Cardiac monitoring alarms on hospital units provide important information; however, unnecessary and too-frequent alarms can lead to apathy among nursing staff, a phenomenon known as "clinical alarm fatigue," which can result in patient harm. Ongoing audible alarms can increase patient anxiety as well. A multidisciplinary team at Boston Medical Center analyzed internal alarm data and observed nursing staff to develop more effective monitoring practices on a cardiology unit and used those observations to test changes they made to their alarm-management system. They modified their alarm system, adjusting alarm defaults and consolidating all patient cardiac information at a central console.

Heart rate default limits were expanded so that instead of a warning alarm sounding when the heart rate fell outside of 50 and 120 beats per minute, a crisis alert (requiring immediate nursing-staff attention) sounded when values fell outside of 45 and 130 beats per minute, which accommodated patients (such as those with congestive heart failure) who typically had "abnormally" high or low rates. The team upgraded warning alerts denoting accelerated ventricular rhythm, tachycardia, and bradycardia to crisis alerts. An advisory alert for measurements of 10 premature ventricular contractions per minute was downgraded to a message. Alerts denoting atrial fibrillation were upgraded to audible advisory alarms to help better single out paroxysmal occurrences; however, nurses were able to adjust the alert to nonaudible status for specific patients.

The pilot study was successful in decreasing audible alarms; maintaining (and likely enhancing) patient safety; and allowing nursing staff to focus on necessary tasks, including bedside patient care. The new settings resulted in an 89% reduction in audible alarms, reducing maximum noise levels from 90 dB to 72 dB. There were no incident reports related to cardiac monitor alarms during 7.5 months with the new settings, compared with one in the year before the study, and there was a 50% decrease in rapid response team activations, compared with the six months before implementation. Patient satisfaction increased, according to Press Ganey cardiology floor patient satisfaction percentile ranks. Similarly, nurses were satisfied with the alarm changes, with 64% rating the noise level as acceptable (compared with 0% previously).

In advice to other facilities eager to make similar changes, the authors write that empowering nurses to change default alarms when warranted and engaging the nursing staff are vital to successful implementation.

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