Boston Medical Center (BMC) of Boston, MA, was selected as a finalist for ECRI Institute's 5th Health Devices Achievement Award for its work to reduce nuisance alarms by standardizing the alarm defaults used for the telemetry monitors in its various care areas.
The Health Devices Achievement Award recognizes outstanding initiatives undertaken by member healthcare institutions to improve patient safety, reduce costs, or otherwise facilitate better strategic management of health technology. ECRI Institute announced the winner and four other finalists for the 5th award in October 2010. Learn about the other submissions that achieved recognition.
Boston Medical Center (BMC), like most hospitals, has struggled with alarm management. But the facility was spurred to try a new approach by two separate findings. The first was that clinical engineering staff noted wide disparities in alarm limits across different care areas, a problem that was particularly acute with the facility's telemetry systems. The second was that a large number of low-level alarms were experienced in care areas that used telemetry, contributing to the noise in these care areas (and presumably to alarm fatigue).
These findings led the hospital administration to investigate the benefits of standardizing alarm limit defaults to reduce nuisance alarms. When the complexity of the undertaking became clear, BMC created a Telemetry Process Committee, which included the chief medical officer, clinical engineering staff, the nursing director, and representatives from a variety of clinical disciplines, including attending physicians, nurse educators, a chief medical resident, and a nurse practitioner.
The committee was asked to perform a holistic review of telemetry capabilities, process improvements, ownership (in terms of responsibility for telemetry-related decisions), policy enforcement, and education, as well as to develop approaches to address any problems that were identified. The committee agreed on several priorities—including review of alarm settings, development of standardized order sets, and education and oversight of clinicians—as well as several long-term strategies (e.g., addressing methods of alarm communication).
Reviewing and standardizing alarm defaults across the 12 areas that use telemetry was a key task of the Telemetry Process Committee. The primary goal of the standardization process was to reduce the number of nuisance alarms. Complementing this work was the creation of an enhanced telemetry order set in BMC's computerized provider order-entry system. The new order set helps ensure that patients receiving telemetry really need it.
The committee also created a telemetry training course for nurses, as well as a telemetry orientation program for medical interns. Development of the training materials was made easier by the fact that the facility had already standardized the way telemetry was used hospital-wide. And having clinicians from across the hospital receive the same training reinforced the principles guiding the standardization.
In addition to reducing nuisance alarms, the work of the Telemetry Process Committee helped BMC efficiently add nearly 100 telemetry beds in two months.
Best Practices for Other Facilities
BMC is not alone in its struggle to manage alarms. The pervasiveness of the kinds of problems that the BMC project addressed is evidenced by the numerous Guidance Articles and Hazard Reports on alarm management and alarm fatigue that we've published over the years, as well as the constant presence of this topic on our annual Top 10 list of healthcare technology hazards. It's interesting to note that alarm management was the subject of the winning submission for the first Health Devices Achievement Award, which was issued to William Beaumont Hospital in 2006 for a project that resulted in a 93% improvement in response times to critical alarms.
Thus, the problems that BMC addressed with its initiative, including different alarm defaults in different areas of the hospital, will be familiar concerns for many hospitals. Facilities faced with such problems can learn not only from BMC's actions, but also from the process that it followed: BMC formed a multidisciplinary committee, bringing together nurses, physicians, and clinical engineering staff to develop solutions that the groups might not have discovered separately, but that were acceptable to all.