How Palomar Health reduced nuisance IV alarms

People can grow used to anything, even alarms. Such is the danger of alarm fatigue; when excessive and nuisance alerts cause healthcare staff to become desensitized. When this happens, healthcare staff are more likely to have trouble prioritizing, managing, and responding to alerts, resulting in delayed treatment and patient harm.

Excessive alarms and alarm fatigue isn’t a new issue in healthcare. The Joint Commission’s Sentinel Event Alert (SEA) 50 on alarm safety reported that between 85% and 99% of alarms don’t require clinical intervention. Healthcare staff have been known to inappropriately tamper with alarm sensitivities, turn down alarm volumes, or silence them completely, according to the alert. The Joint Commission reported that between 2009 and 2012 there were 98 reported alarm-related events resulting in 80 deaths, 13 permanent loss of function cases, and five patients with minor injuries.

The accreditor also implemented phase II of its alarm safety National Patient Safety Goal (NPSG) in 2016, which  requires hospitals to:
•    Establish policies and procedures for identified high-risk alarms 
•    Address issues such as appropriate alarm settings, when settings should be changed, and who has the authority to change alarm parameters
•    Educate staff on how to properly operate alarms to reduce alarm fatigue

Palomar Health 
Palomar Health, the largest healthcare district in California, successfully piloted an IV nuisance alarm reduction program at its flagship facility: Palomar Medical Center Poway and Pomerado Outpatient Pavilion. The Association for the Advancement of Medical Instrumentation (AAMI) held a webinar discussing the district’s results with LaQuoia Johnson, PharmD, BCPS, pharmacy supervisor at Forsyth Medical Center (formerly of Palomar Health), Carol Suarez, MS, Palomar Health clinical nurse specialist of pulmonary progressive care and medical-surgical telemetry acute care, and Diana Schultz, RPh, MHSA, Palomar’s medication safety manager.

“Medical device alarms are designed to save lives, but excessive and misleading alerts remain a leading technological hazard in hospitals,” said Schultz. “Clinical devices sound hundreds of alarms per patient per day, creating an environment that can overwhelm, distract, desensitize healthcare workers.”

“The purpose of this [ongoing] study is to utilize continuous quality data and staff observation to analyze infusion device alarms to develop a set of best practices for medication storage, preparation, pump settings, and infusion administration processes to reduce harm associated with infusion,” Johnson said. “The study was conducted on the premise that an ounce of prevention is worth a pound of cure.”

Measure
The first step of the process, said Johnson, was to collect data on their alarms. They created a project team consisting of pharmacy and nursing representatives from Palomar Health along with clinical consultants, project managers, informatics specialists, and data analysts from their health IT provider CareFusion. The team started by measuring a mix of objective and subjective data to determine:
•    Which kinds of alarms were sounding
•    The number of alarms sounding per shift
•    How frequently certain types of alarms were sounding
•    How long they were sounding for

To define the problem, the project team sent out a survey to nurses on their perspectives of alarms during their shifts. The survey was emailed to all nurses at Palomar Health and was left open for four weeks, said Johnson. As an incentive to participate, nurses who filled the survey had their names entered in a gift card raffle. With these steps, Johnson said that they managed to get data back from 31.8% of their nursing staff. 

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