Amanda C Schondelmeyer1, Patrick W Brady2, Heidi Sucharew3, Guixia Huang3, Kelsey E Hofacer4, Jeffrey M Simmons2. 1. Divisions of Hospital Medicine, Department of Pediatrics, and James M. Anderson Center for Health Systems Excellence, and amanda.schondelmeyer@cchmc.org. 2. Divisions of Hospital Medicine, Department of Pediatrics, and James M. Anderson Center for Health Systems Excellence, and. 3. Biostatistics and Epidemiology, and. 4. Center for Telehealth, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Abstract
BACKGROUND: Concerns about alarm fatigue prompted The Joint Commission to issue a Sentinel Event Alert urging hospitals to minimize alarms. We previously conducted a quality improvement project on a single unit that reduced time on continuous pulse oximetry, a common source of physiologic monitor alarms, for patients with wheezing (ie, asthma and bronchiolitis, wheezing-associated respiratory infections). OBJECTIVE: To study the impact of our improvement work on overall physiologic monitor alarm frequency for these patients. METHODS: This was a retrospective cohort study at a freestanding children's hospital over an 8-week period. We compared alarm count, including respiratory, cardiac, and pulse oximetry alarms, for patients admitted to the intervention unit with the alarm count for similar patients on a control unit by using the Wilcoxon rank sum test. We used negative binomial regression to evaluate differences in alarm count between the units, adjusting for age, medical comorbidity, and length of stay. RESULTS: There were 101 patients on the intervention unit and 46 patients on the control unit. The percentage of patients with medical comorbidities was significantly higher on the intervention unit (P=.01). Median alarm count per day for patients on the intervention unit was lower; however, this difference was not statistically significant (71 vs 76 alarms per patient-day, P=.29). The multivariable model estimated a nonsignificant 6.4-count decrease in alarms for patients on the intervention unit. CONCLUSIONS: Reducing continuous pulse oximetry use alone may not make substantial reductions in overall alarm counts. Even on our intervention unit, alarm burden remained quite high.
BACKGROUND: Concerns about alarm fatigue prompted The Joint Commission to issue a Sentinel Event Alert urging hospitals to minimize alarms. We previously conducted a quality improvement project on a single unit that reduced time on continuous pulse oximetry, a common source of physiologic monitor alarms, for patients with wheezing (ie, asthma and bronchiolitis, wheezing-associated respiratory infections). OBJECTIVE: To study the impact of our improvement work on overall physiologic monitor alarm frequency for these patients. METHODS: This was a retrospective cohort study at a freestanding children's hospital over an 8-week period. We compared alarm count, including respiratory, cardiac, and pulse oximetry alarms, for patients admitted to the intervention unit with the alarm count for similar patients on a control unit by using the Wilcoxon rank sum test. We used negative binomial regression to evaluate differences in alarm count between the units, adjusting for age, medical comorbidity, and length of stay. RESULTS: There were 101 patients on the intervention unit and 46 patients on the control unit. The percentage of patients with medical comorbidities was significantly higher on the intervention unit (P=.01). Median alarm count per day for patients on the intervention unit was lower; however, this difference was not statistically significant (71 vs 76 alarms per patient-day, P=.29). The multivariable model estimated a nonsignificant 6.4-count decrease in alarms for patients on the intervention unit. CONCLUSIONS: Reducing continuous pulse oximetry use alone may not make substantial reductions in overall alarm counts. Even on our intervention unit, alarm burden remained quite high.
Authors: Amanda C Schondelmeyer; Nancy M Daraiseh; Brittany Allison; Cindi Acree; Allison M Loechtenfeldt; Kristen M Timmons; Colleen Mangeot; Patrick W Brady Journal: J Hosp Med Date: 2019-06-19 Impact factor: 2.960