Nurse-Led Initiative Reduces Alarm Fatigue at Florida's Mayo Clinic

New evidence-based bundle standardizes SICU's clinical alarm management practices.

After a Florida hospital surgical intensive care unit (SICU) improved clinical alarm management practices, staff became more sensitive to alarms and fewer alarms were missed, according to a study published in Critical Care Nurse.

Implementing a Unit-Based Alarm Management Bundle for Critical Care Nurses details how the 27-bed SICU at Mayo Clinic, Jacksonville, Florida, created a standardized approach to alarm management so nurses could better match the monitoring needs of individual patients.

"Clinical alarms are important, but they also contribute to a noisy hospital environment for patients and clinicians,” said 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 said.

A key piece of the initiative was an evidenced-based, nurse-driven, patient-specific bundle called the CEASE bundle. This five-step tool addresses:

• 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 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: Involves continuing education on clinical alarm monitoring systems

To help nurses adapt, the CEASE bundle was introduced during their 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 following implementation, that the CEASE bundle helped decrease their alarm fatigue and 83% reported the bundle was helpful and they would continue to use it.

Overall, implementing the CEASE bundle improved nurses' alarm management practices, perceptions, and attitudes, according to the article. Nurses reported that setting alarm parameters was less complex, staff were sensitive to alarms and responded quickly, and there were fewer instances of alarms being missed.

As a result of the project, alarm management skills and monitor training are being more formally integrated into education already required for nurses at the hospital.