A team-based approach to reducing cardiac monitor alarms

A team-based approach can reduce excessive cardiac monitor alarms and therefore alarm desensitization and fatigue, according to a study published in Pediatrics.

Researchers from the Cincinnati Children's Hospital Medical Center created and implemented a standardized cardiac monitor care process (CMCP) on a 24-bed pediatric bone marrow transplant unit. The goal: decrease monitor alarms through team-based standardized care and processes, according to the study.

The team created and implemented a CMCP that included:

1. A process for initial ordering of monitor parameters based on age-appropriate standards
2. Pain-free daily replacement of electrodes
3. Daily individualized assessment of cardiac monitor parameters
4. A reliable method for appropriate discontinuation of monitor

The researchers utilized a model for improvement to design, test and implement changes. The changes that were implemented after testing and adaption were: family and patient engagement in the CMCP; creation of a monitor care log to address parameters; lead changes; discontinuation; development of a pain-free process for electrode removal; and customized monitor delay and customized threshold parameters, according to the study.

The intervention, which took place from January to November 2013, led to a decrease in the median number of alarms per patient-day from 180 to 40. “We recommend a team-based approach to monitor care, including individualized assessment of monitor parameters, daily lead change and proper discontinuation of the monitors,” concluded the authors.