How do you get co-nurses to customize their monitors?

ktliz · Jan 29, 2014

We will be playing a game on our unit where you accumulate "gold star" type stickers (I think they are actually sleeping smiley faces in bed caps, lol) for customizing your alarms. Not quite sure how it works because we haven't started yet, but it's a fun idea.

Other than that, just do it yourself! Ask if it's okay if you change the parameters and then do it. Or, depending on the nurse's personality, just do it and then tell them that you changed it. ;-)

MunoRN, RN · Jan 30, 2014

I ask them why such-and-such alarm is necessary for this patient and then turn it off unless they can make an argument for it.

meanmaryjean, DNP, RN · Jan 30, 2014

Addressing Alarm Fatigue is a 2014 Patient Safety goal. I highly recommend you arm yourself with some evidence that the ANA has out there. It is a real and dangerous problem.

Monitor Alarm Fatigue: Standardizing Use of Physiological Monitors and Decreasing Nuisance Alarms

http://www.medscape.com/viewarticle/782597

megan.g.meyers · Mar 2, 2014

Assert yourself! It's a patient safety issue and you are the patients advocate!

calivianya, BSN, RN · Mar 2, 2014

I always turn the respiratory (as in the rate) alarms off on my patient during the very first assessment of the night, and usually go around to my neighbors if their apnea alarms go off and ask if they mind if I just turn it off. If the patient ACTUALLY stops breathing, the SpO2 alarm is going to go off. Besides, since the apnea monitor is attached to chest leads, what usually happens is that all of my more obese patients alarm apnea all of the time because it can't figure out that they're breathing. Oh, and if someone is choking and their chest is still moving because they're struggling, of course it's going to show it as breaths even if they are blue in the face and about to pass out with a Sp02 in the 70s...

Bonus points when my patients on the ventilator alarm apnea... or when any patient with a SpO2 of 100% alarms apnea... it's pretty obvious that they've found some way to oxygenate other than breathing like the rest of us, right? I guess my patients are just highly advanced organisms that absorb O2 through their skin.

Nalon1 RN/EMT-P, BSN, RN · Mar 2, 2014

I always turn the respiratory (as in the rate) alarms off on my patient during the very first assessment of the night, and usually go around to my neighbors if their apnea alarms go off and ask if they mind if I just turn it off. If the patient ACTUALLY stops breathing, the SpO2 alarm is going to go off. Besides, since the apnea monitor is attached to chest leads, what usually happens is that all of my more obese patients alarm apnea all of the time because it can't figure out that they're breathing. Oh, and if someone is choking and their chest is still moving because they're struggling, of course it's going to show it as breaths even if they are blue in the face and about to pass out with a Sp02 in the 70s...
Bonus points when my patients on the ventilator alarm apnea... or when any patient with a SpO2 of 100% alarms apnea... it's pretty obvious that they've found some way to oxygenate other than breathing like the rest of us, right? I guess my patients are just highly advanced organisms that absorb O2 through their skin.

Wow, so instead of adjusting the apnea/resp section (increasing/decreasing waveform, adjusting sensitivity, changing the time for apnea alarm etc), you just turn it off? :no:

You do realize O2 sats can stay falsely high even if a patient is not breathing, right? I have seen pulse ox sensors give a sat of 92% stuck to a pillow case.

We are not supposed to turn off any alarms. Annoying as heck, but it is what it is. I have learned to adjust the monitor to the patient, so I rarely get false alarms.

The only time we can turn alarms off is for a DNR/Hospice or the apnea alarm for someone who is intubated (since the vent will alarm for that).

calivianya, BSN, RN · Mar 6, 2014

Wow, so instead of adjusting the apnea/resp section (increasing/decreasing waveform, adjusting sensitivity, changing the time for apnea alarm etc), you just turn it off?
You do realize O2 sats can stay falsely high even if a patient is not breathing, right? I have seen pulse ox sensors give a sat of 92% stuck to a pillow case.
We are not supposed to turn off any alarms. Annoying as heck, but it is what it is. I have learned to adjust the monitor to the patient, so I rarely get false alarms.
The only time we can turn alarms off is for a DNR/Hospice or the apnea alarm for someone who is intubated (since the vent will alarm for that).

I usually do because changing the parameters does nothing for our monitors. I tried that for a long time before finally just turning the alarm off. I can set the alarm all the way down to 0 and only increase up to 40 seconds, and still have the apnea alarm going off and waking the patient and family up every five minutes or more often. If there was a way to get the apnea alarm to be accurate I would use it. I don't know if this is a flaw with our monitors or what.

For the record, this does not turn off the monitoring for a patient's breathing. I can still see how many "breaths" the patient takes per minute and the patient's respiratory rate still shows up on the monitor tech's monitors, so we still see it and the monitor techs will usually still ask us about it if it goes low - it just does not make an obnoxiously loud noise. I have some coworkers that just turn off the respiratory monitoring altogether - no waveform or anything - so I find turning off the apnea alarm to be a pretty fair compromise. I wish there was just a way to change it to the less intense alarm setting so I could leave it be. If I could get it to sound with the "you should probably look at your patient" alarm as opposed to the "OMG THE PATIENT IS ABOUT TO DIE!!!" alarm, I might still use it.

Catchall_RN · Mar 7, 2014

Wow, so instead of adjusting the apnea/resp section (increasing/decreasing waveform, adjusting sensitivity, changing the time for apnea alarm etc), you just turn it off?
You do realize O2 sats can stay falsely high even if a patient is not breathing, right? I have seen pulse ox sensors give a sat of 92% stuck to a pillow case.
We are not supposed to turn off any alarms. Annoying as heck, but it is what it is. I have learned to adjust the monitor to the patient, so I rarely get false alarms.
The only time we can turn alarms off is for a DNR/Hospice or the apnea alarm for someone who is intubated (since the vent will alarm for that).

Which monitors do you use? I have found some monitors are better than others. Nihon Kohden never gave me apnea alarms but gave me the sinus asystole alarm alllll the time. On the other hand, Phillips tends to give me apnea alarms pretty frequently, but much better with the rhythm alarms.

Definitely also change your leads/electrodes if you're getting a lot of alarms. q24hrs is best, there is a huge difference sometimes just by changing out your electrodes (and double check placement, they jump around or sometimes someone brain farts and puts the white over the left and the smoke over the trees!).

calivianya, BSN, RN · Mar 7, 2014

Which monitors do you use? I have found some monitors are better than others. Nihon Kohden never gave me apnea alarms but gave me the sinus asystole alarm alllll the time. On the other hand, Phillips tends to give me apnea alarms pretty frequently, but much better with the rhythm alarms.
Definitely also change your leads/electrodes if you're getting a lot of alarms. q24hrs is best, there is a huge difference sometimes just by changing out your electrodes (and double check placement, they jump around or sometimes someone brain farts and puts the white over the left and the smoke over the trees!).

We have the Phillips monitors. We do have a policy to change out electrodes q24h - I have no idea if day shift does it, so I usually do just in case. I usually shave my male patients' chests just to make sure the electrodes have somewhere to stick and rub them down with alcohol swabs to get rid of any oil, and it doesn't seem to help. Some patients will just alarm apnea no matter what you do with these monitors, and I'd rather turn it off than have the monitor alarm V-fib and have me roll my eyes and take my time investigating if I'm in my other patient's room because "the stupid apnea alarm is going off for the 35th time tonight..."