Background: The rapid deployment of technology enabled care has led to the unintended consequence of alert/alarm fatigue and desensitization, which poses risk of health care providers missing alerts that require immediate action to improve patient outcomes. Alert fatigue occurs when: 1) clinicians are exposed to multiple alerts and alarms, and do not have the time to process which alerts are relevant and 2) when most alerts clinicians are exposed to are false or irrelevant to their specific workflow. Among the alerts and alarms that clinicians are exposed to, about 80-90% have been identified as of not requiring any clinical action by the user.
Objective: This quality improvement project focused on reducing alert fatigue through removal and redesign of unactionable high firing disruptive electronic health record alerts.
Methods: The top 4 high firing alerts were identified through the BPA tune up report. Empathy mapping sessions and review of user feedback was used to capture users' behaviours and attitudes on the identified alerts.
Redesign Intervention: Re-designing of the top 4 disruptive high firing low yield BPAs was guided by user research results, clinical decision support tool design principles, and expected nursing practices and behaviours. All 4 disruptive BPAs did not require an immediate action from the nurse when it appeared in the electronic health record in their workflow. Recommended design changes were reviewed and approved through the organizations nursing practice councils and clinical decisions support committees.
Results: Four disruptive alerts were removed from the electronic health record system which released 877 unactionable nursing hours a year. Future work will focus on to strengthening the use of alert design principles to continue to monitor and respond to alert fatigue and ensure new electronic health record alert request meet clinical needs without contributing to unactionable disruptive time to care.
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