Reducing nursing alarm fatigue

Reducing nursing alarm fatigue

Reducing nursing alarm fatigue

Reducing nursing alarm fatigue

  1. Introduction

In the healthcare setting, clinical alarm fatigue management failure is often as a result of nursing mistakes relating to complexity of the system. Telemetry technicians as well as nurses are occasionally affected by clinical alarm fatigue which hinders their capability to respond to the clinical alerts in the monitors (Sowan et al, 2015). Often, these practitioners are inundated with a significant number of visual and audio alerts which makes them ignore or fail to see the pertinent clinical alarm. According to a qualitative research done by Dressler et al (2014), fatigue alarms rate from about 187 alarms per day in a single bed, 88.8% of which are false positives. This high rate has been a nuisance and a distraction in the healthcare setting as they can lead to increased number of mistakes in patient care. They are also a cause of panic and stress to patients who may be trying to rest as well as recover from illnesses and surgeries. 

Problem statement 

The rate at which false alarm fatigue go off has remained to be a huge problem for telemetry technicians and nurses in charge of monitoring alarm signals in the telemetry room. These nurses and technicians are faced by a barrage of alarms and alerts during their shifts which makes them ignore the alerts at times. As a result, these practitioners may ignore a true positive alarm that needs immediate action leading to detrimental safety complications on the patient (Sowan et al, 2016).

Purpose of this study

The main aim for this study is to investigate whether healthcare organizations can minimize the amount of fatigue alerts in the telemetry rooms by applying the Plan Do Study Act (PDSA) method.  Failure to respond to true actionable alarms has led to serious patient injuries and even deaths in the healthcare setting (Christensen, Dodds, Sauer, & Watts, 2018). 

Significance of the study

This research is important because it informs the healthcare practitioners on how to minimize the severity of non-actionable alerts that nurses and other clinicians face during their shifts. Reducing the number of false positive alarms will create an environment that can improve the practitioner’s awareness of the alarms thus decreasing alarm fatigue (Cho, Kim, Lee, & Cho, 2016)

Research Questions (PICO)

How does an organization’s infrastructure, culture, technology, and practices influence a strong alarm management plan?

How can the elimination of false alarms such as premature ventricular contraction (PVC) and low amplitude GCG complexes lower the number of non-actionable alerts in the telemetry room? 

Key words

Alarm fatigue, false positive alarms, premature ventricular contraction, and telemetry room 

  • Methods

This qualitative research investigates how the healthcare system can minimize the number of alerts that cause fatigue among nurses as well as telemetry technicians to enhance patient safety. This paper uses peer reviewed papers from credible sources retrieved from databases such as PubMed, CINAHL, MEDLINE/EBSCO, Proquest, and HEALTH SOURCE/NURSING/ACADEMIC EBSCO. The key terms that were used in this research includes clinical alarms, alarm fatigue, and physiologic monitor alarms. The timeline for this research was publications that dated from 2012 to 2019. The inclusion criteria for this research study included qualitative and quantitative studies that discussed how to reduce false positives in the telemetry room. A total of 46 research articles were reviewed though only 10 were used as the rest were duplicates or did not include detailed information.  

Reducing nursing alarm fatigue

  • Results

Srinivasa et al. (2017) and De Vaux et al. (2017) carried out quality improvement projects using the PDSA methodology in an effort of minimizing the severity of false alarms that nurses and technicians are exposed to in a single shift by revisiting the alarm alert typology. While De Vaux et al. (2017) used direct observations based on the alarm codes to develop concepts, Srinivasa et al. (2017) captured data using electronic software tools to capture data. The two research studies investigated the PVC alarms and asserted that these alarms go off when physiologic monitor peaks irregularities in cardiac rhythms. During the beginning of physiological monitoring, most healthcare practitioners treated PVCs using various interventions or medications. However, recent research shows that cardiac irregularities are basically benign and are not treated. Nonetheless, even after this discovery the PVCs alarms were not removed from the physiologic monitoring system. These two researchers concluded that PVC alarms should be removed from the physiologic monitoring system to reduce alarm fatigue among the practitioners. 

In their research, Walsh-Irwin and Jurgens (2015) also investigated how the healthcare system can reduce false alarms by adopting better cultures and patient care systems. These researchers carried a research that involved monitoring physiologic alarms before interventions and after the application of certain physiologic monitor leads following improved skin preparation.  Walsh-Irwin and Jurgens (2015) analyzed the collected data before and after the skin care intervention in an effort of determining whether the number of alarms reduced or accelerated. The statistical data that was collected in this research showed that proper skin preparation results to a reduced number of false positive alarms. The healthcare system should therefore adopt cultures that ensure proper skin preparation in patients to reduce the number of false alarms in the telemetry room. 

