How Can We Safely Reduce 50% of Patient Monitor Alarms in the Surgical Intensive Care Unit? Samuel Galvagno, DO PhD1; Peter F. Hu, PhD1,2, Li-Chien Lee, MS1, Hsiao-Chi Li, PhD1, Shiming Yang, PhD1, Samuel Tisherman, MD2, Steven Gee, RN2, Peter Rock, MD1 1. Department of Anesthesiology, University of Maryland School of Medicine. 2. Department of Surgery, University of Maryland School of Medicine. 25% of alarms were less than 28 seconds (C1), 4 seconds (C2), 2 seconds (C3), and 4 seconds (C4). 50% of alarms were less than 322 seconds (C1), 10 seconds (C2), 13 seconds (C3), and 12 seconds (C4). Alarm fatigue Results 426,647 alarms were recorded during the study period resulting in 148 alarms per bed per day in the 24 bed Surgical Intensive Care Unit (SICU) The majority of the alarms were classified as “C1: and System Warning” (66,300, 15.5%); “C2: Patient Advisory” alarms (n = 245,779, 57.6%); “C3: Patient Warning” (98,024, 23%) Only 3.9% were in the “C4: Patient Crisis” alarm category. “We didn’t hear it” “We couldn’t tell what was alarming” “We just got too busy” “Things were just crazy that day” “The place is like a casino with so many bells and whistles” Background Alarm fatigue is a critical patient safety concern Hypothesis: a significant reduction in the number of monitor alarms can be achieved by instituting a short delay (seconds) in activating the alarm to eliminate brief, transitory alarms, and by changing alarm limits SpO2 Low SpO2% ≤ 90%  88% 41% Methods Retrospective analysis of patient vital signs in a 24-bed Surgical Intensive Care Unit Alarm data were collected between October 12, 2015 and February 15, 2016 Data were obtained from networked vital signs monitors (GE Solar ®) using the BedMasterEX® system Duration (seconds) was analyzed to achieve alarm reductions of 25% then 50% To reduce individual VS alarms, different alarm limit settings were compared with the default settings of hypoxia (SpO2 low ≤ 85%,) and tachycardia (heart rate: HR high ≥ 130 bpm) Fig 2: SpO2 low limit change from the default setting (SPO2 ≤ 85%) and associated alarm reduction ( frequency n, change % and duration in hrs.) Fig 1: 24 Beds SICU Alarm reduction study. 18 weeks pre and 8 weeks post intervention (44% total alarm reduction) Tachycardia HR ≥ 130  ≥ 135 bpm 40% Alarm (Top 10) Total N 1 2 3 4 5 6 7 8 9 10 Level Category (C1) System Warning 66300 (15.5%) SPO2 PROBE NO ECG CONNECT PROBE NBP MAX TIME SENSOR ARRHY SUSPEND SPO2 SENSOR NBP FAIL RR LEADS FAIL NBP OVER PRES 33.4% 23.6% 16.2% 14.7% 5.8% 4.6% 1.0% 0.4% (C2) Patient Advisory 245779 (57.6%) ART S LO PVC CHECK ADAPTER ART S HI NBP S LO ART M LO CO2 RSP HI NBP S HI ART D HI ART M HI 25.7% 15.7% 13.6% 13.3% 6.2% 4.7% 4.2% 3.5% 3.4% 2.7% (C3) Patient Warning 98024 (23.0%) SPO2 LO ART DISCONN V TACH VT > 2 NO BREATH FEM2 DISCONN HR HI   93.4% 2.8% 1.8% 1.1% 0.9% 0.0% (C4) Patient Crisis 16544 (3.9%) LEADS FAIL HR LO BRADY  V TACH  ASYSTOLE  V BRADY  VFIB/VTAC  27.1% 25.0% 14.9% 12.4%  11.8%  6.5%  1.4%  0.6%  0.3%  Fig 3: Heart rate high limit change from the default setting (130) and associated alarm reduction (frequency n, change % and duration in hrs.) Triple-redundant BedMaster® VS System Next Step: Hospital wide alarm dashboard Target: Reduce 30% alarms in 12 months Near 100% complete VS and alarm collection Conclusion 4-month data from 24 SICU beds Alarm fatigue from physiologic alarms is a well recognized problem A viable solution to safely reduce alarms has not been established Delaying all alarms for 4 seconds could reduce 31% of the total alarms Lowering alarm thresholds of the lower SpO2 limit by 2% and increasing the tachycardia threshold by 5 bpm could reduce 41% and 40% of alarms for SpO2 and tachycardia respectively Further study is needed to determine what impact such changes would have upon the safety of patients being cared for in the SICU Table 1: Top 10 most frequent alarms in each category Supported by University of Maryland School of Medicine, Department of Anesthesiology and University of Maryland Medical Center.