Chinn Urology

In many nursing units, patients are connected to monitors that signal dozens of different occurrences -- everything from cardiac arrest to a patient simply rolling over.

Alarm fatigue is the term for what happens when alarm sounds occur so frequently that caregivers may begin to tune them out.

Recognizing the concern with alarm fatigue across the county, Duke University Hospital charged the Monitoring Committee to study hospital practices in responding to cardiac monitor alarms.

The study found variability in nursing management of and response to alarms across various care units, due in part to differences in policies for monitoring and procedures for physician ordering of monitoring. This led to a significant performance improvement effort to standardize and streamline protocols not just at the hospital, but systemwide.

The study also identified a need to record data from cardiac monitors to measure caregivers’ response to alarms.

With the current monitoring system, there is no way of storing information gathered by monitors -- and therefore no means of reviewing if and when response was adequate. It is difficult to fully determine whether staff are providing optimal care per the defined protocols and policies.

“If you don’t measure it, you can’t improve it,” says Chris Granger, MD, chair of the study committee. Granger adds that recording and storage of data would allow physicians to review patients’ cases in a way that has not been possible before, even after patients leave the hospital.

The Monitoring Committee is evaluating technology products that can help with data storage and interpretation.

The review of the variability in process and method was compelling enough to escalate this project to a system-wide effort. Nurses, physicians, and technicians from the three DUHS hospitals are collaborating to achieve more reliable application of cardiac monitoring, including standardized measurements.

Greater standardization can lead to a better understanding of the core processes that need improvement, and that improvement will contribute to more effective and timely patient care.