa Pahl and Jillann Walker, February 25th, 2016.

• Alarm Management - Phase II: Post Changes - Healthcare Transformation Services, Lisa Pahl and Jillann Walker, December 21, 2016.

• American Association of Critical-Care Nurses. AACN Practice Alert. Alarm management. Crit Care Nurse. 2013;33(5): 83-86. Available at: http://www.aacn.org/wd/practice/docs/practicealerts/alarm-management-practice-alert.pdf. Accessed July 20, 2015.

• ECRI Health Devices (2003). ECG Leads Off Shouldn’t Be a Low Priority.• ECRI Institute. The Alarm Safety Handbook. Strategies, Tools, and Guidance.

ECRI Institute. 2014.

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