The American Journal Of Critical Care

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

In Cvach’s (2012) article, an integrated review synthesized research and non-research findings of seventy-two articles, published between 1/1/2000 and 10/1/2011. The author used the John Hopkins Nursing Evidence Based-Practice model to measure and evaluate the articles for this review. The data collected were categorized into 5 main themes: excessive alarms and the effects on nurses, nurse's response to alarms, alarm sounds and audibility, technology to reduce false alarms, and alarm notification system (Cvach, 2012). The purpose of this integrated review was to find out if the volume of noise (false alarms vs true alarms) disrupts the nurse’s response and perception to physiologic clinical alarms. The 3 main recommendations provided by the researcher were to implement the use of smart technology, generate change within the hospital's environment and protocols, and use of precautionary measures by healthcare staff in order to reduce monitor alarm fatigue.

This paper examines this culture of alarm fatigue among nurses in clinical care areas and the resulting potential for harm among the patient population. Although alarm fatigue may happen in any clinical area with frequent or repetitive alarms, this paper focuses on the phenomenon in critical care. The broad scope of this issue coupled with the high risk of patient harm demands insight and action from the nursing profession. By discussion and review of contributing factors such as repetitive alarms, noise level, lack of individualized settings, poorly configured devices, and desensitization of nurses, healthcare providers can strategize methods to prevent patient harm resulting from alarm fatigue. These measures also promote efficiency

Alarm fatigue was brought into the spotlight in recent years because of adverse patient outcomes. These sentinel events triggered the Joint Commission to make alarm safety a goal in 2014, and mandating policies and procedures to be in place by 2016 for better monitoring and observance of alarms. I decided to highlight this topic since a large part of a critical care nurse’s daily routine is silencing alarms for monitors, pumps, ventilators, beds and call lights. In my personal experience inappropriately set parameters for monitors can lead to sensory overload for staff, patients and families leading to a less than desirable work and care environment. In most cases false alarms can be minimized with simple interventions, alerting staff to real situations requiring intervention.

With the proliferation of technology in the today’s healthcare environment, the healthcare community is increasingly concerned about the patient safety risks associated to clinical alarm hazards. In 2012, 2013, and 2014, the Emergency Care Research Institute (ECRI) identified clinical alarm hazards as a high priority potential danger area in hospitals and health systems (ECRI, 2014). The Joint Commission, the American Association of Critical-Care Nurses (AACN), the Food and Drug Administration (FDA), ECRI, and the Association for the Advancement of Medical Instrumentation (AAMI) have all identified the need to address alarm management and alarm fatigue as a priority patient safety concern (Horkan, 2014). In response to these concerns, federal regulatory mandates are increasingly coupled with recommended alarm management practices and protocols. Despite these focused efforts, alarm fatigue and alarm management continue to be priority national patient safety concerns.

Hospital noise is more than an annoyance. It disrupts patient sleep, creates spikes in blood pressure, and hinders wound healing and pain management. The post-partum unit at North Fulton Hospital has installed a traffic light device that reinforces awareness of the need for a quieter atmosphere by monitoring the noise level and turning from yellow to red as it rises. Even with this added device, noise consistently gets the worst marks on patient surveys. Noise-reduction efforts really gained momentum recently, when Medicare began basing a portion of hospital reimbursement on quality measurements including patient ratings of the quality of care (Landro, 2013). Additional measures need to be put in place in order to improve quality care by reducing distracting noises. White noise amplified through an intercom or machine will make the typical sounds become less obtrusive or obvious to the patient.

