The Nurse’s Perspective and responsibilities Alarm Fatigue: The Nurse’s Perspective and responsibilities
What is Alarm Fatigue? For staff on the floor, it’s too easy to relate to Staff can experience as many as 700 alarms per patient per day Monitor alarms seem to be constantly beeping, honking, chirping, etc… Nurses and other staff become desensitized to the alarms Alarms become background noise instead of a serious alert.
What contributes to alarm fatigue? Nuisance alarms related to: Improper lead placement for telemetry Patient movement and artifact Poor signal strength/batteries low Excessive monitoring, i.e. monitoring patients who do not need to be monitored Nurses and other staff silencing alarms Turning down the volume on the monitor Improperly set parameters Lack of policy regarding monitors and alarms
What are the consequences of alarm fatigue? From January 2009 – June 2012 the Joint Commission reported: At least 80 alarm related deaths At least 13 serious alarm related injuries Injuries and deaths were related to falls, medication errors, delay in response, and ventilator use Top technology hazard for 2013
What can we as nurses do to prevent alarm fatigue? Know the policy regarding the monitors Know who is allowed to silence alarms and change a patient’s parameters Set appropriate parameters for each individual patient. For example, know the goal oxygen level for a patient with COPD and set alarms around that range Prevents unnecessary alarming and habits of silencing Follow proper lead placement for telemetry Ensure equipment is working properly and receiving a good reading Change batteries in an appropriate time frame Pause the alarm for a patient that is going to be disconnected for long time – in the shower, off the floor, etc…
What are impairs nurses from effectively responding to alarm fatigue? High patient – nurse ratio Busy assignment Lack of evidence based practice regarding alarm fatigue – relatively new issue Need for better monitoring technology. Need for a multidisciplinary approach While nurses need to embrace a cultural change regarding monitor alarms, it is not only a nursing problem!
Reflective Note In nursing, many policies are covered via in-services. I imagined that teaching regarding alarm fatigue would be a great subject for an in-service. The teaching is geared towards the clinical staff on a nursing floor. The audience could potentially be my peers, subordinates, or superiors. In addressing this audience, I kept in mind that the information needed to presented clearly and quickly, as many in- services are squeezed into the work day or done during lunch breaks. No one ever really wants to or has time to sit through a long presentation. I organized the information in bullet points so it is easy to read and easier to remember, as compared to a paragraph. I included graphics to keep the audiences focus, but tried to limit them as to not be distracting.
References http://www.amednews.com/article/20130424/profession/130429992/8/ http://www.medscape.com/viewarticle/805050 http://bangordailynews.com/2013/07/08/health/alarm-fatigue-leads-hospital- caregivers-to-ignore-beeps-posing-risks-for-patients/ http://www.aami.org/publications/bit/2012/JA_alarm_fatigue.pdf