A team-based approach to reducing cardiac monitor alarms.
OBJECTIVE
Excessive cardiac monitor alarms lead to desensitization and alarm fatigue. We created and implemented a standardized cardiac monitor care process (CMCP) on a 24-bed pediatric bone marrow transplant unit. The aim of this project was to decrease monitor alarms through the use of team-based standardized care and processes.


METHODS
Using small tests of change, we developed and implemented a standardized CMCP that included: (1) a process for initial ordering of monitor parameters based on age-appropriate standards; (2) pain-free daily replacement of electrodes; (3) daily individualized assessment of cardiac monitor parameters; and (4) a reliable method for appropriate discontinuation of monitor. The Model for Improvement was used to design, test, and implement changes. The changes that were implemented after testing and adaptation were: family/patient engagement in the CMCP; creation of a monitor care log to address parameters, lead changes, and discontinuation; development of a pain-free process for electrode removal; and customized monitor delay and customized threshold parameters.


RESULTS
From January to November 2013, percent compliance with each of the 4 components of the CMCP increased. Overall compliance with the CMCP increased from a median of 38% to 95%. During this time, the median number of alarms per patient-day decreased from 180 to 40.


CONCLUSIONS
Implementation of the standardized CMCP resulted in a significant decrease in cardiac monitor alarms per patient day. We recommend a team-based approach to monitor care, including individualized assessment of monitor parameters, daily lead change, and proper discontinuation of the monitors.
Divisions of Bone Marrow Transplantation and Immunodeficiency, and James M. Anderson Center for Health Systems Excellence, christopher.dandoy@cchmc.org.
Christopher E
CE
Dandoy
Divisions of Bone Marrow Transplantation and Immunodeficiency, and.
Stella M
SM
Davies
Divisions of Bone Marrow Transplantation and Immunodeficiency, and.
Laura
L
Flesch
Divisions of Bone Marrow Transplantation and Immunodeficiency, and.
Melissa
M
Hayward
Divisions of Bone Marrow Transplantation and Immunodeficiency, and.
Connie
C
Koons
Divisions of Bone Marrow Transplantation and Immunodeficiency, and.
Kristen
K
Coleman
Divisions of Bone Marrow Transplantation and Immunodeficiency, and.
Jodi
J
Jacobs
Divisions of Bone Marrow Transplantation and Immunodeficiency, and.
Lori Ann
LA
McKenna
Clinical Engineering, and.
Alero
A
Olomajeye
Clinical Integration, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Chad
C
Olson
Divisions of Bone Marrow Transplantation and Immunodeficiency, and.
Jessica
J
Powers
Divisions of Bone Marrow Transplantation and Immunodeficiency, and.
Kimberly
K
Shoemaker
Divisions of Bone Marrow Transplantation and Immunodeficiency, and.
Sonata
S
Jodele
James M. Anderson Center for Health Systems Excellence.
Evaline
E
Alessandrini
Oncology, Cancer and Blood Disease Institute.
Brian
B
Weiss
D000046:Academic Medical Centers; D016026:Bone Marrow Transplantation; D002648:Child; D056902:Clinical Alarms; D003299:Cooperative Behavior; D004562:Electrocardiography / Q000592:standards*; D004567:Electrodes, Implanted; D004868:Equipment Failure; D006284:Health Plan Implementation / Q000458:organization & administration / Q000592:standards; D006776:Hospitals, Pediatric; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration / Q000592:standards; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration* / Q000592:standards; D033183:Interdisciplinary Communication; D064926:Neurophysiological Monitoring / Q000592:standards*; D009820:Ohio; D059408:Pain Management / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration* / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards
Model for Improvement; Plan-Do-Study-Act; alarm fatigue; cardiac monitor; quality improvement