Using the Influencer Model to Improve Alarm Management Practices.

Decreasing alarm fatigue is an essential initiative for hospitals to improve the quality and safety of patient care. As technology has advanced, the number of alarms per patient per day has rocketed into the hundreds. It was once believed every alarm available needed to be activated for every patient, but this philosophy, along with advances in technology that increase the variety of alarms available, has resulted in overwhelming, insignificant noise. An estimated 85% to 99% of alarms are false, creating a significant patient care distraction. For example, clinical staff may overlook a fatal cardiac dysrhythmia or significant vital sign abnormality because the patient’s cardiac monitor produced frequent, nonactionable alarms. Numerous definitions for alarm fatigue are cited in the literature. This article defines alarm fatigue as “sensory overload when clinicians are exposed to an excessive number of nonactionable alarms, resulting in desensitization to alarms and missed alarms.” A delayed response to excessive alarms may negatively affect patient care, as evidenced by several highly publicized cases of patient deaths attributed to alarm fatigue.2 National organizations have identified alarm fatigue as a patient safety concern. The ECRI Institute described “the failure to recognize and respond to actionable clinical alarms . . . in a timely manner” as a top health technology hazard in 2016.3 The Joint Commission implemented the first phase of the National Patient Safety Goal (NPSG) on Using Alarms Safely (NPSG.06.01.01) in 2014; the second phase of NPSG.06.01.01, effective in 2016, mandated the establishment of clinical alarm management policies and education as an institutional priority. Professional organizations including the American Association of CriticalCare Nurses5 and the National Association of Clinical Nurse Specialists6 have also published alarm management best practices. Winchester Hospital, a 223-bed acute care community hospital serving the healthcare needs of many communities in northwest suburban Boston, responded to the issue of alarm fatigue through a cardiac dysrhythmia alarm initiative in 2013–2014, with the goal of reducing audible nonactionable alarms.