Pediatric Meaningful Alarm Management Approach Public Deposited

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  • March 20, 2019
  • Gilmore, Jessie
    • Affiliation: School of Nursing
  • The North Carolina Children’s Hospital staff on an acute care pediatric general medicine floor are subject to unnecessary physiological monitor alarming and are at high risk for alarm fatigue. Pediatric clinicians are faced with the daunting task of determining appropriate age-based vital sign parameters and often fail to order suitable vital sign parameters or correctly program physiological monitors. This breakdown in care magnifies the importance of implementing meaningful alarm use to reduce alarm fatigue in clinicians caring for pediatric patients and to prevent clinically significant adverse events through early detection. This project was a quality improvement study with the objective to improve cardiorespiratory monitor parameter practice adherence among clinicians through education. The first phase collected retrospective patient data to determine clinician adherence and to fully understand the burden of alarm fatigue on an inpatient acute care unit. Clinician adherence was measured by comparing electronic health records to physiological monitor settings and the relevance to actual patient data. The second phase analyzed the baseline data and applied the Institute for Healthcare Improvement’s Model for Improvement. After project completion, the intent was to have increased alarm parameter adherence and hence decreased alarm fatigue on the unit. I found a significant lack of alarm parameter adherence among the nursing staff. The alarm parameters routinely did not match the orders for each patient, and as a result, the patients alarmed excessively or had wider alarm parameter settings than what was ordered for them. This project highlighted the need for parameter customization for every child, using the default age groups as a guide for parameter orders. The average minimum respiratory rate value registered lower than the default alarm settings for all age groups, which indicates a strong association with the total number of low respiratory rate alarms. The intervention implemented in this project included strong emphasis on staff education for nurses and physicians. Also included were recommendations for policy and practice changes of physiologic monitoring, which remain in process and are expected to continue longer than the timeline of this project.
Date of publication
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Rights statement
  • In Copyright
  • Troxler, Heidi
  • Zegre-Hemsey, Jessica
  • Travers, Debbie
  • Doctor of Nursing Practice
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2017

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