Boston Medical Center Is Ahead of the Curve on Alarm Fatigue

Boston Medical Center's program sets an example for the entire country.

The Joint Commission, a nonprofit organization that accredits more than 20,000 health care organizations and programs in the U.S., has mandated that starting in January 2014, hospitals nationwide are required to reduce “alarm fatigue,” defined as “when providers become desensitized to the constant beeps from monitors that could result in a failure to respond (or failure to respond quickly enough) to alarms indicative of a potential life-threatening condition.”

So it’s a good thing that Boston Medical Center (BMC) made this a priority years ago. BMC completed a pilot study in late 2013 that resulted in an 89 percent decrease in audible alarms in a cardiac/telemetry unit and was asked to present their findings during a Joint Commission webinar that thousands of participants from hospitals across the country watched.

The study, published in the Journal of Cardiovascular Nursing, showed that not only was alarm fatigue decreased, but it also increased patient safety and staff satisfaction. This was all done using existing alarm equipment, and no additional technology or financial resources were used. The cost-effective approach has now been expanded to all BMC inpatient medical surgical units and is being touted as a model for other hospitals working to combat alarm fatigue.

According to The Joint Commission, there were 80 alarm-related deaths in the U.S. between January 2009 and June 2012. Because of this, the commission identified alarm safety as a 2014 national patient safety goal. “Alarm fatigue and management of alarms are important safety issues that we must confront,” says Dr. Ana McKee, executive vice president and chief medical officer of The Joint Commission. “The work of Boston Medical Center and numerous others who are trying to find solutions to this very serious patient safety issue should be applauded. By making alarm safety a priority, lives can be saved.”

BMC data showed that patient status arrhythmia and parameter limit “warning” alarms frequently preceded life-threatening arrhythmic events. Instead, these alarms were raised to “crisis” levels. “Crisis” alarms are heard in real-time and require immediate action, which nurses felt could increase patient safety. Nurses also tailored alarm settings that did not indicate a true crisis based on individual patient health care needs. Basically, the study reduced the warning alarms and made other adjustments so that all alarms became actionable by the staff.

According to the study:

Working in a cardiology unit, BMC reduced audible cardiac monitor and telemetry alarms by 89 percent, dropping daily audible alarm averages from 12,546 to 1,424. Before the pilot, the unit averaged 87,823 weekly audible alarms. During the pilot, the number dropped significantly to an average of 9,967 weekly audible alarms, with the largest decrease from the changes to monitors for bradycardia, tachycardia and heart rate parameter limits, which dropped from 62,793 to 3,970. Noise levels fell to 72 decibels from 90 decibels pre-pilot.

“While some hospitals are looking to add technology to combat this issue, BMC’s approach demonstrates the opportunity for clinicians to interact with current alarm systems more effectively to decrease clinical alarm fatigue while simultaneously capturing and displaying all important alarms,” said James Piepenbrink, director of clinical engineering at BMC and the study’s co-author.

According to Boston Medical Center, nurses were surveyed anonymously both before and after the pilot about the unit noise level, and the “acceptable” noise level score went from 0 to 64 percent. Additionally, nurses were asked how these changes had impacted their work environment. “I feel so much less drained going home at the end of my shift,” one nurse responded.