A Florida hospital surgical intensive care unit (SICU) improved clinical alarm management practices and reduced nurses’ self-reported alarm fatigue, according to a study published in Critical Care Nurse (CCN).
“Implementing a Unit-Based Alarm Management Bundle for Critical Care Nurses” details how the 27-bed SICU at Mayo Clinic, Jacksonville, Florida, implemented a standardized approach to alarm management and improved nurses’ knowledge for configuring the settings to match the monitoring needs of individual patients better.
“Clinical alarms are important, but they also contribute to a noisy hospital environment for patients and clinicians,” says lead author Stephanie Bosma, DNP, APRN, FNP-BC, an advanced practice nurse practitioner at the hospital. “With high sensitivity and low specificity, monitors can generate an overwhelming number of alarms, many of which are false or nonactionable alerts.”
“Our project gave alarm management skills much-needed attention and introduced a new tool to help staff maximize the benefits of clinical alarms,” she says.
A key aspect of the initiative was an evidenced-based, nurse-driven, patient-specific bundle called the CEASE bundle. The five-step tool addresses the following:
- Communication – focuses on working with colleagues (fellow nurses, respiratory therapists, providers, and patient care technicians) to identify patient-specific goals and determine when to suspend or silence alarms while performing care activities that induce nonactionable alarms.
- Electrodes – targets proper skin preparation for daily ECG electrode and pulse oximeter changes.
- Appropriateness – encompasses determining what is clinically indicated for the patient and choosing appropriate monitoring parameters with physician and interprofessional team members.
- Setup – includes customizing alarm parameters for individual patients at the beginning of each shift.
- Education – relates to the need for continuing education on clinical alarm monitoring systems.
To help nurses adapt, the CEASE bundle was introduced during regular staff meetings, and descriptions were placed around the unit for easy reference.
Some 82% of nurses reported via a survey administered to all SICU nurses before and after implementation that the CEASE bundle helped decrease their alarm fatigue, and 83% reported the bundle was helpful and would continue to use it.
Implementing the CEASE bundle improved nurses’ alarm management practices, perceptions, and attitudes. Several indicators improved from baseline, including nurses reporting that setting alarm parameters was less complex, staff was sensitive to alarms and responded quickly, and fewer alarms were missed.
As a result of the project, alarm management skills and monitor training is being more formally integrated into the hemodynamic education already required for nurses at the hospital.
