Silence the crying wolf: How to reduce hospital alarm fatigue

Incessant alarms from cardiac monitors, patient call buttons and IVs may lead nurses to tune out noise in a phenomenon called "alarm fatigue." This experience can be life-threatening — the Joint Commission reported 80 alarm-related deaths between January 2009 and June 2012, according to The Columbus Dispatch.

However, measures can be taken to successfully decrease false alarms, according to a study led by Cincinnati Children's Hospital's Christopher Dandoy, MD.  

Dr. Dandoy and his team tested a standardized cardiac monitor care process in the hospital's 24-bed pediatric bone marrow transplant unit. In eleven months, the median number of alarms dropped 78 percent and nurses cut their time dealing with monitors and alarms in half compared to the start of the project, though they gave the monitors more thought, according to the report. The monitor standards are now applied throughout the entire hospital.

Other Columbus, Ohio-based hospitals reported success using similar monitor guidelines, including Nationwide Children's Hospital and Ohio State University's Wexner Medical Center, according to the report.

The hospitals used the following strategies to reduce false alarms:

1. Change leads regularly. Monitor leads on patient's skin lose conductivity after 24 hours and need to be replaced daily, according to the report.  
2. Individually set monitors. Setting the monitor's parameters in terms of the current patient's condition can go a long way in reducing false alarms. For example, children in stable condition in Dr. Dandoy's unit often have a fever and naturally high heart rates, so nurses set monitors accordingly to reduce alarms.
3. Send some alarms directly to nurses' phones. OSU's Wexner Medical Center reduced alarm noise 20 percent by directing alarms to nurses' phones.
4. Discontinue monitors when appropriate. Develop a reliable method to assess when discontinuation is appropriate and a pain-free process for electrode removal.

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