While further research is needed, we need to be focused on positive patient outcomes. Nurses should set set realistic individualized parameters on monitors when possible in an effort to reduce nonsense alarms. Parameters should be at a reasonable level to grab their attention at appropriate times when an intervention may be required. Translation to Practice This evidence can be translated into practice in several ways. An astounding “80-99% of EKG monitor alarms are false or insignificant” (Sendelbach & Funk, 2013.) First, continuous cardiac and oxygenation alarms cannot be turned off, but alarm parameters may be changed on an individualized basis depending on their baseline data. For example, the patient comes in with tachycardia so adjust …show more content…
Nurses should make it a habit to check all alarms when assessing their patients. Each should check to verify that alarms are on, verify the parameters are appropriate for the patient and their baseline vitals, check equipment that requires batteries such as pacemakers, and all equipment should be plugged in. Checking these alarms early each shift is easy, does not require a lot of time, and has the potential to stop several nonsense alarms. These steps would not require additional funds or staff, it’s an easy self check of the equipment …show more content…
This assignment has changed the way I view alarms. I work in the ICU where everything beeps, buzzes, and dings. I’ve become more aware of the very high percentage that are “nuisance” alarms and require no intervention. It is becoming a habit of mine at the beginning of my shift when I first assess any patient to assess their alarms as well. I personalize their alarm parameters, change their EKG pads, and assure that everything is plugged in. I am also able to share this information with my co-workers, which also reduces the number of nuisance alarms on the
378). Hospitals have an array of medical devices at the bedside that have alarms, which have grown significantly within recent years. Nurses may be exposed to over 350 physiologic alarm monitors per day, resulting in sensory overload thus leading to desensitization. When the alarm sounds it should be corrected immediately, even though it may be a false alarm or no issues with the patient. The Joint Commission has identified alarm fatigue as a 2014 National Patient Safety Goal, requiring hospitals “to establish improvement of alarm system safety as an organization priority” (as cited in Horkan, 2014, p. 83). Alarms are deliberately designed for high sensitivity so that nurses do not miss a true event. Firing alarms are usually muted, disabled or ignored by nurses altogether because alarms are viewed as a nuisance. Alarm hazards have generated national attention, in one highly publicized case an alarm sounded for 75 minutes before a nurse responded to a patient’s heart monitor that needed a battery replaced. When the nurse finally went to change the battery the patient was found unresponsive and could not be resuscitated because he had gone into cardiac arrest (Sendelbach & Funk, 2013). The patient’s heart monitor battery eventually died and did not issue the critical alarm alert. In another event, a patient fell getting out of bed and bleed to death because the nurse
Nursing sensitive indicators reflect the structure, process and outcomes of nursing care. The structure of nursing care is indicated by many factors such as supply of staff, education level and quality of care provided. Process indicators measure aspects of nursing care such as assessment, intervention, and RN job satisfaction. Patient outcomes that are determined to be nursing sensitive are those that improve if there is a greater quantity or quality of nursing care (Nursing world, 2013). In 1999, the American Nursing Association recognized a total of 10 indicators that apply to hospital based nursing care (Americansentinel.edu, 2017). Indicator such as pressure ulcers, patient falls and nosocomial infections are recognized in this list and are considered preventable with proper nursing action. Knowledge of these indicators could have assisted the nurses in several ways involving this case study involving Mr. J.
Traditionally, nursing shift-to-shift reports were organized methods of communication between only the oncoming and leaving nurse, designated to a location such as the central nursing station or nook of a hallway. Shift reports can be considered the foundation of how the day is going to plan out because it introduces the patient, diagnoses, complications, medications, consults, upcoming test and the entire plan of care. These reports are full of complicated and vital information and while set in certain locations that are vulnerable to interruptions, such as the nursing station, medical errors and miscommunication are more likely to be made. The Joint Commission’s 2009 and 2010 National Patient Safety Goals (Joint Commission, 2015) included two patient safety standards, first to encourage patients to be involved in their health care plan and second, to implement a standardized communication process for handoff reports between providers. Soon after in 2013, The Agency for Healthcare Research and Quality under the United States Department of Health and Human Services introduced a set of strategies to improve patient engagement along with safety and quality in patient care. Within these strategies the new method of nurse bedside shift report was developed, which suggests nurses to conduct shift-to-shift reports at bedside in the room of each patient, rather than out of the room. The benefits of this new method were
Alarm fatigue in health care has grown to be an ever-growing concern in the health care arena, especially when looking at patient safety concerns. There must be an understanding of the problem before we can develop policies and effective strategies to counter this problem. The concept of alarm fatigue in health care will be evaluated utilizing the method developed by Walker and Avant (2010) that identifies and gives the significance of the attributes, antecedents, and end-consequences of alarm fatigue in health care. This will be developed based
The findings found that nurses felt irritated with inappropriate alarm settings and the high volume of noise on unit, resulting in delays in response times. False alarms were the main culprit in the nurses' opinions. The interventions supplied by the article were individualizing alarm limits, buddying systems, a charge nurse making rounds, and the development of smart alarms with algorithms that cover multiple conditions (Christensen et al., 2014).
