Implementation of an Educational Program on Physiologic Monitor Alarm Management in an Intensive Care Unit

By LO Wai Shun Wilson, RN, BSN, MSc (ACP, Critical Care)
Hong Kong Sanatorium & Hospital

Purpose

The purpose of this project was to improve nurses’ attitudes toward alarm management, raise
staff awareness of clinical alarms, and increase the level of understanding and identifying thealarms with ease.

Background

The Intensive Care Unit (ICU) environment contains a plethora of high sensitivity yet low specificity false positive alarms. Although monitor alarms are crucial and sometimes lifesaving, nurses’ attitudes toward alarms are imperative. Based on observations, nurses may silence the alarms inappropriately, ignore alarms, delay alarm response, set the alarm parameters and volumes improperly, or even shut off the alarms

Methods

The Healthcare Technology Foundation Clinical Alarm Survey 2011 was adopted with permission. Nurses were recruited to participate in an educational program on physiologic monitor alarm management. Pre-implementation and Post-implementation data regarding nurses’ perceptions about clinical alarms were collected.

Results

Participants (n=29) were asked about their level of agreement with 19 statements regarding alarms. An educational program was implemented after the survey was first completed by participants. Many of the statements revealed no meaningful differences. Post-implementation survey respondents were more likely to agree with statements about alarm sounds differentiating the priority and parameter of alarm. Post-implementation survey respondents reported less confusion about determining which device is in an alarm condition. Respondents also ranked the importance of nine different alarm issues. In both pre- and post-implementation surveys, respondents ranked frequent false alarms as the most important issue.

Discussion

After conducting the educational program, it was identified that reduction of nuisance alarms must be made a high priority. Alarm ambassadors are selected for sustaining a positive culture and to continue good alarm stewardship. Alarms awareness programs for ST, QTc, Telemetry, Ventilator and Continuous Renal Replacement Therapy may be further explored. An audit of nurses’ and physiotherapists’ practice is recommended.

Implications/Conclusion

This evidence-based practice project improved staff understanding and ease of alarm identification. Staff awareness of clinical alarms was increased and nurses’ attitudes towardalarm management were also improved.