Critical Alarms, who answers?

[Emergent, RN]

Do you have a policy on critical alarms? I find that they often get ignored. If I'm walking past a room where a critical alarm is ringing, I always pop my head in to see if it's real and how the pt looks.

I ask this because we had a recent bad outcome in our unit because the nurse didn't respond to a critical alarm. I wasn't on shift, don't know how busy it was. Nurse in question, I hear, was quite defensive that he didn't hear it. But apparently, no one else bothered to peek in the room either. There will be a root cause analysis probe, I'm certain, that hopefully will exam the event from all angles.

Also, what is your unit doing to reduce unnecessary alarms? Alarm fatigue is a very real thing. I've, personally, tried to minimize the problem by turning off unnecessary alarms, but we have no policies coming down from administration yet.

[emtb2rn, BSN, RN, EMT-B]

Alarm fatigue is definitely an issue. We have yet to come up with a viable solution. While we can change the alarm parameters, the danger is that they're not reset after that pt leaves.

Responsibility to check alarms is on that pt's rn and anybody else who can hear it. Not an official policy, just how it works at my er. Everybody watches/listens/checks.

[HikingEDRN, BSN, RN]

We have assigned rooms so I always keep an ear out and try to poke my head in other rooms if I hear one. Our secretaries get basic training in lethal cardiac rhythms and they know to look for a good waveform if the oxygen saturation is reading low before calling. They are very good about calling us to have us check on a patient and they will recycle blood pressures from the desk as well. Our techs also act as secretaries and one of them called me to tell my patient was in v tach. And she really was.

[sweetdreame, BSN, RN]

This was a HUGE problem in my ER. The alarms were constantly ringing. When I was in charge I would sit by the monitors as much as possible, but was called away frequently. Do you have a central monitoring station?

My solution? I think there needs to be a tele tech that watches strips and v/s and can act as a second set of eyes for the nurse. Of course, that's merely a dream...haha!

[Altra, BSN, RN]

OP, if your department/hospital does not have a policy which covers monitor settings and/or the criteria by which the settings can be modified (including turning off the monitor) ... I urge you to consider carefully before doing these things independently. In the event of an unexpected occurrence/outcome ... it would be difficult to defend why your patient's monitor settings were not in compliance with policy. If you're tempted to turn off the monitor and just periodically spot check -- better to get an order to do so.

[msjellybean]

In my ED, we have two nurses stations. One larger, more central area that shows all the monitors and a smaller area that only shows the monitors in the rooms close to that station. It seems to be an unwritten rule that everyone is responsible for looking out for the rhythms and responding to those critical alarms. I have frequently gone to rooms where critical alarms are sounding, to check on the patient. Thankfully, have never found anything worse than a slightly slower than usual bradycardia.

[Ruby Vee, BSN]

Alarms should be checked at the start of every shift. They should also be set appropriately. If the patient's heart rate is normally 120, why set the upper alarm limit at 100? Conversely, if he's 100% paced at 65, why set the lower limit at 70? Set your alarm limits appropriately (our policy is 20% above or below the patient's norm) and there won't be as many extraneous alarms sounding. Now if I could just get people to set their "Volume to be infused" for some reasonable amount so their pumps weren't always alarming!

[ljrn135, ASN]

We have a monitor station and a medic/monitor tech that is assigned to that station 24/7. It is NEVER left unattended. We also have a computer monitor with each rooms monitor on it at each nursing station. That way we can see at our nursing station what going on but then we have another set of eyes keeping watch over all 60 rooms. They have so many to watch that if we have a critical patient that needs a closer eye all we have to do is call them and given them a heads up and they flag that particular room, Im sure it has saved many patients lives but just the other day we had a pt that was bouncing in and out of vtach and vfib and all 3 nurses and our medic for that particular section were in other rooms and the monitor tech over headed that someone needed to go to that room stat. We knew he was already having issues (life vest shocking him) so all of us ran into that room and we started defibrillating him. I honestly can say Im certain if we did not have a monitor tech that patient would have died!

[BrooklynRN11201]

my goodness, some of you sound like you work at FANCY facilities! I'm lucky to find a monitor that works in my ED.

I usually set the parameters around my pt's baseline for the most part, but I always look when I hear any alarm going off - it only takes a second.

Great point about the facility's policy on alarm parameters on monitors! I need to look into that.

[Emergent, RN]

By unnecessary alarms I mean someone being left on a sat monitor who doesn't need it. Turning off the resp monitoring (which is inaccurate anyway) so the apnea alarm doesn't ring. Once we're aware of fast heart rate and working on it, raising the limits.

It was told to us in a meeting that we should be taking steps to only have meaningful alarms on.

But people walking by rooms where red alarms are ringing is very concerning. Part of the problem could be too many overwhelmed nurses. Also too many unnecessary alarms.