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EBP

Practice Problem:The use of audible alarms to monitor pediatric patients is crucial to patient care. Alarms notify nurses of potentially life-threatening situations. However, increasing non-actionable alarms can cause desensitization. This leads to ignoring and mismanaging alarms, ultimately putting patients at serious risk. For those caring for the sickest pediatric patients, strategies for reducing non-actionable alarms to mitigate alarm fatigue are needed to enhance patient safety.

Literature/Evidence:A review of the literature highlighted emerging evidence-based practice supporting the use of the CEASE bundle for nurse-led alarm management, as outlined in a quasi-experimental research study. Multiple systematic reviews substantiate the effectiveness of the interventions within the CEASE bundle.

Practice Change(s):CEASE is an acronym for Communication, Electrodes (daily changes), Appropriateness (evaluation), Setup alarm parameters (patient customization), and Education (initial and ongoing). These strategies work together to reduce the level of non-actionable alarms.

Implementation/Pilot Testing:A pilot of the CEASE Bundle was conducted in a pediatric intensive care unit (PICU). Pre-pilot survey data was collected on alarm management practices and perceived alarm fatigue. The PICU staff received educational sessions on alarm management and the CEASE bundle, followed by a 5-day pilot period during which nurses implemented the bundle. Alarm data was collected before, during, and after the pilot, and survey data was gathered from participating PICU nurses after the pilot.

Outcomes/Results:During the pilot period, there was a 44.17% reduction in physiological alarms on the unit compared to pre-pilot data. The pre/post survey results did not show a decrease in perceived alarm fatigue from participants but did show a decrease in the perceived frequency of non-actionable alarms and in complaints from patients/families about the level of alarms.

Recommendations/Conclusions:During this pilot period, the CEASE bundle effectively reduced the number of alarms in the PICU. Further study is recommended to understand the impact on staff's perceived alarm fatigue.

References:
1) Bach, T. A., Berglund, L.-M., & Turk, E. (2018). Managing alarm systems for quality and safety in the hospital setting. BMJ Open Quality, 7(3). DOI: 10.1136/bmjoq-2017-000202
2) Bi, J., Yin, X., Li, H., Gao, R., Zhang, Q., Zhong, T., … Li, Z. (2020). Effects of monitor alarm management training on nurses’ alarm fatigue: A randomised controlled trial. Journal of Clinical Nursing, 29(21–22), 4203–4216. DOI: 10.1111/jocn.15452
3) Bonafide, C. P., Localio, A. R., Holmes, J. H., Nadkarni, V. M., Stemler, S., MacMurchy, M., … Keren, R. (2017). Video Analysis of Factors Associated With Response Time to Physiologic Monitor Alarms in a Children’s Hospital. JAMA Pediatrics, 171(6), 524–531. DOI: 10.1001/jamapediatrics.2016.5123
4) Bosma, S., & Christopher, R. (2023). Implementing a Unit-Based Alarm Management Bundle for Critical Care Nurses. Critical Care Nurse, 43(2), 36–45. DOI: 10.4037/ccn2023418
5) Dee, S. A., Tucciarone, J., Plotkin, G., & Mallilo, C. (2022). Determining the Impact of an Alarm Management Program on Alarm Fatigue among ICU and Telemetry RNs: An Evidence Based Research Project. SAGE Open Nursing, 8. DOI: 10.1177/23779608221098713
6) Engel, J. R., Lindsay, M., O'Brien, S., Granger, C. B., Moore, E. S., Hughes, T., … Fuchs, M. A. (2022). Health System Redesign of Cardiac Monitoring Oversight to Optimize Alarm Management, Safety, and Staff Engagement. The Journal of Nursing Administration, 52(10), 511–518. DOI: 10.1097/NNA.0000000000001192
7) Gül, G., & İntepeler, Ş. S. (2021). Ensuring Specificity as a Strategy for Increasing Alarm Safety. Journal of Basic and Clinical Health Sciences, 7(3), 139-147.
8) Lewandowska, K., Weisbrot, M., Cieloszyk, A., Mędrzycka-Dąbrowska, W., Krupa, S., & Ozga, D. (2020). Impact of Alarm Fatigue on the Work of Nurses in an Intensive Care Environment-A Systematic Review. International Journal of Environmental Research and Public Health, 17(22), 8409. DOI: 10.3390/ijerph17228409
9) Lewis, C. L., & Oster, C. A. (2019). Research Outcomes of Implementing CEASE: An Innovative, Nurse-Driven, Evidence-Based, Patient-Customized Monitoring Bundle to Decrease Alarm Fatigue in the Intensive Care Unit/Step-down Unit. Dimensions of Critical Care Nursing, 38(3), 160–173. DOI: 10.1097/DCC.0000000000000357
10) López‐Espuela, F., Rodríguez‐Martin, B., Lavado García, J., Toribio‐Felipe, R., Amarilla‐Donoso, F. J., Rodríguez Almagro, J. J., … Moran‐García, J. M. (2022). Experiences and mediating factors in nurses' responses to electronic device alarms: A phenomenological study. Journal of Nursing Management, 30(5), 1303–1316. DOI: 10.1111/jonm.13614
11) Nyarko, B. A., Nie, H., Yin, Z., Chai, X., & Yue, L. (2023). The effect of educational interventions in managing nurses' alarm fatigue: An integrative review. Journal of clinical nursing, 32(13-14), 2985-2997. DOI: 10.1111/jocn.16479
12) Ruppel, H., Pohl, E., Rodriguez-Paras, C., Froh, E., Perry, K., McNamara, M., … Bonafide, C. P. (2023). Clinician Perspectives on Specifications for Metrics to Inform Pediatric Alarm Management. Biomedical Instrumentation & Technology, 57(1), 18–25.
13) Shaoru, C., Hui, Z., Su, W., Ruxin, J., Huiyi, Z., Hongmei, Z., & Hongyan, Z. (2023). Determinants of Medical Equipment Alarm Fatigue in Practicing Nurses: A Systematic Review. SAGE Open Nursing, 9. DOI: 10.1177/23779608231207227
14) Stoltzfus, K. B., Bhakta, M., Shankweiler, C., Mount, R. R., & Gibson, C. (2019). Appropriate utilisation of cardiac telemetry monitoring: a quality improvement project. BMJ Open Quality, 8(2), e000560. DOI: 10.1136/bmjoq-2018-000560
15) Zadvinskis, I. M., Schweitzer, K., Murry, T., & Wood, T. (2018). Tele Talks: Nurse‐Led Discussions Regarding Need and Duration of Cardiac Telemetry May Impact Alarm Fatigue, Empower Nurses, and Reduce Cost. Worldviews on Evidence-Based Nursing, 15(4), 323–325. DOI: 10.1111/wvn.12294

Publication Date

9-27-2024

Keywords

EBP, Evidence-Based Pracitce, Evidence-Based Nursing

Disciplines

Pediatric Nursing

CEASE the Alarms: A Nurse-Led Bundled Approach to Alarm Management

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