PICO Question
In nursing staff working in the Critical Care Unit, do the control of false alarm, compared to no intervention, reduce the false alarm fatigue?
P (Population): Nursing staff in a Critical Care Unit
I (Intervention): control the occurrence of false alarms in critical care units.
Control: No intervention
O (outcome): the possible outcome of implementing the intervention is the reducing annoying/bothersome alarms. Prevent ICU staff from becoming desensitized to the alarms (Alarm fatigue).
Critical Thinking questions: what are the best methods which are helpful and recommended to reduce and fight false alarms which in-turn reduces alarm fatigue among the ICU nurses and the entire staff?
The method of Evaluation: Research literature to find the best practices related to alarm monitoring without causing alarm fatigue. Once relevant research is done, I will then write a paper on what changes would be beneficial and safe to make and the best ways to implement the necessary modifications and changes.
Healthcare Systems Background/ Statement of Purpose
The healthcare systems are increasingly transforming technologically to provide the patients with advanced treatment options. At the same time organizations and clinicians tend to give the best to thus utilizing the increased growth of technology and thus innovation of medical devices and systems; thus the issue of alarm fatigue progressively contribute to patient safety in critical care units across the hospitals.
The article research on different sources to discuss the increasingly emerging topic in the healthcare settings principally in the critical care unit. Alarm fatigue has been defined in many different ways by different physicians, clinicians and different organization including The Joint Organization (TJC). According to Jim & Kae of PubMed (2013), Alarm fatigue is, therefore, defined as sensory overwork when the clinicians are exposed to an infinite number of alarms and overabundance transmission of medical devices such as blood pressure monitors, ventilators, ECG (Electrocardiogram) machines. As a result clinicians including the ICU nurses become desensitized, or rather they become immune to sound and thus lacking information on the current situation thus leading to alarm fatigue, which has then attributed to the mass death of patients in the intensive care unit. The research was conducted to determine how nurses in the ICU, can intervene and help to reduce the alarm fatigue. The demonstrates possible strategies that can be implored by nurses to curb alarm fatigue, including the provision of appropriate skin penetration for electrocardiogram electrodes, changing of ECG electrodes, provision of awareness and education on warnings, prior monitoring of the patients with clinical indications and also customization of signal parameters and the levels of ECG monitors.
The ECRI Institute which is a non-profit and federally designated organization to work on the safety of the patients identified the alarm fatigue to be the first health hazard innovated medical device in 2012. Articles by the Boston Globe states that several cases have been reported in adverse patient outcomes, including deaths due to failures of cardiac monitor alarms which were not responded due to the increased alarm fatigue in units. HTF also conducted several surveys, and in 2011 the study carried out indicated that five institutions chosen for research experienced adverse patient events linked with alarm failure problems (HTF 2011).
ICU nurses and Their Advanced Skills
Dealing with the case of Alarm Fatigue is something that needs a lot of strategies so as to stop compromising the patient safety and thus ICU thus strategies by offering the nursing unit to help in the premises. The ICU nurses use their more advanced skills and knowledge to take great care of the patients who are then in critical condition. The nurses are hence subjected to certain duties which include: daily checking on the patient’s conditions, giving treatments such as cleaning the wounds and assisting the physicians in performing various procedures to the patient. The ICU nurses also monitor the proper functioning of the medical equipment and also administers intravenous fluids, ordering diagnostics tests, and the ICU nurse act as the patient advocate.
In the Intensive Care Unit, there is a staff of nurses that work hand in hand to realize their goals. The team consists of Nurse Unit Managers, Associate Nurse Unit Managers who are there to assist the Unit Managers on a day to day management, Critical Care Liaison Service who provides support to the patients and their respective families. The staff also have Clinical Nurse Educators that provides regular lectures to the nurses and also gives after hours support to the other nurses. The unit then extendedly employ’s the Organ Donation Nurse Specialists who helps patients who wish to become tissue or or4gan donor through different programs imposed. Nurse Donation Specialist also provides lectures to all other staff in the medical or nursing field. All these people from the ICU nursing staff that work in conjunction to provide significant monitoring to the patient thus working effortlessly to fight the alarm fatigue which imposes danger to the life of the patients at the critical care units. The purpose of this project was then to identify helpfully and recommended methods to address the problem of alarm failures in the critical care units regarding effects impounded by the problem to Intensive Care Unit nurses.
Signal Analysis Literature Review
The literature review on the topic of signal analysis was performed with the help of databases such as Pub Med, Action For Better HealthCare, HJF and ECRI giving information between 2010 and 2014. Keywords of the research included alarm fatigue, false alarms, nursing staff and the duties assigned to them, monitor alarms and ways of reducing alarm fatigue problems. In AAMI notes in the recent safety innovations series, about alarm management, many hospitals have been establishing an alarm management programs due to the advice of the joint commission for the hospitals to give the best compilation practices.
The Joint Commission after realizing the patient’s risk associated with the clinical alarm, TJC developed national patient goal safety related clinical alarms creating alarm style management in 2013. This paper is thus written to highlight possible ways which are helpful and recommended for reducing the alarm fatigue is because alarm fatigue has become of great concerning and according to research it is considered the leading health technology hazard (ECRI institute’s top 10 health technology hazards) in 2010 and 2011. Different hospitals have been experiencing various major events that draw attention on the shortcomings of alarm systems. The Safe Medication Institute had stated in a report that they lost an 18-year-old boy. Whom after surgery had been given medication that reduces his breathing rate, which led to a fatal respiratory arrest. The occurrence was attributed to a muted alarm which was designed on his monitoring equipment, and this was to alert the nurse that was attending to the other patient and thus the nurse was not able to listen to the alarm.
