Eliminating False Alarms Can Increase Safety of Patients in Burn ICU: Study

Interventions implemented in a specialized intensive care unit at a North Carolina hospital helped to reduce false alarms and alarm fatigue among nurses, increasing the quality of care for critically injured patients, according to the findings of a new study.

Monitoring and attending to bed alarms in the ICU can be difficult, when some alarms do not alert nurses to real concerns. This can result in alarm fatigue, when nurses must attend to multiple alarms, sometimes of no significance. As a result, they can become desensitized to the alarms, to the point that critical warnings may not receive the response needed or the response could be delayed.

Research published this week in the medical journal Critical Care Nurse highlights how one hospital was able to reduce alarm fatigue by more than 50% by implementing interventions before patients were admitted.

The study involved a collection of baseline data on alarm counts per patient by day and alarm type for one month in a Burn Intensive Care Unit (BICU) at the North Carolina Jaycee Burn Center at University of North Carolina Medical Center, Chapel Hill. Data was collected before interventions and education were implemented, then data was collected every six months for two years after new interventions were put in place.

Interventions included raising awareness of about the risks linked with alarm fatigue, customizing alarm parameters and default settings, providing education on electrode placement and daily electrode changes, using physical reminders, and consistently sharing alarm data.

In burn ICUs, reducing alarm fatigue is challenging, because of the patients are often critically ill. In 2016, estimates indicated 486,000 burn injuries required medical attention. In 2013, more than 54,000 patients with burn injuries required inpatient stays. Of those, 10.5% required intubation and mechanical ventilation.

These types of conditions require frequent monitoring of alarms and responding to the alarms. For example, patients with inhalation injuries or burns involving the face and neck sometimes require continuous monitoring of heart rate and oxygen saturation, but false alarms can lead nurses to suffer alarm fatigue.

According to the findings, the interventions helped to significantly reduce the total alarm rate over time and researchers were able to reduce the number of alarms by more than 50%.

Prior to the interventions, in January 2016, the overall number of alert alarms was higher than the numbers of critical and inoperative alarms. This means nurses were responding to more alarms for non-critical issues than they were to alarms that indicated critical problems.

After researchers implemented the interventions, the number of alarms per patient day was lower than at the January 2016 baseline. Fewer unactionable alarms occurred at each point post-intervention than at the January 2016 baseline.

Similarly, fewer critical alarms also occurred in June 2016 than at the January 2016 baseline.

“Even in a highly specialized BICU with critically ill patients and multiple monitoring challenges due to burn skin injuries, changes can be made to reduce non-actionable alarms and ultimately reduce alarm fatigue,” the researchers reported.