Alert Fatigue Case Study

Christensen, M., Dodds, A., Sauer, J., & Watts, N. (2014). 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 & Critical Care Nursing, 30(4), 204-210. doi:10.1016/j.iccn.2014.02.003.

The Merriam-Webster online dictionary (2015) defines fatigue as “a state of being very tired” (Merriam-Webster Dictionary, 2015). Stedman’s concise medical dictionary for the health professions (2001) further defines

Clinical alarm systems in acute and critical care health care settings are an assistive way to maintain communication between the client and the nurse. Awareness and comprehension of health devices is crucial to provide nurses with appropriate strategies for critical or non critical interventions that can lead to sentinel events. The ECRI, a nonprofit institute, has identified alarm hazards as the “Top Ten Health Technology Hazards” for 2014. (cite) In 2013 The Joint Commission published a Sentinel Event Alert proposing a National Safety Goal to focus on alarm safety (cite). This topic is pertinent information to be recognized and set as an achievable action in improving patient safety.

Clinical Information Systems (CIS) is a type of electronic computer system database that has the capability of storing clinical information for healthcare delivery (Biohealthmatics.com, 2016). CIS has been implemented in many clinical settings to help guide clinicians with decision making abilities to provide appropriate treatments based on the patient’s history of illness, age, and other information of care provided by the facility that has been entered in the electronic health record (EHR) (Biohealthmatics.com, 2016). In regards to the case study, CIS automatically prompted an MRI of the brain alert as an appropriate intervention based on Mrs. John’s history of present illness, diagnosis, age, and the assessment competed by the nurse entered into the (EHR).

Health care providers as well as nurses must keep track of all pertinent patient information and failure to do so leads to detrimental effect on the patient's life. CIS clinical information systems are "large, computerized database management systems that support several types of activities that include physician order entry, result retrieval, documentation and decision support". CIS is intended to replace medical records department of a hospital or any other medical institution. Physicians and clinicians can safely and quickly access information, order medication and treatments and implement appropriate care. CIS will hopefully improve productivity, increase quality care and reduce costs across the organization.

Within the Electronic Health Record program, the nurse has access to evidence-based practice tools that can assist the nurse in making decisions regarding the patients plan of care (Linder, J., Bates, D., Middleton, B., & Stanfford, R., 2007). The most important feature of the Electronic Health Record is the ability to instantly provide real-time patient-centered data to all authorized providers (HIT, 2013). The Electronic Health Record is real-time, providing nurses with the most up to the moment patient information the significance of this feature can be explained in the following example. For example, if a patient is in surgery, the patient's health record is available to the circulating nurse in the Operating Room, the Post Anesthesia Care Unit nurse and can be shared with the unit staff nurse the patient will be transferred to after recovering in the Post Anesthesia Care Unit. This is of particular importance because having access to the patient's chart, allows the nurses at each phase on the patient's care the ability to prepare supplies, gather necessary equipment and arrange for supplementary staff. Evidence-based practice suggests appropriate planning is a key factor in promoting positive, cost efficient patient outcomes (Anderson, 2012). In the profession of nursing when time is of the essence, and time loss can mean loss of a life, this is a feature that is very

Electronic Health Systems are equipped with many features that are designed to reduce medical errors and help navigate patients through the healthcare system. One system that is worth looking at is the MedicsDocAssistant™ (MDA™). MDA™ supports many features such as alerts (“MedicsDocAssistant,”). Alerts will pop up on a provider’s screen letting them know that there is something wrong with the patient’s care. Alerts can range from prescription alerts, warning physicians of potential adverse drug effects or allergy complications, to alerts pertaining to clinical decisions regarding patient examinations, procedures and screenings that may be crucial. For example, the system will alert to the physician to remind female patients of a certain age to schedule a mammogram screening. The objectives of these alerts are to aid in properly diagnosing patients, identifying gaps in care, running appropriate tests as well as improving patient outcomes (“How EHR Alerts,” 2012).

