A Quality Improvement Project to Reduce Clinical Alarm Fatigue in an Emergency Department
Marcy Achterhof, MSM, BSN, RN, CEN and Susan Dunn, PhD, RN
The presence of alarms in an emergency department (ED) can be both chaotic for patients and result in desensitization of the nurses’ awareness to alarms. The objective of this quality improvement project was to describe the number and type of SpaceLab alarms in a midwestern community hospital ED and disseminate these results to the nurses, with the goal of decreasing unnecessary alarms. The conceptual framework used was Jean Piaget’s Theory of Constructivism, which explains learning as a process of integrating knowledge and experience to construct new ideas or concepts. Supporting literature was used to identify specific ways to reduce alarms, such as widening patient parameters and suspending monitoring when the patient is disconnected from the monitor. Pre-intervention data was collected by 2 student nurses on 4 occasions over a 2-week period (8 hours total) with a total of 654 alarms recorded from SpaceLab monitors. After collecting initial data, an intervention, focused on nurse education, was developed to reduce the number of SpaceLab alarms. Student nurses developed an 8-page education booklet to use at a 10-minute training session, including a presentation of the problem, instruction on widening limits and suspending alarms, and an interactive case study. The effectiveness of the intervention was evaluated by comparing the pre-intervention and post-intervention data. Two types of alarms were compared, with a 56 percent reduction of “sensor off” alarms (514 to 227) and a 68 percent reduction of “outside limit” alarms (140-45). The frequency of total SpaceLab alarms was reduced by 58 percent (654 to 272 total alarms), thus the nurse training session was effective. Limitations include data collected at one hospital with limited generalizability, potential for human error in data collection, and potential participant bias related to nurses’ awareness of project goals. Emergency departments may consider providing nurse education to decrease unnecessary alarms. Future quality improvement projects should include interventions to increase nurse awareness, in addition to considering education for ED techs and radiology techs to further reduce alarms.
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