Ten staff nurses shared their ideas about improving alarm management. Pulmonary critical care physicians verbalized that alarm noise detracted from the team’s ability to interact with the patient and family at the bedside during rounds. Clinical staff members were engaged in the project using shift change huddles, patient safety and quality briefings, pulmonary critical care provider and alarm management meetings. The performance improvement team addressed staff feedback regarding noise levels. Decibel meters were placed in a central location in the intensive care unit to obtain measurements of noise from all sources. The team identified audible alarms from bedside physiologic monitors as the largest contributor to the noise levels in the units. Overall, noise levels in the units averaged 68.4 dB. [AU: Reorganized paragraph for clarity. –edited paragraph

Hospitals are chaotic and can be difficult places to maintain safety if precautions aren’t taken. One-way that healthcare providers attempt to combat safety issues is by using different alarm systems to alert staff to issues in patient rooms. The many different alarms can be beneficial but can also cause a phenomenon that is referred to as alarm fatigue. Alarm fatigue is defined as a condition of sensory overload for staff members who are exposed to an excessive number of alarms (Blake, 2014). It is a national problem and the number one medical device technology hazard in 2012. The problem of alarm desensitization is multifaceted and could be attributed most heavily to high false alarm rates. Studies have indicated that the presence of false and/or clinically insignificant alarms ranges from 80-90% (Cvach, 2012). The constant alarms make it difficult for nurses to discern the difference between emergent and annoying alerts and can cause many to not respond as urgently as necessary.

Throughout trauma calls, noise levels can be very high and it can prove difficult to hear instructions from other team members, leading to interactions between staff members being disturbed (Haire, 1998). Technological advancements within critical care environments are becoming increasingly complex, meaning more staff members are needed, which can add to the noise levels of a trauma call (Tracy and Ceronsky, 2001). This needs to be managed by a good team leader who can take control of a noisy and busy situation. Prior to trauma calls, a large number of staff members await the arrival of the patient, which can lead to noise levels increasing. The degree of noise allowed during a trauma call is at the discretion of the team leader in charge,

Alana Keenan and Lynn Joseph’s study on “The Needs of Family Members of Severe Traumatic Brain Injured Patients during Critical and Acute Care: A Qualitative Study” utilizes well known phenomenological research and data analysis methods and presents their findings in a thorough and well thought out manner. The report makes adequate effort to discuss what was done to enhance and evaluate the quality of the data and the overall inquiry with the findings being “part of a larger mixed method study of both qualitative and quantitative data collected over three time periods” (Keenan, 2010, p. 25)

Hospitals across the United States are spending copious amounts of resources on research that focuses on providing quality care that not only shortens hospital stays, but also promotes a return to individual functional status prior to admission. Mechanically ventilated patients who remain on bed rest for extended periods of time are at risk of developing complications that can affect all body systems. This literature review examines critically ill patients on mechanical ventilation admitted to the intensive care unit (ICU) and the effects of early mobilization compared to standard bed rest and physical therapy. The findings of this study indicate that early mobilization interventions have been proven to decrease the length of hospital stay, maintain neurological aptitude, and increase muscle function among mechanically ventilated patients experiencing prolonged bed rest.

Bring forth the conversation on the effects of equipment alarms toward patient's safety is a major concern. As nurses, we think the alarms are a nuisance and tend to be distracting. However, minimum thoughts are address toward the patient's concern.

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This business proposal outlines the recommended use of alarm management in the neonatal intensive care environment to support the COH NNICU transition from an open nursery to a private room setting. The complexities of the NNICU environment warrant the use of proven innovative technology to integrate the mass amount of medical systems within the chaotic NNICU setting. A unified communication system is needed to help simplify the transmission of relevant information, improve communication, and assist caregivers in making informed decisions. Our research supports the notion that clinicians and families are truly overwhelmed by the multitude of sounding medical equipment that can directly impact patient outcomes and

The field of critical care is rapidly changing. It is important for anesthesiologists be knowledgeable of these changes for providing care to critically ill patients in the perioperative period. The purpose of this chapter is to provide update for clinicians on ICU issues relevant to clinical practice. Topics which will be discussed include: modes of mechanical ventilation, renal replacement therapy, antibiotic prophylaxis, nutritional support, sedation management, transport and transfer of care.