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Sustainability of bundled approaches to alarm fatigue: Lessons from a long-term quality improvement study
Shogo Akahoshi1,2, Shun Nagasawa1,3, Kentaro Fukuda1,4
1Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
Insights
Physiological monitor alarms in pediatrics cause fatigue. Interventions reduced alarm frequency but were unsustainable, requiring a durable framework for long-term success.
Area of Science:
- Pediatric critical care
- Clinical engineering
- Patient safety
Background:
- Physiological monitor alarms are vital but cause alarm fatigue, especially in pediatrics due to patient movement and crying.
- Excessive, non-actionable alarms lead to reduced responsiveness and potential patient harm.
- The long-term effectiveness of strategies to mitigate alarm fatigue is not well understood.
Purpose of the Study:
- To assess the long-term impact of quality improvement initiatives aimed at reducing physiological monitor alarm frequency.
- To evaluate the sustainability of implemented alarm management strategies in a tertiary pediatric center.
Main Methods:
- A quality improvement initiative with two intervention phases and non-intervention periods was conducted from January 2016 to February 2024 across nine pediatric wards.
- Interventions included monthly data review, daily electrode replacement, discussions on monitoring discontinuation, patient-specific alarm thresholds, and setting reminders.
- Alarms were classified as Advisory, Warning, or Crisis. Daily alarm frequency per patient (ppd) was the primary outcome, analyzed using interrupted time series analysis.
Main Results:
- Analysis of over 46 million alarms in 65,720 pediatric patients revealed significant fluctuations in alarm frequency.
- The first intervention phase reduced alarm frequency from ~143 ppd to 99 ppd, but it increased to 124 ppd during the non-intervention period.
- The second intervention phase achieved the lowest frequency (86 ppd), yet it surged to the highest level (165 ppd) during the subsequent non-intervention period. Crisis alarms consistently decreased in the final phase.
Conclusions:
- Implemented alarm management interventions temporarily reduced alarm frequency in pediatric settings.
- The observed reductions were not sustainable long-term without continuous reinforcement.
- Achieving lasting success in reducing alarm fatigue necessitates integrating countermeasures into a robust and durable operational framework.
Background:
Physiological monitor alarms are critical for detecting abnormalities but often cause alarm fatigue due to excessive, nonactionable events. This issue is pronounced in the pediatric setting, where movements and crying increase the alarm frequency. The long-term feasibility of countermeasures to reduce alarm fatigue remains underexplored.
Objectives:
To evaluate the long-term outcomes of alarm countermeasures implemented through a quality improvement initiative.
Methods:
From January 2016 to February 2024, two intervention phases were implemented in nine wards of a tertiary pediatric center, with each phase being followed by a nonintervention period. The first intervention involved monthly data assessment, daily electrode replacement, and discussions about monitoring discontinuation criteria. The second intervention introduced patient-specific alarm thresholds and reminders to reconsider monitoring settings. Alarms were categorized as Advisory, Warning or Crisis. The primary outcome was daily alarm frequency per patient (ppd). A negative binomial regression was used for interrupted time series analysis.
Results:
Overall, 46,302,740 alarms in 65,720 patients were analyzed. The alarm frequency declined from approximately 143 ppd to 99 ppd during the first intervention phase but rose to 124 ppd in the subsequent nonintervention phase. In the second intervention phase, the frequency declined to 86 ppd, the lowest value recorded, but rebounded to 165 ppd, the highest level, during the nonintervention phase. Advisory and Warning alarms showed a similar trend while Crisis alarms decreased consistently in the last phase.
Conclusions:
The interventions were associated with reduction in the alarm frequency but were unsustainable. Long-term success requires integrating countermeasures into a durable framework.
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