Regaining Reliable Patient Physiologic Surveillance System Performance After Nursing Practice Drift: An Example of...

Area of Science:

• Biomedical Engineering
• Clinical Informatics
• Patient Safety Systems

Background:

• Physiologic surveillance systems aim to alert nurses to patient deterioration.
• High alarm burden can lead to alarm fatigue, reducing system effectiveness and nurse confidence.
• Practice drift can compromise the reliability of patient safety systems over time.

Purpose of the Study:

• To evaluate and improve a hospital's patient safety system affected by high alarm burden.
• To understand environmental changes impacting surveillance system performance.
• To restore reliable system performance through a systems approach.

Main Methods:

• Implemented a systems approach to analyze and modify the care environment.
• Adjusted the continuous surveillance pulse rate alarm threshold to 40 beats per minute.
• Restandardized the peripheral capillary oxygen saturation alarm threshold to 80% and reset alarm response expectations.

Main Results:

• Bedside alarms for low peripheral capillary oxygen saturation decreased by 66.4% (P < .001).
• Bedside alarms for low pulse rate decreased by 71.2% (P < .001).
• Pager notifications significantly decreased for both peripheral capillary oxygen saturation low (84.5%, P < .001) and pulse rate low (93%, P < .001).

Conclusions:

• Clinical process standardization and continuous performance measurement are crucial for sustaining patient safety systems.
• Even stable systems require regular evaluation to prevent performance degradation due to practice drift.
• Interventions effectively reduced alarm burden, enhancing the reliability of critical patient monitoring.