Too lazy to adjust your alarms? or Don't know how?

Esme12, ASN, BSN, RN · Jul 11, 2011

I think what we tend to forget is that in every area of nursing there are idiosyncrasies to each area. The rules and regs are governed by the patient popoulation and the history of the unit/facility itself. I know of a HUGE PROMINANT medical facility that recently go in HUGE trouble from a patient death because someone got tired of hearing the alarm and just SHUT IT OFF! :eek: THe patient was in cardiac arrest, apparently had a lot of false alarms for VT/VF, the patient could not be resuscitated once found to be in cardiac arrest and died, and it wasn't a newbie who shut it off....... :uhoh3: Needless to say the policies even at this prominent, respected medical facility now has policies that restrict the adjustment of alarms, who adjusts the alarms and why they adjust the alarms, thus restricting their autonomy and decision making processes.

So we all need to remember.......LOOK at your patient, ASSESS your patient! :nurse: , don't assume the alarm is right or wrong for that matter. It's a machine after all and if it was always correct they wouldn't need us. :rolleyes: I once had the most beautiful V.Tach I have ever seen on the monitor.......the patient was brushing his teeth with the Tele leads drapped over his arm. :uhoh3: We need to remember that floor nursing isn't critical care nursing and that ED nursing is unique unto itself. The floor nurse isn't necessarily going to try to restore a chroinc lunger to a normal 02 sat but she will obtain an order from the MD for new parameters of treatment and alarms to be set so that that patient is the exception and not the rule.

A floor nurse has 7-8 patients, on a surgical floor with almost every patient returning with an epidural, the cacophony of 02 sat alarms can be deafening........but they are necessary. Some hospitals require 02 sat monitors and apnea moniotrs on every patient with and epidural and a RN must accompany that patient when they leave the floor, some hospitals just spot check the 02 sat and find that is sufficient. Do I know which is the more prudent practice? Yes...... but is the other one dead wrong? maybe......but that is their policy. WOuld I check more frequently? Yes, whether it was policy to or not. Do I make fun at someone else because they were taught different? NO......I take the time to eplain how and why another way may improve patient care. An ICU nurse has 2 patients (hopefully the max excep in extreme cricumstances or incredible stability) which is a whole lot easier to customize/individualize alarms and to monitor which is necessary because of their instability. That's why they are in intensive care.

The ER? I think we like the alarms and the noise......it adds to the drama..... :smokin: ( :lol2: ). Peace.

suanna · Jul 11, 2011

Your sarcasm is immature. Way to look like a professional. Keep in mind we all have different patient populations but policies are put in place (influenced by JCAHO recommendations) for the safety of our patients and the protection of our license.

I'm sorry you feel my response was immature- You accused me(an others) of endangering my patients and uncaring/unsafe practice because I didn't want to be inconvenienced by those pesky alarms. I did take offence. My intention with this thread was to point out appropriate alarm parameters improve patient safety. By the way, I thought my sarcasm was quite mature. I hoped it pointed out why I feel preset alarms are dangerous.

bjaeram · Jul 12, 2011

I work in the ER and I think it's one of the most important places to adjust alarms. We have 20+ people on the monitor and they all alarm in the nurses station. If 6 of them are alarming at once all the time we tend to ignore them. If alarms are constantly going off patients and families get very annoyed. Families often come out concerned because it's alarming and no one is in the room. We aren't there because it's not important but the family doesn't know that.

We may not be okay with a sat of 85 but we also may not be able to fix it in 10 minutes. Why should the entire ER listen to an alarm forever when we all know it's low, we are working on it! Someone may have a heartrate of 30. Of course that is bad, the patient needs a pacemaker, we don't need to be reminded every 30 seconds though. We know! Someone with high blood pressure may have been living that way for awhile and it's dangerous to lower it fast.....we know it's high and we are okay with it.

It's okay and important to change alarms!!! Please do it so you dont annoy your co-workers, the patients, and the families!!

The person that said changing the alarms affects the next patient.....it shouldn't. You should turn off the monitor between them and it resets to factory alarms so it will not be an issue!

MunoRN, RN · Jul 12, 2011

Your sarcasm is immature. Way to look like a professional. Keep in mind we all have different patient populations but policies are put in place (influenced by JCAHO recommendations) for the safety of our patients and the protection of our license.

The Joint Commission does not prohibit proper adjustment of alarms, in my experience they prefer that alarms are patient specific, failing to adjust alarms when indicated is what poses a threat to your patient's safety, not leaving the alarms on continual default settings.

