Regaining Reliable Patient Physiologic Surveillance System Performance After Nursing Practice Drift: An Example of Continuous Quality Improvement.

Abstract

Physiologic surveillance systems are intended to notify nurses of patient deterioration but can be rendered ineffective when alarm burden is high. Nurses reported increased alarm burden, loss of confidence that alarms signaled actionable events, and alarm fatigue. Additionally, standard quality assurance tracking indicated a need to evaluate comprehensively the hospital's crucial patient safety system. A systems approach was used to understand changes in the care environment and regain reliable system performance after practice drift. Interventions included decreasing the continuous surveillance pulse rate alarm threshold to 40 beats per minute, restandardizing the peripheral capillary oxygen saturation alarm threshold to 80%, and resetting expectations for alarm response and utilization of alarm escalation pagers. Bedside alarms per patient day decreased by 66.4% (P < .001) for peripheral capillary oxygen saturation low and by 71.2% (P < .001) for pulse rate low. Initial pager notifications per patient day decreased by 84.5% (P < .001) for peripheral capillary oxygen saturation low and by 93% (P < .001) for pulse rate low. Even systems that are stable for long periods are subject to practice drift. This study underscores the importance of clinical process standardization and continuous measurement of system performance with feedback to sustain performance of the patient safety systems nurses rely on.