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Building an Effective Clinical Alarm Management Program

How one hospital was able to reduce the average per bed/per day alarm count by 30 percent

Clinical alarm management is one of the hottest topics in healthcare today – and for good reason: it’s critical for patient safety, essential for staff satisfaction, and mandated by regulatory agencies. But alarm management represents a complex set of challenges and processes for any institution.

One of our customers, Avera Heart Hospital, successfully met this challenge. To comply with the National Patient Safety Goal (NPSG) mandate, the hospital adopted a data-driven approach to build an effective alarm management program.

Avera Heart Hospital uses a universal bed model of care that allows families to stay in the same room with the patient – whether admitted for a simple procedure or a triple bypass. Patients stay in the same room for their entire hospitalization and are monitored from admission to discharge. The hospital established alarm fatigue as an institutional priority for patient safety – an initiative that was supported by the hospital’s CEO and medical staff. After making initial changes, the hospital was able to reduce the average per bed/per day alarm count from 71 to 42 – a reduction of 30%.

Here’s how they did it.

Step #1: Create a multi-disciplinary alarm management team

Avera Heart Hospital’s quest to create a NPSG-compliant clinical alarm management system began with a call to Dräger for alarm information.

As a launch point, the hospital created a multi-disciplinary alarm management team that included nursing department heads, the CNO, biomeds, and IT staff. Physicians were available to give input and perspective. The hospital asked Dräger to work with this team.

Step #2: Establish a baseline alarm count

The next step was to gather an automated baseline alarm count on the hospital’s various physiological alarms.

Working together, Dräger and Avera Heart Hospital evaluated the current state of alarms to collect baseline alarm data. The effort was focused initially on three care units by evaluating physiological alarms as the starting point. To establish a meaningful benchmark, alarm data was collected around the clock for seven days. Dräger collected and presented the data in the context of best practices, scientific literature, policy, and observed workflow.

The baseline alarm count showed that for three units, there were 18,798 alarms in a week – which averaged 71 alarms per patient, per day. The biggest alarm source was advisory alarms specific to SpO2, which accounted for 46% of the alarms.

Step #3: Eliminate duplicate and non-actionable alarms

Based on this baseline information, Dräger and Avera Heart Hospital reviewed default settings and eliminated duplicate and non-actionable alarms – such as couplets, bigeminy, bradycardia and tachycardia – and replaced them with high/low parameters. PVC parameters were changed from 10 to 20/min. SpO2 was decreased to 88%. Re-training was done on proper skin hygiene prior to lead placement and uses of the OxiMax oximetry technology.

By implementing a data-driven approach, the hospital had the information it needed to reduce the noise, nuisance alarms, redundant alarms, and too tightly set parameters – and still keep patients safe.

After the initial changes, Avera Heart Hospital was able to reduce the average per bed/per day alarm count from 71 to 42 – a reduction of 30%.

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