Title : Transforming alarm management in the ITCU through the CEASE bundle: A quality improvement project to reduce alarm fatigue and enhance safety
Abstract:
Background: Excessive non-actionable clinical alarms contribute to alarm fatigue, a state of desensitization that delays or prevents response to genuine emergencies. Evidence suggests up to 99% of clinical alarms may not require action. A sentinel event involving an unrecognized ventilator disconnection in the Long-Term Care Unit (LTCU) at NMC Royal Hospital Sharjah prompted the development of this project to establish a structured alarm management protocol .
Aim: To reduce alarm fatigue among LTCU nurses by implementing the CEASE bundle (Communication, Electrodes, Appropriateness, Setup, Education), while improving staff awareness of alarm fatigue, decreasing non actionable alarms, strengthening interprofessional collaboration, and enhancing overall patient safety.
Methods: The project applied the DMAIC (Define, Measure, Analyze, Improve, Control) framework. Root cause analysis identified missing protocols, high nurse-to-patient ratios, and equipment faults as primary drivers of alarm fatigue. A literature review informed development of the CEASE bundle. Pre- and post-intervention data were gathered overfive days using the Healthcare Technology Foundation alarm survey and alarm-count logs. Implementation combined staff education, hands-on training, and collaboration among nurses, biomedical engineers, and quality staff, with compliance audits sustaining gains in the control phase.
Results: Peak-day alarms per patient decreased by 20%, from 25 to 20 (Table 1). Post-intervention surveysshowed increased nurse confidence and competence in distinguishing actionable from non-actionable alarms, and fewer nursesreported feeling overwhelmed by alerts. Equipment-related alarms declined following closer coordination with biomedical engineering, and adherence to alarm-setting protocolsimproved across shifts.
Conclusion: The CEASE bundle reduced alarm fatigue and strengthened patientsafety in the LTCU through a structured, evidence-based, multidisciplinary approach. Sustaining these gains will require continued auditing, refresher training, and equipment maintenance. The project offers a scalable model for alarm management in other highacuity care settings.