Therefore, according to the joint commission, the alarm fatigue is addressed as ‘false alarms.’ The state in which the nurses get desensitized as a result of the continuous sounding of the alarms, whose parameters are set too stiff. Also, no adjustment of the default programs or settings the electrodes drying up or sensors getting dislodged. All these makes up the reasons as to why the nursing staffs become desensitized, due to the failure to differentiate between many calling alarms. On other occasions, it was noted that other factors that lead to the alarming burden are instances like shutting the door this makes the signal difficult to be hard. And also the nurse may decide to mute the alarm to give the patient ample time for rest this may make it difficult to listen. Also at the time, the staff may have heard the alarm after the patient time has elapsed, and also some scenarios of the alarm fatigue are culprit meaning by the time the warnings gives alert it might be too late for the patient.;;
False Alarms
A false alarm occurs when the systems set to detect physiologic events on patients report a false event; (ECRI, 2011). The literature reveals that increased frequency of false alarms creates concern to the environment where nurses assume their previous experiences that do not respond appropriately. The observational study that was conducted by HJF, that included 122 patients and 206 observations, for a total of 1234hours of care. A total of 3745 alarms took place during the observations. However, about 5.8% of the alerts led the nurse to call a physician for a possible intervention. Twenty-six percent of alarms were due to staff manipulation; sixteen percent was caused by technical problems and patient themselves. As the literature on the alarm fatigue mounts and the list of suggestions to address the problem continued to expand.
Results
Several of the research reviewed provided recommendations for tackling this challenge, as the survey conducted included evaluating every clinical equipment within the ICU environment starting with alarms (Phillips ; Barnsteiner, 2005). And this recommendation included: proper identification of default settings and the limits by prior activation of the alarm. Also, the sensors should be changed routinely to prevent nuisance alarms. Bell (2010) made the recommendation on a well thought and organized plan should be placed to educate the nurses on the appropriate use of monitors and alarms. To reduce the problem of signal failures, (Grahm and Coach, 2010) conducted studies which yielded beautiful results as they recommended default parameters to be adjusted and set to the patient’s conditions. It was also recommended that inspections and cleaning measures should be put in place and a maintenance program for the medical devices consisting of the alarm by testing the regularly and also the aging monitors should be replaced (Gina Pugliese, 2014).
Emerging Topic in The Healthcare Environment
Alarm fatigue has been an emerging topic in the healthcare environment basing on the critical care unit settings, several definitions of alarm fatigue have been imposed by different organizations including The Joint Commission (TJC). Basing on the (TJC 2013), they defined alarm fatigue as the regular sounding of alarms and other medical devices. As a result, the nurses and other clinicians become desensitized, and in-turn leads to patient health being not compromised. Therefore a research was conducted to check and identify different methods which can be helpful, and that can be recommended to reduce the alarming burden. The literature on the topic was reviewed using the databases like PubMed creating a research between 2010 and 2014. Different methods which could be of great help was found and highlighted also highlighting current situation and failure experienced by various hospitals from alarm burden.
The results of the question were then highlighted giving clear indications on how to improve and impose the changes, to curb the fatal incidence created by the medical devices. It was also found that nurses desensitize because of the false alarms, thus if the recommendations are managed appropriately, then the signals will work efficiently creating no alarm fatigue. Therefore, in conclusion, the paper sufficiently shows that there is need to adjust many areas in the healthcare unit settings so as to prevent the near occasion of fatal incidences creating the massive loss of lives in the intensive care unit.
TJC proposed in their published article in 2013 that a new patient safety goal should be developed regarding the alarm management (AAMI,2011). Therefore, it will be an expectation that all TJC certified hospitals are actively addressing alarm system safety. Conversely, nurses did not exhibit a delayed response to critical alarms averagely six seconds which. A critical alarm is defined as a loud continuous ringing which needs acknowledgment to be stopped at the time of ringing to be stopped. This creates a difference in low tone produced when a leads-off condition exists. The lead off alarm also continue to sound until the issue is corrected; however, the resultant signal is not nearly as concerning as the critical warning signal.
References
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Willemsen, I., Nelson-Melching, J., Hendriks, Y., Mulders, A., Verhoeff, S., Kluytmans-Vandenbergh, M., & Kluytmans, J. (2014). Measuring the quality of infection control in Dutch nursing homes using a standardized method; the Infection prevention RIsk Scan (IRIS). Antimicrobial Resistance And Infection Control, 3(1), 26. http://dx.doi.org/10.1186/2047-2994-3-26
Best, Allan, and Bev Holmes. “Systems thinking, knowledge and action: towards better models and methods.” Evidence & Policy: A Journal of Research, Debate, and Practice 6.2 (2010): 145-159.
Graham, Kelly Creighton, and Maria Cvach. “Monitor alarm fatigue: standardizing the use of physiological monitors and decreasing nuisance alarms.” American Journal of Critical Care 19.1 (2010): 28-34.