Goal 6: Know Your Alarms. Alarms familiarity on your unit is integral to the best patient safety. Take faulty
Back in 2003, the Joint Commission created a National Patient Safety Goal due to 23 occurrences of death or injury to a patient where alarms had been applied incorrectly or the alarms had been muted (Sendelbach & Funk, 2013). By 2004, Joint Commission had removed it from their National Patient Safety Goal list and made it a requirement for Joint Commission accreditations (Sendelbach & Funk, 2013). In 2013, it was brought to the attention of the Joint Commission regarding many alarm-related events, including multiple deaths, permanent loss of function, and prolonged hospital stays due to health care worker’s decreased response times to alarms (Horkan, 2014; Joint Commission, 2013). The Joint Commission reinstated a National Patient Safety Goal in 2013 and had requirements for all hospitals that had to be met by July 1, 2014 (Joint Commission, 2013). These goals included being able to make alarm safety a priority and develop a plan to decrease the amount of alarms. This plan could include preventing unnecessary patient monitoring, clarifying who is allowed to monitor and silence alarms, setting the cardiac monitors to have multiple tones, and having a brief delay in the alarm to see if the patient can self-resolve. The second phase of the Joint Commission’s plan was to be implemented by January 2016, to where the hospital must have followed through with their designated plan (Joint Commission, 2013).
Horkan, A. M. (2014). Exploring the Evidence Alarm Fatigue and Patient Safety. Nephrology Nursing Journal, 41(1), 83-85.
If the nursing staff understood the concept of the nursing-sensitive indicators, they would recognize that nursing-sensitive indicators are a measure of quality care at the unit level. They would be able to identify the issues that may interfere with good quality patient care, such as the prevalence of restraints affecting the quality of care. They would be able to discern that the decisions for the excellent healthcare would be evidenced – based, so it would be easy
- Risk to patients if the alarm signal is not attended to or if it malfunctions
After exposure to repetitive and continuous alarms, nurses may become desensitized or overwhelmed with the number of alarms to respond to; this phenomenon is known as alarm fatigue (Graham & Cvach, 2010). Alarm fatigue can lead to dangerous practices such as turning off alarms, silencing alarms without evaluating or troubleshooting this issue, changing the alarm parameter to unreasonably broad settings, or complete disregard of the alarm (Ulrich, 2013). A significant contributing factor is the number of duplicate or false positive alarms nurses experience each shift, with studies showing that anywhere from 72-99 percent of alarms in the clinical setting are false or non-emergent (Graham & Cvach, 2010). Although alarm fatigue is commonly associated with critical care areas, it may occur in any patient care area with frequent or repetitive alarms (Gross, Dahl & Nielsen, 2011). In addition to causing a permanent harm or death, clinical alarms also contribute to noise levels in patient care areas, which in turn can cause insomnia or delirium.
Despite many efforts to improve staffing numbers, there is often still a staff shortage among staff in hospitals and acute care settings. While the most obvious solution to short staffing is to hire more nurses, there are also other ways to make staffing more effective. A patient acuity tool is a staffing instrument that can be used to decide how much time and attention each individual patient requires. By knowing the acuity level of each patient, charge nurses can decide how many patients each nurse can be assigned to at a time. This essay describes the way a patient acuity instrument improves healthcare outcomes by promoting patient-centered care and improving on key nurse competencies including teamwork and collaboration, quality improvement, and safety measures.
Studies have shown strong correlations between nurse sensitive indicators or nursing quality indicators and patient outcomes. Nursing sensitive indicators are performance measures that can measure outcomes of nursing care. Nursing indicators can include nursing hours per patient day, patient falls, pressure ulcer prevalence, restraint
Monitoring of the vital signs should be closely monitored (pulse, blood pressure, respiration and pulse oximetry
This is especially important on those patients admitted with low mortality risk DRGs. This is accomplished by identifying and preventing, potentially avoidable complications and adverse events. For example, patients admitted for syncope and collapse secondary to dehydration will more than likely be placed on IV Fluids. One goal would be to hydrate the patient and reevaluate them throughout their hospitalization for improvement. However, if the patient’s intake and output is not monitored closely, the patient can become volume overloaded and develop symptoms similar to those seen with Right Sided Heart Failure. Once that happens, the patient will require additional medications and additional hospital days because of provider error of not placing an order for the Nurses to monitor his/her volume status.