MunoRN, RN · Jul 12, 2011

It is much more common to adjust alarms in the critical care setting than anywhere else., especially in the cardiac surgery setting. In other settings, like the ED,if the alarms get shut off or changed for one patient...the overturn is such that the next patient may suffer the consequences becasue they do not alarm. That is why a lot of ED's have disabled their alarms on off swtiches, to prevent a fatality from accidentially shutting of an alarm.
In the cardiac surgery setting of critical care.... If I didn't set my alarms custom to my patients I felt I was asking for trouble and performing bad care.........and YES.......It drove me crazy :bugeyes:when someone was either......so uneducated, inexperienced, or frankly too lazy:devil: to set their alarms really would drive me to want to commit a felony.
So I feel your pain. I would give an impromptu inservice on the functions of the monitors and their alarms and use their monitor for the example.....just to shut it up!!! Other times, I would be blantaly honest and tell them....adjust your alarms and shut that thing up before I got crazy!!!:throcomp:

The problem with ED alarm settings and having old alarm settings in the monitor when you get a new patient is one we had as well. It's a simple fix, always put the patient's name in the monitor and clear your sectors when the patient leaves. As someone who works ED, ICU, and tele, and I can attest to the fact that it doesn't do much good to have your patients on continuous tele in the ED if it's not saving the data. Cardiologists love it when we tell them that the good news is they were on tele when they had their sustained VT, but the bad news is you can't see the strip because the ED doesn't enter patient names so they can be saved.

NicuGal, MSN, RN · Jul 12, 2011

Each area of our hospital has limits written into the guidelines. We always have alarms going off in our unit because of how our limits are to be set, and woe to the person that adjusts them out of those guidelines, esp without a written order. Each area is different. Sometimes it is out of our hands and we have to deal with it.

psu_213, BSN, RN · Jul 12, 2011

for the safety of our patients and the protection of our license.

Why is it that people feel that their argument is right if they can somehow include "protect our [my] license" in their argument for or against a certain practice? If I want to make sure absolutely nothing happens to my license, then I should just quit my job and stay home.

Also, the issue of "normal" was brought up. Yes, an SBP of 60 is not normal and is detrimental to pretty much everyone. However, I have seen patients who live with a SBP in the 80s and have no problems. Yet, if you go by what is the textbook "normal" this is way too low.

Someone else made a good point of the danger of giving more and more supplemental O2 to a COPD pt. just to 'make' a good sat. (I recently saw a paramedic crew make this mistake in their effort to 'chase' the ideal O2 saturation)

Another example, I had a pt yesterday whose HR was sustained in the 50s, occationally he would go down into the 40s. Never did he have any detrimental effects from this. Yet, everytime, his low heart rate alarm would go off. At first I ran in. After a few times, however, the charge nurse just said to me "he does this, right?" and she would turn around and silence the alarm. She even made the comment about the boy who cried wolf and said "you know that one of these times it will be alarming because he is in Vtach and we won't be paying attention." (luckly nothing happened to the pt and he was discharged after a workup) So even if you intend to do what's right and appropriate, alarm fatigue can definitely get to you. As I said in a previous post, this is why my hospital is making an intiative for all nurses to taylor alarms to their pt's norms. The nice thing, on our monitors, is that you only have to hit one button on them and the alarms go back to their default settings (such as, sat 90-100).

Esme12, ASN, BSN, RN · Jul 13, 2011

I work in the ER and I think it's one of the most important places to adjust alarms. We have 20+ people on the monitor and they all alarm in the nurses station. If 6 of them are alarming at once all the time we tend to ignore them. If alarms are constantly going off patients and families get very annoyed. Families often come out concerned because it's alarming and no one is in the room. We aren't there because it's not important but the family doesn't know that.
We may not be okay with a sat of 85 but we also may not be able to fix it in 10 minutes. Why should the entire ER listen to an alarm forever when we all know it's low, we are working on it! Someone may have a heartrate of 30. Of course that is bad, the patient needs a pacemaker, we don't need to be reminded every 30 seconds though. We know! Someone with high blood pressure may have been living that way for awhile and it's dangerous to lower it fast.....we know it's high and we are okay with it.
It's okay and important to change alarms!!! Please do it so you dont annoy your co-workers, the patients, and the families!!
The person that said changing the alarms affects the next patient.....it shouldn't. You should turn off the monitor between them and it resets to factory alarms so it will not be an issue!

Key word there is SHOULD......... :smokin: