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NCH Healthcare System

NCH decreases nuisance alarms with alarm management reporting

Naples, Fla.-based NCH Healthcare System (NCH) was no stranger to alarm fatigue. Its nursing staff was overwhelmed with too many nuisance alarms that hindered their efficiency. To combat alarm fatigue, NCH established a game-changing process.

The two-hospital, 715-bed health system partnered with Cerner on a transformational alarm management strategy using CareAware®. Together, they reduced non-actionable alarms by 69 percent, without a negative impact on patient safety.

NCH began sending secondary alarms to the nurses’ Apple iPhones® in September 2013. The intent was to alleviate their burden and improve mobility; still, this step generated too many alarms. NCH then formed an interdisciplinary Alarm Safety Committee, including Cerner representatives, to drastically limit the types of alarms firing on the smartphones.

This group implemented numerous interventions — including proper skin preparation and changing the telemetry leads daily — to prevent alarm misfires. But it wasn’t enough.

Changing the culture of alarm safety

With a shared vision of using real-time data, NCH and Cerner perfected the Alarm Management Shift Report. The report analyzes the alarm ecosystem by displaying the frequency, number and type of alarms for each bed by the hour. Clinicians use this data to limit non-actionable alarms and redirect focus on those with potential impact to patient safety.

In March 2015, NCH incorporated the Alarm Management Shift Report into the workflow of a de-centralized, 45-bed telemetry unit. Armed with the shift report, the new alarm management strategy quickly generated results. By April, the total number of non-actionable alarms dropped from 255,912 in January to 79,486 — a 69 percent reduction in nearly four months.

“Our alarm management team has come a long way,” said Kevin Smith, RN, director II of cardiac telemetry services and integral contributor to the shift report. “There have been dramatic improvements. We’ve changed the whole culture of alarm safety.”

Linking outcomes to alarm management

Today, clinicians use this report daily to minimize alarm fatigue and provide a quieter, better care environment. Meanwhile, NCH is rolling out the alarm management process and shift reports to other units.

The health system is also working with Cerner on additional alarm improvements. NCH plans to give nurses access to real-time Alarm Hot Spot dashboards to show all of the individual alarms on their unit.

Additionally, NCH and Cerner are using the critical care solution, APACHE Outcomes™ to measure a possible link between severity-adjusted outcomes and alarm management. Together, they’re designing approaches to proactively alert clinicians to potential adverse events before they occur.

“We know that we have meaningful alarms, meaningful data — we can correlate that to a patient outcome, we can predict what’s happening and do interventions before we get to that place,” Smith said. “That’s what I’m excited about.”

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Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.