In the modern world technology is everywhere and it affects everyone’s daily life. People are constantly attached to cell phones, laptops, and other electronics, which all have affected how people live their lives. Technology is also a large part of the healthcare system today. There are many electronics and technologies that are used in health care, such as electronic health record, medication bar code scanning, electronic documentation, telenursing, and there are many more forms of technology that impact nursing. One technology that stands out is the electronic health record. The electronic health record, also referred to as EHR, is an electronic version of a patient’s chart, and it contains is a list of the patient’s current medications, allergies, laboratory results, diagnoses, immunization dates, images, treatments, and medical history (“Learn EHR Basics,” 2014). The purpose of the electronic health record is to have a patient’s health care record available to health care providers nationwide, but the patient can decide who has access to their record (Edwards, Chiweda, Oyinka, McKay, & Wiles, 2011). The electronic health record is a very important technology in health care and it impacts nurses, nursing care, and has a significant impact on patient outcomes.

Alarm fatigue is out of control, and patients are being harmed, if not killed. Alarm fatigue is a disturbing subject in healthcare and primarily in the acute care setting in all institutions. In the acute care setting, alarm fatigue is the constant barrage of noise consisting of an excessive amount of information being communicated by medical devices such as blood pressure, intravenous pumps, and electrocardiogram machines. Alarm fatigue is a nationwide concern and the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience database received 566 details of patient deaths related to medical device alarms between 2005 and 2008 (Bai et al., 2014). Deaths are normally attributed to the physiological or chronic health of the individual, not alarm fatigue. In 2010, an analysis exposed 73 alarm-related deaths with 33 directly linked to physiologic monitors (Cvach, 2013). Routinely alarms are intended to warn the clinician to situations that deviate from what is conceived as ‘normal’ for the patient, not a stressful, irritating barrage of noise.

Alarm fatigue is a critical problem in health care setting. Nurses may not respond to alarms because they know that most of them are false or non-actionable. Sometimes, the alarms become the noises that nurses no longer hear because they are heard all the time. In addition to ignore alarms, nurses may also reduce audible alarm levels, change alarm limits, and inappropriately silence or deactivate alarms (Cvach, 2012). The alarm fatigue has led to sentinel events and deaths of patients (Cvach, 2012). Therefore, the alarm fatigue problem has to be fixed in order to improve patient safety. This paper will introduce interventions based on evidence-based practices and leadership theories related to alarm fatigue prevention.

This paper will identify the use of Electronic Health Records and how nursing plays an important role. Emerging in the early 2000’s, utilizing Electronic Health Records have quickly become a part of normal practice. An EHR could help prevent dangerous medical mistakes, decrease in medical costs, and an overall improvement in medical care. Patients are often taking multiple medications, forget to mention important procedures/diagnoses to providers, and at times fail to follow up with providers. Maintaining an EHR could help tack data, identify patients who are due for preventative screenings and visits, monitor VS, & improve overall quality of care in a practice. Nurse informaticists play an important role in the

Clinical decision-support systems (CDSS) apply best-known medical knowledge to patient data for the purpose of generating case-specific decision-support advice. CDSS forms the cornerstone of health informatics research and practice. It is an embedded concept in almost all major clinical information systems and plays an instrumental role in helping health care achieve its ultimate goal: providing high quality patient care while, at the same time, assuring patient safety and reducing costs. This computer based systems designed to impact clinician decision making about individual patients at the point in time that these decisions are made. If used properly, CDSS have the potential to change the way medicine has been taught and

There are a lot of problems and challenges involved in implementing a clinical decision support system. It is important for medical staff (doctors, administrators etc.) to be an integral part in the implementation and development of CDSS. Our limited research concluded that acceptance of such technology is not easy amongst physicians. One of the main reasons for non acceptance is that the physicians want to be a standalone entity. We plan to investigate many challenges such as lack of technical expertise, cost, integration, misdiagnosis, speed etc involved in implementation of different types of CDSS in the health care industry today. Our research paper will focus on the different decision problems involved in these challenges.

The use of computer technology has widely taken over the workforce and forcing a false sense of security (Carr, 2013). However, the use of decision support systems (DSS) has caused workers to become reliant upon the technology leading to automation bias (AB) and complacency. The use of clinical decision support systems (CDSS) causes workers not to identify errors readily because of trust in the CDSS (Goddard, Roudsari and Wyatt, 2011). The use of CDSS is not meant to take the place of the human decision making process, but meant to improve work outcomes. As more

Electronic medical records had a great impact in the ushering in of the age of Nursing Informatics. (Himss, 2010)EMRS present healthcare professionals with the ability to retrieve and organize data in a quick and efficient approach. With information so readily available, patient safety increases and we know that patient cost goes down. This happens because patient medications, allergies, history, demographic, and treatment information is more collectively available.