• Christopher E Dandoy, Stella M Davies, Laura Flesch, Melissa Hayward, Connie Koons, Kristen Coleman, Jodi Jacobs, Lori Ann McKenna, Alero Olomajeye, Chad Olson, Jessica Powers, Kimberly Shoemaker, Sonata Jodele, Evaline Alessandrini, and Brian Weiss.
• Divisions of Bone Marrow Transplantation and Immunodeficiency, and James M. Anderson Center for Health Systems Excellence, christopher.dandoy@cchmc.org.
• Pediatrics. 2014 Dec 1; 134 (6): e1686-94.

Background And ObjectivesExcessive 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.MethodsUsing 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.ResultsFrom 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.ConclusionsImplementation 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.Copyright © 2014 by the American Academy of Pediatrics.

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