What "killed" the patient EICU or the nurse and alarm fatigue.....

[Esme12, ASN, BSN, RN]

i don't usually post threads but this one caught my eye. which cause this patient to have an untoward outcome. the hospital is calling it "alarm fatigue" and it's the nurses who didn't respond. but they have eicu where the is constant monitoring of the patients and the monitors by remotely located staff, like air traffic controllers watch airplanes.

who's job was it to watch the monitors and where did they all go? does anyone work at an eicu? what do you think of them......

the umass memorial health care system offers an extra level of care through the icu® program to patients admitted to intensive care units across our system, including umass memorial medical center and community hospitals healthalliance hospital, marlborough hospital, and wing memorial hospital, and affiliated hospital harrington hospital. (read related boston globe article).

the eicu program's specially trained critical care physicians known as intensivists use voice, data and video technology to enhance the patient care provided by the icu bedside staff. this attention to detail helps identify a potential concern in a patient's condition in the early stages, allowing icu staff to intervene with prompt treatment before conditions worsen.

because even the slightest change in a patient's condition could lead to a potential health problem, any sudden alert is instantly sent over the eicu program's high-speed data lines, notifying the intensivist to closely examine the situation. the intensivist can then activate a video camera at the bedside to visually check the patient's condition.

a soft chime and a green light displayed at the patient's icu bedside indicate that one of the icu monitoring cameras is being activated. the icu nurse, now at the patient's bedside, evaluates the sudden change in medical status by providing the intensivist with a verbal assessment. the intensivist can now communicate with both the patient and the icu bedside caregiver to better determine the cause of the sudden change in health status.

http://www.boston.com/business/globe/articles/2007/11/19/tele_treatment/

flash forward.....

the second patient death in four years involving "alarm fatigue'' at umass memorial medical center has pushed the hospital to intensify efforts to prevent nurses from tuning out monitor warning alarms.

nurses exposed to a cacophony of beeps may no longer hear them or begin to ignore them, and that's what appears to have happened in the latest case: a 60-year-old man died in an intensive care unit after alarms signaling a fast heart rate and potential breathing problems went unanswered for nearly an hour, according to state investigators who reviewed records at the hospital.

http://articles.boston.com/2011-09-21/lifestyle/30185391_1_alarm-fatigue-nurses-patient

very interesting.....

edit 1643: some have been upset about the title....i have no intention of accusing nurses of killing anyone. just to start the dialog about eicu safety and nurses being the fall guy's once again....

[SuesquatchRN, BSN, RN]

How about going back to 1-2 critical patients per nurse? Think that might make a difference? Naw....

They come in older and sicker and frailer. The nurses didn't stop those hearts, sickness did.

[Altra, BSN, RN]

Nowhere in the newspaper article did it indicate that this particular patient was in the E-ICU set up. Or did I miss that?

[SuesquatchRN, BSN, RN]

I thnk you missed it. There were two articles, BTW.

[Altra, BSN, RN]

Am I losing it ... ?

Both this thread and the one under the Nursing News forum reference the same one Boston Globe article of Sept. 21. The article describes this patient as being a 60-year old male s/p TBI. It also describes the patient being given a dose of 5mg of Ativan. At some point after that, the alarms signaled the patient's respiratory arrest.

[SuesquatchRN, BSN, RN]

From the first page of the first article:

"From this carpeted, fluorescent-lit support center, called an "eICU," Lilly and nurse practitioner Joanne Lewis were supervising the care of 109 of UMass Memori al's sickest patients, scattered among eight ICUs at three of the system's hospitals. They are part of a new program that aims to cope with the soaring number of ICU patients, a problem exacerbated by a shortage of intensive care specialists."

italics mine

[classicdame, MSN, EdD]

not enough staffing IMHO

Also, why was no one in his room for that period of time?

[Altra, BSN, RN]

http://www.boston.com/business/globe/articles/2007/11/19/tele_treatment/

This article, from 2007, describes the e-ICU set up.

http://articles.boston.com/2011-09-21/lifestyle/30185391_1_alarm-fatigue-nurses-patient

This article, Sept. 21, 2011, describes the recent patient death (the 60-year old male) ... as well as another patient death of a female patient related to a dead battery in her monitor.

[**LaurelRN, MSN]

i honestly think this is an unfortunate result of alot of different sources. what isn't in that article is

1) how many patients that rn was assigned

2) were there any uap's (was this rn the secretary, tech, phleb and ekg tech too...i know many times on my unit- that's me)

3) how many other rn's were there??

4) what was the response of the eicu?

5) if none...why?

alarm fatigue is real...i am guilty of it..i really try not to ignore them..but after the 1000th time of going into granny's room because she keeps picking at hings...it does get tiresome. we don't have an eicu- but i understand the basics of it- so if this alarm was going off for an hour and the rn did not respond....why didn't the eicu??

bottom line is both the primary rn and the eicu md are ultimately responsible- tho we as nurses see all the variables- the law does not...imho

[Horseshoe, BSN, RN]

How about going back to 1-2 critical patients per nurse? Think that might make a difference? Naw....

They come in older and sicker and frailer. The nurses didn't stop those hearts, sickness did.

Did the nurses in this ICU have more than 2 patients?

At my hospital, all ICU's have a 2:1 ratio which is set in stone. Step down ICU is 3:1. They do try to mess with ratios everywhere else, but the ICU ratio is non negotiable. If someone calls in and they can't get coverage, agency nurses are used.

I cannot imagine working ICU and not going into a patient's room for an hour. I was in there almost every few minutes, and when we were at the nurse station, we could see our patients at all times (round unit with glass walls into patient rooms).

[Pepper The Cat, BSN, RN]

I can fully see alarm fatigue happening. On our Rehab Unit we have IV pumps alarms, G-Feed pumps alarming, Bed Exit alarms going off, Chair exit alarms going off. We have PITA med cart that locks itself after a certain time out - and it alarms first. Add in the microwave with an annoying beep that doesn't stop until the door is opened.. it just gets to be too much after a while.

And then add in the annoying people with cell phones, blackberries etc that keep going off as they get text messages, voice mail whatever!

[Rob72, ASN, RN]

the eicu program's specially trained critical care physicians known as intensivists use voice, data and video technology to enhance the patient care provided by the icu bedside staff. this attention to detail helps identify a potential concern in a patient's condition in the early stages, allowing icu staff to intervene with prompt treatment before conditions worsen.

e-medicine is an attempt to validate a business, not a care, model. intensivists and staff are expected to prioritize on what the brain interprets as scenario based protocols. everyone remembers case studies, right? case studies do not have immediate and variable sequelae, tho'. behavioral psych is also pretty clear, the farther humans are removed from interpersonal action, there is less immediacy, accountability if you will, and communication is more frequently misinterpreted.

i'm not sure what umass' model is, but when i first read about e-med design, iirc, the ideal was 1 intensivist to 50 patients, rn-10/1, "aide"-3/1. no, i can't source those figures, but something concrete is out there on pubmed, webmedicine, etc.. patient/staff ratio has to be significantly higher, otherwise the facility could not justify the large front-end investment in the e-package.

its a bad idea, based on dollars. if we thought what happened in hospitals in nola was "bad", just wait until we have a grid failure effecting one of these facilities...