First name
Elizabeth
Last name
Ely

Title

Safety Huddle Intervention for Reducing Physiologic Monitor Alarms: A Hybrid Effectiveness-Implementation Cluster Randomized Trial.

Year of Publication

2018

Date Published

2018 Feb 27

ISSN Number

1553-5606

Abstract

<p><strong>BACKGROUND: </strong>Monitor alarms occur frequently but rarely warrant intervention.</p>

<p><strong>OBJECTIVE: </strong>This study aimed to determine if a safety huddle-based intervention reduces unit-level alarm rates or alarm rates of individual patients whose alarms are discussed, as well as evaluate implementation outcomes.</p>

<p><strong>DESIGN: </strong>Unit-level, cluster randomized, hybrid effectiveness-implementation trial with a secondary patient-level analysis.</p>

<p><strong>SETTING: </strong>Children's hospital.</p>

<p><strong>PATIENTS: </strong>Unit-level: all patients hospitalized on 4 control (n = 4177) and 4 intervention (n = 7131) units between June 15, 2015 and May 8, 2016. Patient-level: 425 patients on randomly selected dates postimplementation.</p>

<p><strong>INTERVENTION: </strong>Structured safety huddle review of alarm data from the patients on each unit with the most alarms, with a discussion of ways to reduce alarms.</p>

<p><strong>MEASUREMENTS: </strong>Unit-level: change in unit-level alarm rates between baseline and postimplementation periods in intervention versus control units. Patient-level: change in individual patients' alarm rates between the 24 hours leading up to huddles and the 24 hours after huddles in patients who were discussed versus not discussed in huddles.</p>

<p><strong>RESULTS: </strong>Alarm data informed 580 huddle discussions. In unit-level analysis, intervention units had 2 fewer alarms/patient-day (95% CI: 7 fewer to 6 more, P = .50) compared with control units. In patient-level analysis, patients discussed in huddles had 97 fewer alarms/patientday (95% CI: 52-138 fewer, P &lt; .001) in the posthuddle period compared with patients not discussed in huddles. Implementation outcome analysis revealed a low intervention dose of 0.85 patients/unit/day.</p>

<p><strong>CONCLUSIONS: </strong>Safety huddle-based alarm discussions did not influence unit-level alarm rates due to low intervention dose but were effective in reducing alarms for individual children.</p>

DOI

10.12788/jhm.2956

Alternate Title

J Hosp Med

PMID

29489921

Title

Systematic Review of Physiologic Monitor Alarm Characteristics and Pragmatic Interventions to Reduce Alarm Frequency.

Year of Publication

2016

Number of Pages

136-44

Date Published

2016 Feb

ISSN Number

1553-5606

Abstract

<p><strong>BACKGROUND: </strong>Alarm fatigue from frequent nonactionable physiologic monitor alarms is frequently named as a threat to patient safety.</p>

<p><strong>PURPOSE: </strong>To critically examine the available literature relevant to alarm fatigue.</p>

<p><strong>DATA SOURCES: </strong>Articles published in English, Spanish, or French between January 1980 and April 2015 indexed in PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Cochrane Library, Google Scholar, and ClinicalTrials.gov.</p>

<p><strong>STUDY SELECTION: </strong>Articles focused on hospital physiologic monitor alarms addressing any of the following: (1) the proportion of alarms that are actionable, (2) the relationship between alarm exposure and nurse response time, and (3) the effectiveness of interventions in reducing alarm frequency.</p>

<p><strong>DATA EXTRACTION: </strong>We extracted data on setting, collection methods, proportion of alarms determined to be actionable, nurse response time, and associations between interventions and alarm rates.</p>

<p><strong>DATA SYNTHESIS: </strong>Our search produced 24 observational studies focused on alarm characteristics and response time and 8 studies evaluating interventions. Actionable alarm proportion ranged from &lt;1% to 36% across a range of hospital settings. Two studies showed relationships between high alarm exposure and longer nurse response time. Most intervention studies included multiple components implemented simultaneously. Although studies varied widely, and many had high risk of bias, promising but still unproven interventions include widening alarm parameters, instituting alarm delays, and using disposable electrocardiographic wires or frequently changed electrocardiographic electrodes.</p>

<p><strong>CONCLUSIONS: </strong>Physiologic monitor alarms are commonly nonactionable, and evidence supporting the concept of alarm fatigue is emerging. Several interventions have the potential to reduce alarms safely, but more rigorously designed studies with attention to possible unintended consequences are needed. Journal of Hospital Medicine 2016;11:136-144. © 2015 Society of Hospital Medicine.</p>

DOI

10.1002/jhm.2520

Alternate Title

J Hosp Med

PMID

26663904

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