Reducing alarm fatigue in the ICU
Topics
At a glance
Partner Tourcoing General Hospital, France
Challenge
Solution Philips reviewed alarm data and settings, staff workflow and processes, and worked collaboratively with the hospital to support optimal practices configured to the needs of the patients and staff.
Results
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In the intensive care unit (ICU), alarms on monitoring devices alert clinicians to a change in a patient’s condition, or warn that the device may have failed. Each day, staff can be exposed to as many as 350 alarms per patient (1). Different devices compete for their attention, and false alarms are common. This can desensitize staff to alarms.
Faced with this challenge, the ICU at Tourcoing General Hospital in northern France called on Philips consultants to work together to find a solution. Together they devised a customized approach to clinical, operational and technical processes, which led to a reduction in the number of non-actionable alarms by 39% in six months.
What causes excessive alarms?
Often, the issue is not that alarms do not work; it is that they work too precisely. Part of the challenge with a project like this is that there are multiple reasons for alarms to sound. These can include settings that are not tailored to the individual patient, alarms that repeat, or incorrectly attached electrodes and sensors. Alarm noise can prevent patients from resting and can make nurses and physicians feel overwhelmed and eventually de-sensitized to an alarm.
"Reducing the number of non-actionable alarms has enabled us to be more vigilant with regard to critical alarms, so we are a lot more responsive."
Ms Jouvenez, Nurse Tourcoing general hospital
Alarm fatigue project
In 2015, Philips and the hospital set up a project team including ICU nurses, physicians and executives, and a biomedical engineer, supported by Philips consultants. Philips built an alarm management performance dashboard to provide a detailed view of alarm data and trends. When the team assessed the Philips monitors in the ICU over the course of one week, they found that an average of 237 alarms sounded per day per bed, equal to one alarm every five minutes. The team then reviewed alarm settings and staff workflow, conducted key stakeholder interviews and documented current processes, after which they recommended a new alarm management strategy tailored to their needs. The team identified a number of immediate changes they could implement. These included pausing the alarms when performing bedside procedures such as drawing blood, and reducing the sensitivity of some of the monitors. This project has enabled the care teams to make better use of the capabilities of monitoring devices and to adopt new practices that are now integrated into their daily routine.
Bringing silence back to the ICU
“The Philips team understood that we needed facts and not assumptions or contingencies. Simply by outlining some short-term actions, we have seen a difference. There are now periods of silence in the unit,” said Mr Bouchareb, Nurse Manager at Tourcoing general hospital. Six months after the project, a second assessment of monitors revealed a 39% reduction in nonactionable alarms, from 237 down to 173 alarms per day per patient.
Sources: 1. Keith J. Ruskin and Dirk Hueske-Kraus, Alarm fatigue: impacts on patient safety, Current Opinion in Anesthesiology, Volume 28, Number 6, December 2015. Results are specific to the institution where they are obtained and may not reflect the results achievable at other institutions.
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