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Recent Research About Nursing, December 2014 – Robert Wood Johnson Foundation.

Alarm fatigue UNC study: 

Alarm fatigue occurs when nurses and other clinicians are exposed to a high number of physiological alarms generated by modern monitoring systems. In turn, alarms are ignored and critical alarms are missed because many alarms are false or non-actionable.

In the ICU, parameters for BPs, heart rates, respiratory rates, oxygen saturation, and the like are often outside of normal limits. It is not uncommon for every patient’s monitor to show tachycardia. Or atrial fibrillation for that matter.

Investigators analyzed a subset of 12,671 arrhythmia alarms, which are designed to alert providers to abnormal cardiac conditions, and found 88.8 percent were false positives. Most of the false alarms were caused by deficiencies in the computer’s algorithms, inappropriate user settings, technical malfunctions, and non-actionable events, such as brief spikes in heart rate, that don’t require treatment.

True story: the only alarm on the floor that makes me jump is the one that goes off when the medicine drawer attached to our computer has been open too long.

So to quiet the floor and maybe do a more precise job monitoring the status of ICU patients, smarter technology that will observe for artifact and normal abnormals would be great. For now, we can better manage the technology we have by knowing our patient’s history and tailoring care. If someone is in chronic afib with a resting rate of 110, set the monitor with an appropriate upper limit–also you might might raise the lower limit to alert you if they convert to sinus rhythm. An alarm on a heart rate of 118 on this patient would be meaningless information, but an alarm on a heart rate of 70 could help you identify a stroke risk and prompt appropriate assessments and prophylaxis.

Nurses can often determine the reason for an alarm by looking at the monitor (as of now it’s that alarm that draws them to look) A bad wave form because the O2 monitor is lose, artifact on the ECG leads, heart rate up and O2 sats down ’cause the patient is using the bathroom are common non-urgent alarms.  Rather than blow up the unit with noise, shouldn’t we have an app for that? In my pocket, a phone that vibrates, so I can check it out trouble shoot, ya know?

These are partial solutions but reasonable I’m thinking.

What we’re going to do about those distal occlusions man, I haven’t a clue (IV pump humor!).

ivpump

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