Paine et al. (2016) also carried out a quasi-experimental research to investigate how healthcare organizations can reduce the number of false positive alarms among patients. This research examined topics such as the relationship between nurse response time and alarms exposure, non-actionable and actionable alarm propositions, and important interventions that help in the reduction of false alarms frequency. This research established that the actionable alarms raged between <1% and 36% across many healthcare organizations in the United States. This research also found that there is a considerable correlation between alert exposures and the time that nurses take to respond to the alarm. 

In another experiment, Pelter, Fidler, and Hu (2016) investigated the probable impacts of a low-amplitude QRA complexes on asystole alarms that are false positives. Low-amplitude QRS complexes occur when limb complexes lead to less than 5-10 millimeters in the precordial leads. This qualitative study involved 82 patients who were observed in a period of 31 days. The research suggested that there was no significant statistical data to having a false positive asystole alarm when a 12-lead ECG measured QRS complexes that were low amplitude. This experiment demonstrated that the low amplitude QRS complex alarm can be eliminate from the physiologic monitor. 

  • Discussion

The themes that are evident in the above research studies provide insight to the healthcare’s struggles to apply PSDA methods that can manage alarm alerts. The studies establish that most alarms are not actionable and are a source of disruption and fatigue among nurse and therefore there should be active efforts to minimize the number of false positive alarms because they result to alarm desensitization and important alerts can be ignored as a result (Model for Improvement, 2018). The research studies also establish that modifying alarms to ensure that only actionable physiological changes are recorded is a good of reducing alarm fatigue. Pelter, Fidler, and Hu (2016) clearly show that interventions are also a safe way of reducing the number of non-actionable alarms. 

  • Conclusion

In essence, alarm fatigue is a huge problem that puts patients in grave danger and a practitioner can ignore an actionable alarm thinking that it is a false positive. As such, adopting a PSDA methodology to reduce the number of false alarms will enhance the opportunities for practitioners to respond to the actionable alarms as well as reduce alarm fatigue. The healthcare organizations should create an environment that provides meaningful information to telemetry room monitors.    

Reducing nursing alarm fatigue

 References

Cho, O. M., Kim, H., Lee, Y. W., & Cho, I. (2016). Clinical alarms in intensive care units: Perceived obstacles of alarm management and alarm fatigue in nurses. Healthcare informatics research22(1), 46-53.

Christensen, M., Dodds, A., Sauer, J., & Watts, N. (2018). Alarm setting for the critically ill patient: a descriptive pilot survey of nurses’ perceptions of current practice in an Australian regional critical care unit. Intensive and Critical Care Nursing30(4), 204-210.

De Vaux, L., Cooper, D., Knudson, K., Gasperini, M., Rodgerson, K., & Funk, M. (2017). Reduction of nonactionable alarms in medical intensive care. Biomedical Instrumentation & Technology51(s2), 58-61.

Dressler, R., Dryer, M. M., Coletti, C., Mahoney, D., & Doorey, A. J. (2014). Altering overuse of cardiac telemetry in non–intensive care unit settings by hardwiring the use of American Heart Association guidelines. JAMA internal medicine174(11), 1852-1854.

Model for Improvement: Plan-Do-Study-Act (PDSA) Cycles. (2018). Retrieved April 29, 2018, from http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTestingChang es.aspx

Paine, C. W., Goel, V. V., Ely, E., Stave, C. D., Stemler, S., Zander, M., & Bonafide, C. P. (2016). Systematic review of physiologic monitor alarm characteristics and pragmatic interventions to reduce alarm frequency. Journal of Hospital Medicine, 11(2), 136-144.

Pelter, M. M., Fidler, R., & Hu, X. (2016). Research: Association of low-amplitude QRSs with false-positive asystole alarms. Biomedical Instrumentation & Technology, 50(5), 329- 335. Srinivasa, E., Mankoo, J., & Kerr, C. (2017). An evidence‐based approach to reducing cardiac telemetry alarm fatigue. Worldviews on Evidence‐Based Nursing, 14(4), 265-273. Walsh-Irwin, C., & Jurgens, C. Y. (2015). Proper skin preparation and electrode placement decreases alarms on a telemetry unit. Dimensions of Critical Care Nursing, 34(3), 134- 139.

Sowan, A. K., Gomez, T. M., Tarriela, A. F., & Reed, C. C. (2016). Changes in default alarm settings and standard in-service are insufficient to improve alarm fatigue in an intensive care unit: a pilot project. JMIR human factors3(1), e1.

Sowan, A. K., Tarriela, A. F., Gomez, T. M., Reed, C. C., & Rapp, K. M. (2015). Nurses’ perceptions and practices toward clinical alarms in a transplant cardiac intensive care unit: Exploring key issues leading to alarm fatigue. JMIR human factors2(1), e3.

Walsh-Irwin, C., & Jurgens, C. Y. (2015). Proper skin preparation and electrode placement decreases alarms on a telemetry unit. Dimensions of Critical Care Nursing, 34(3), 134- 139.

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