Boston Medical Center innovation reduces alarm fatigue

A pilot at Boston Medical Center that reduced clinically significant alarms in its cardiac unit made it easier for nurses to respond to alarms signaling genuine problems, according to the Agency for Healthcare Research and Quality (AHRQ).

The center implemented a series of interventions, including expanding the default parameters that trigger alarms due to low and rapid heart rates and elevating heart rate alarms and other rhythm violation alarms previously identified as “warning” alarms that do not require a nurse response to "crisis" alarms that do require such a response. The center added an audible alarm for atrial fibrillation episodes to the existing visual alarm, allowing two nurses—with a physician’s approval—to collaborate to change alarm parameters for individual patients.

The initiative reduced audible alarms by 89 percent—from 87,823 during the two weeks prior to implementation to 9,967 per week during the six-week pilot—with no adverse events attributed to the changes, according to AHRQ’s profile of the innovation. It also significantly increased satisfaction among both nurses and patients.

Nurses who rated the noise level as acceptable rose from 0 percent before the pilot began to 64 percent when it ended. Nurses also expressed less irritation with the alarms and reported feeling less drained going home at the end of their shift, according to AHRQ.