Alarms Fatigue: How are you planning to meet this NPSG?

[Chinmay Singh]

TJC made alarms management a national patient safety goal. Also AACN came out with some suggestions to reduce alarms. fatigue.

National Patient Safety Goal on Alarm Management

How is your hospital planning to meet this NPSG? Who is leading the effort biomed or nursing?

[MunoRN, RN]

These are their specific guidelines:

• Ensure that there is a process for safe alarm management and response in areas identified by the organization as high risk.
  
• Prepare an inventory of alarm-equipped medical devices used in high-risk areas and for high-risk clinical conditions, and identify the default alarm settings and the limits appropriate for each care area.
  
• Establish guidelines for alarm settings on alarm-equipped medical devices used in high-risk areas and for high-risk clinical conditions; include identification of situations when alarm signals are not clinically necessary.
  
• Establish guidelines for tailoring alarm settings and limits for individual patients. The guidelines should address situations when limits can be modified to minimize alarm signals and the extent to which alarms can be modified to minimize alarm signals.
  
• Inspect, check and maintain alarm-equipped medical devices to provide for accurate and appropriate alarm settings, proper operation, and detectability. Base the frequency of these activities on criteria such as manufacturers’ recommendations, risk levels and current experience.
  

The JC has two levels of requirements; Goals and Standards, as this still just a goal the requirements to show actual results are still minimal. Basically, you can get an "A" for effort. You do need to inventory everything that makes an alarm and list the defaults. You also need to show that Biomed has been performing routine quality checks.

The big project involved is setting guidelines for when alarms can be adjusted and/or turned off. I find the culture of this varies widely from one facility to another. There are facilities where staff are very hesitant to aggressively limit alarms, it's these cultures that the JC surveyors will likely crack down on hard. Basically, any alarm should be providing information that is used for clinical decision making. If nobody cares that the patient had a pair, then that alarm should be off. The other acceptable reason for alarms is when a piece of equipment needs attention, and lack of attention could harm the patient, otherwise alarms should be turned off.

[FineAgain]

And it would be nice if people wouldn't pull the emergency cord in the bathroom unless it was...ummm...an emergency!

[Chinmay Singh]

Thats what I have heard MuroRN. So given it is not a standard but a goal, why would a hospital even do more than show the effort?

[Esme12, ASN, BSN, RN]

.......because facilities that are given accreditation from the JC....they "recommend" things....... however in the guidelines you will see that some of the recommendations that "Indicate scoring category " some indicate "documentation necessary", "threat to health and safety", "measure success".....they will evaluate your success or failure are their "recommendations" during their survey that the hospital pays for.....or they (the facility) can choose to not participate in medicare/Medicaid.

The JC will get their way.....and this will become a standard.

[wooh, BSN, RN]

Maybe THIS will be what it takes to get residents to quit ordering every single patient to be put on cardiac and pulse oximetry monitors. It doesn't matter what the settings are, an awake toddler is going to beep nonstop.

[wooh, BSN, RN]

Actually, now that I read it more closely, it's just going to turn into, "Why didn't the nurse run into the room EVERY SINGLE TIME the alarm beeped on the awake toddler?"

[MessyMomma]

I have to say that this is the first I've heard about this. None of my coworkers (acute care hospital) have either. So, I have no idea what we're gonna do.

[Esme12, ASN, BSN, RN]

Actually, now that I read it more closely, it's just going to turn into, "Why didn't the nurse run into the room EVERY SINGLE TIME the alarm beeped on the awake toddler?"

I don't know about that............. but I will tell you that there have been some alarming sentinel events that have caused deaths in some of the "TOP HOSPITALS" where patients have been found stone cold dead.....with dead batteries in their telemetries.....or "LEAD OFF" alarms silenced repetitively or shut off for HOURS!!!! because they were "alarming incessantly" or "someones elses patient".......and not one single person got up off their behinds to check the leads or patient..... someone DIED because of a lack of ownership and responsibility. INEXCUSABLE!

If that means that someone has to go in that room on that alert toddler....then so be it. This did not happen to me personally......however I do KNOW for a fact this has happened and is alarmingly common. Not only as a manager and supervisor this is one of my HUGE pet peeves....and was NOT tolerated i the department Iwas in charge of.....I checked alarm's ALL this time the need to be answered within a specific amount of time or there better be a good reason.

[Chinmay Singh]

So in your opinion, what % of alarms should be turned off? I guess as hospitals try to implement this NPSG, they will be turning off some permanenetly, turning off some or lowering volume certain hours (such as night?)

[Esme12, ASN, BSN, RN]

None...no alarm should ever be turned off.....the alarms should be set for each patient. Customized to limit unnecessary alarms. If the alarms are set correctly it will lessen the noise level...the goal is NOT to shut off alarms but make them important to our ears again.

Which alarms depend on your system...for instance...a patient in chronic afib.....can have the "irregular heart rate shut off" and have their rate alarms on and set for whatever your parameters are for that patient. You can customize the alarms for the patient to eliminate unnecessary alarms....the problem here is that people forget to turn them back on for the next patient.

I think that is how we got away form setting them...many took the easy way out and instead of making people adhere to policy and reset the alarms for every patient...an arrhythmia was missed ...so the standard became "leave the alarms alone." When it should have been to keep the staff to task until they learned what is acceptable. The challenge...quality and follow up. It requires work and attention to detail.

I would challenge my staff and check the alarms for all systems have the capability of knowing how long the alarm rang if it was answered/verified and how long that took. Alarms had to be cleared at the end of EVERY SHIFT and documented. The goal would be 95% of acknowledged alarms...I would check them my self.

I would remove leads in rooms...while the patient on a portable eagle and timed them...until they realized I was serious. I am also a believer that every call button is a chest pain or potential code.....call lights get answered. They're ALL of our patients not his patient or their patient. We all bear the responsibility for the patient in our care. I had progressive disciplinary in place for non compliance....for me it has always been NO joke. Those who were chronic violators were addressed. But I always had mock codes as well.

[nurseprnRN, BSN, RN]

I am always astonished when this discussion gets going that no one ever suggests the A-Number-One factor to address this: BETTER STAFFING. An intelligent and educated RN is the best monitor you have. You don't need IV alarms for completed volumes if you have RNs to check often enough, for example. If you could avoid even IV pump alarms, that would be helpful. And of course Esme's description of how to actually use those functions that come with your arrhythmia monitoring software...your hospital paid good money for them, use them properly. Use your critical thinking skills to explain why.

[azhiker96, BSN, RN]

I wonder who or what system TJC will approve for adjusting alarm limits. I doubt they would approved of the patient's nurse doing that. I expect them to want alarm limits to be set by physician order considering their stance on medication range orders.