Alarm Fatigue and Cardiac Monitors

[kbnocturna]

Hello everyone, I'm a monitor tech in a rather large hospital with centralized monitoring (200+ telemetry units and 70 critical beds). Recently there has been a lot of attention given to alarm fatigue, probably in large part because of the recent Joint Commission report on it.

With close to 300 patients being monitored and 8 monitor techs in one room, alarm fatigue is definitely an issue in my unit. The current state is, non-urgent alarms (pvc's, leads off, moderately low O2 sat) are a faint background cacophony that you tune out for your own sanity, and urgent, high-pitched alarms (VT, asystole, etc) get addressed fairly quickly. Personally, I do a pretty good job of keeping up with my patient's rhythms and alarms, but it's because I watch them constantly and am vigilant about keeping up with the alarm history; all non-emergency alarms that I address are from a purely visual notification. Constant phone calls also contribute greatly to the noise level.

One of the goals of this investigation into alarm fatigue is to get us to a point where every non-urgent alarm is immediately addressed, eliminating the background cacophony. I think, that while updating to evidence-based standardized protocols and teaching how to customize individual alarms can greatly reduce the noise clutter, getting to where any beep is immediately addressed is very idealistic and not practical at all. Several things contributing to the constant beeping: critical care nurses have dual control with the monitor techs over alarms, and they prefer to address their own alarms when they can, so we let non-urgent alarms ring for a minute or two before we silence them; pulse oximetry monitors alarm constantly every time a patient moves, sneezes, or goes to 89% briefly for half a second; monitor techs not properly adjusting alarms; more urgent issues (phone calls, admissions, emergency rhythms, etc) cause you not to notice the background beeping. I'm concerned about potential changes because those implementing them don't really have a practical working knowledge of what it's like "in the trenches."

I would like to hear from nurses and other healthcare workers who deal with cardiac monitoring, specifically:

-how specific are your monitoring guidelines, and how much do they impact your patient care, especially in your type of setting (non-serious patients, critical care, etc). I ask this because currently my hospital has very generalized guidelines to fall back on, but most monitoring relies on clinical judgement and nurse-monitor tech communication.

-Do you think quality of patient care could increase if certain changes were implemented? If so, what changes?

-Has your hospital made any changes to it's monitoring system or policies? What changes were made? What was the result? What methods did your institution use to determine what changes to make?

One more thing I'd like to hear from other people on: how your monitor techs interact with/fit into the larger inpatient nursing structure as a whole. Most unlicensed staff have a very specific, well-defined role under a nurse as part of a unit as a whole, but I fall outside that infrastructure. A lot of nurses are grateful for "a second set of eyes," but many perceive me as a nuisance or even a threat (I attribute this to the fact that I have more ekg-specific knowledge than most nurses, and a bit of authority in that particular area, but to some people, I have more "perceived power," so, for the nurse, it becomes a struggle against the non-RN instead of us both working on the same team for the patient.) I think that part of the problem is that most of the hospital is on one computer system, and we are completely separate. We communicate verbally with nurses and deliver paper strips at the end of each shift, while virtually every other department can access the computer system via electronic charting. I am often treated with disrespect, contempt, dismissiveness, arrogance, downright hostility, and I'm even lied to a lot ("I was in there 3 times already," "They're in the bathroom," I'm looking at them right now and all the leads are on," etc). And that's when they even bother to answer their phones. I just think that someone who makes 2-3x what I do should treat me some basic professional courtesy. If you have come across this separatist, us vs them mentality, how have you addressed it? I'm very interested in various solutions to this.

Sorry this is so long. I think I'm venting my frustrations a bit too. Thank you in advance for any responses.

[HyperSaurus, RN, BSN]

We don't have monitor techs--we monitor our own teles (maybe 300 bed facility). However, I can commiserate with the alarm fatigue (PVCs oh my! --oh wait, that's just artifact) as well as calling to say, "Your pt is doing such-and-such" and getting blown off (we have a long unit, with monitors just on one end, so we monitor for the other half of the unit and call with any issues). I agree that you should be treated with professional courtesy. I'm not sure what your knowledge base is, ect. So far, I haven't seen any new policies r/t alarm fatigue.