@article{4093,
  keywords = {Model for Improvement, Plan-Do-Study-Act, alarm fatigue, cardiac monitor, quality improvement},
  author = {Christopher E. Dandoy and Stella M. Davies and Laura Flesch and Melissa Hayward and Connie Koons and Kristen Coleman and Jodi Jacobs and Lori Ann McKenna and Alero Olomajeye and Chad Olson and Jessica Powers and Kimberly Shoemaker and Sonata Jodele and Evaline Alessandrini and Brian Weiss},
  title = {A team-based approach to reducing cardiac monitor alarms.},
  abstract = {<p><b>BACKGROUND AND OBJECTIVES: </b>Excessive cardiac monitor alarms lead to desensitization and alarm fatigue. We created and implemented a standardized cardiac monitor care process (CMCP) on a 24-bed pediatric bone marrow transplant unit. The aim of this project was to decrease monitor alarms through the use of team-based standardized care and processes.</p><p><b>METHODS: </b>Using small tests of change, we developed and implemented a standardized 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; and (4) a reliable method for appropriate discontinuation of monitor. The Model for Improvement was used to design, test, and implement changes. The changes that were implemented after testing and adaptation were: family/patient engagement in the CMCP; creation of a monitor care log to address parameters, lead changes, and discontinuation; development of a pain-free process for electrode removal; and customized monitor delay and customized threshold parameters.</p><p><b>RESULTS: </b>From January to November 2013, percent compliance with each of the 4 components of the CMCP increased. Overall compliance with the CMCP increased from a median of 38% to 95%. During this time, the median number of alarms per patient-day decreased from 180 to 40.</p><p><b>CONCLUSIONS: </b>Implementation of the standardized CMCP resulted in a significant decrease in cardiac monitor alarms per patient day. We recommend a team-based approach to monitor care, including individualized assessment of monitor parameters, daily lead change, and proper discontinuation of the monitors.</p>},
  year = {2014},
  journal = {Pediatrics},
  volume = {134},
  pages = {e1686-e1694},
  month = {12/2014},
  issn = {1098-4275},
  doi = {10.1542/peds.2014-1162},
  language = {eng},
}