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

Nurses General Nursing

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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?

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
So who takes care of my other patients while I'm sitting in the toddler's room? Who's watching the monitor on my apnea baby that I can't tell when it goes off because the alert toddler is going off non-stop and I'm sitting in the toddler's room?

THAT is the problem with alarm fatigue. It's blamed on nurses being too LAZY to check the monitors. When the problem is patients that don't need to be monitored going off so we can't tell when one we need is going off. When my phone doesn't stop buzzing because of an awake toddler, I don't know that it's buzzing for the apnea baby that's actually having apnea. Unless we're going to get 1 on 1 staffing, it's not laziness, it's prioritizing.

wooh....That is extreme....and you know that. ;)

All this initiative is asking is to set standards. Standards in an attempt to alleviate alarm fatigue...which we used to just say that the monitors "ARE DRIVING ME NUTS!!!!!".....change alarms so that it alarm less....if you have a patient that has a heart rate NORMALLY 55-68 then you can "customize" that alarm for that patient to be low heart rate less than 50 before it alarms. For a patient that has frequent ruins of VT of 3 or more....change the VT alarm to be PVC> 5 to alarm VT.

These sentinel events were batteries in op leads off and by the time these patients were found rigor had almost set in....HOURS (10 hours in one incident) had gone by......is INEXCUSABLE. The common statement upon investigation was....."they (the patient) never kept their leads on" so they "didn't think anything was wrong"...however no one checked.

It includes "unnecessary monitoring" but the dialog needs to occur....standers need to be set. I have worked monitored units my entire career.....35 years. Alarms will always be there it's what we do with them and how we respond that counts.

While a HUGE percentage of nurses react appropriately to every alarm....There are those that are frighteningly obtuse in matter of common sense or they just don't care......that small percentage that doesn't respond is what needs to be addressed

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Why in the world don't manufacturers produce equipment that allows you to customize the alarm sounds??? Wouldn't it be great if you could differentiate "your" alarms from everyone else's? As an ICU nurse - you may just 'tune out' alarms because you think it belongs to someone else's patient or an unimportant function.... but if there was some way for alarms to be customized - Yeah!!

unfortunately this boils down to the monitor and if the hospital paid for the software. which we ALL know is, for the most part a pipe dream...sigh

OP......most facilities will have huge meetings of pharmacy and therapeutics to set policy on how best to set the alarms ....some will include bedside nurses...however that isn't usually the norm but they will include nursing educators and admin/managers/supervisors. Biomed may be included for they "know the machine" and it assets/limits and will get medical staff approval before instituting policy.

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Specializes in NICU, PICU, PACU.

A lot of the alarm issues were set of by a sentinel event when someone in a PACU received narcotics and because someone had turned to alarms off, went into respiratory arrest and died.

I can tell you we get so sick of alarms due to the parameters we ave to set for our pulseox since micronates should be between 86 and 92 to prevent eye issues....show me one that stays in those parameters and I'll eat my stethoscope ! Lol. But we do tend to tune it out, not completely but enough that we will go oh Sheet when we realize it isn't that kid. It just wears on you after 12 hours!!

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wooh....That is extreme....and you know that. ;)

Not any more "extreme" than the sentinel events you cited.

A few sentinel events aren't proof of an overall lazy disregard of monitor alarms by nursing staff. It's the easy way out to blame the problem on staff too lazy to check a monitor. If the patient was dead for hours, it wasn't a monitor problem. I look at my patients often enough that even without them being on a monitor, I'd catch that they were dead within a couple hours. It's like med errors. You can take the easy way out and blame the nurse because they were the final check. Or you can look at the system and actually fix the problem by looking at the steps along the way that led to a nurse who missed the final check.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Not any more "extreme" than the sentinel events you cited.

A few sentinel events aren't proof of an overall lazy disregard of monitor alarms by nursing staff. It's the easy way out to blame the problem on staff too lazy to check a monitor. If the patient was dead for hours, it wasn't a monitor problem. I look at my patients often enough that even without them being on a monitor, I'd catch that they were dead within a couple hours. It's like med errors. You can take the easy way out and blame the nurse because they were the final check. Or you can look at the system and actually fix the problem by looking at the steps along the way that led to a nurse who missed the final check.

I wish they weren't true....and there are more than everyone realizes....I can't name the source of the information ....I know I usually do......so just once I have to say trust me.......but it is very true.

I agree not all nurses are lazy and that those patients weren't dead for 10 hours....they were off the monitors for 10 hours.....it was on the alarm history. A couple of hours dead is pretty dead. I'm not blaming the nurse itnis a systems issue. This initiative isn't blaming the nurse either...it's to address an ever increasing problem that is occurring with more frequency...open a dialog. Have I witnessed alarms being ignored? Yes....and I address it immediately.

Now...will it help? Probably not...for so many nurses are understaffed, over worked and just sick and tired of being blamed for everything....be we are the final check. we are that one thing that stands between the patient and potential disaster.

Are we paid what we are worth? NO....and with this present employment environment we aren't valued....sad really.

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Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.
I was looking for a few things:

- If hospitas are doing anything on this.

No. Not mine, at least.

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I think my level of patient care and job satisfaction would go up if I was allowed to physically assault whoever decided that you can't turn off the lower limit on our breathing rate. I work at night. A sleeping patient who is on their side or obese has poor pick up when it comes to breathing rate. I spend a significant portion of the evening temporarily silencing apnea alarms for people with a hx of tachypnea with a sat of 93, HR of 85, and a breathing rate that registers as 0 to 10. I go in and they're asleep, reapers at 14 or so, nice and easy and deep. Can't turn them off because I need to know if they shoot up....not that the monitors would freaking register it if they did, this is hy I do hourly stand and count checks, if I can, but gotta cover my butt.

As for doing something to lower fatigue? Ha. Ha. Ha.

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Thanks all for great feedback. Appreciate it. I am thinking of developing an application that would enable hospitals to manage and improve alarm policies. If I want to pilot such a product, which hospital should I appraoch?

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Specializes in Med-Surg Nursing.

My hospital is not JCAHO certified so I don't need to worry about this. We are certified by the AOA only and of course our state's Dept of Health. Being JCAHO certified is not the be all end all that everyone thinks it is.

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Specializes in NICU, ICU, PICU, Academia.

I'm currently watching the first in a series of webinars sponsored by AACN on this topic.

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Did you find yesterday's webinat useful? I believe it would be CNO or Dir of Patient Safety at most hospitals to lead this effort. Funny thing was list of sponsors who have some kind of Wireless alarms system. Well many of devices that alarm, including CoW dont have that wireless capability to send the alarm.

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The hospital I work for is piloting a "quiet" hour.From 2-3 every day doctors can't round, PT/OT etc can't visit patients, patients are encouraged to wear headphones if they want to watch TV. Nursing is supposed to sit and silently chart during that time, I know as a tech I'm not allowed to go reposition patients, check vitals etc unless the pt asks or in case of an emergency. Our floor has 12/13 patients on vents and many on tele so I'm not sure what the plan is to tackle those alarms? But yeah. It should be interesting.

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