Questions for a paper on alarm fatigue

delphine22 · Oct 1, 2014

We are not only allowed but expected to adjust our monitor alarm settings for every pt, and should during every shift. I work ICU so we have multiple alarms. We are not expected to ignore any alarm, so if things are alarming that shouldn't, we fix it right away.

I had a pt with a pacemaker and atrial flutter underlying, that kept alarming vtach. Obviously we can't shut off the vtach alarm, ever. But it took a lot of playing (like, half the shift) to come up with the right lead to look at with the right setting so the machine didn't erroneously think it was vtach.

Here.I.Stand, BSN, RN · Oct 1, 2014

I haven't read an exact P&P on alarms, but I'll look online to see if I can find one.

That said, like Delphine, we are expected to customize them. Alarm fatigue is a very real safety issue! Plus, the monitor's default settings are simply not always appropriate. I believe the default SBP high is 160...but sometimes we'll have a stroke pt whose SBP *needs* to be >180. Not too long ago I actually had a pt on Levophed to keep her SBP between 180-220. For someone on a ventilator with a set rate (as opposed to pressure support only), there is no reason to have the apnea alarm on. They cannot be apneic if on a vent with a set rate; the vent will alarm "circuit disconnect" if it pops off and therefore not giving breaths.

Here.I.Stand, BSN, RN · Oct 1, 2014

Hmmm, looks like our P&P are only on the intranet. I thought I could access them logging into employee resources from home. Sorry!

Here.I.Stand, BSN, RN · Oct 2, 2014

Just a thought; I don't post much in the cardiac nursing forum, just happened to see this topic under the list of specialties. I don't know how the traffic typically is on this one, but you might get some more responses if you move this to one of the critical fora.

JustAdmitToObs · Oct 2, 2014

Hmm all of your responses are in line with my research. I'm stumped because I have to do a literature review on the "pros and cons of alarm fatigue." I'm stumped in terms of being able to report any kind of argument in favor of it.

JustAdmitToObs · Oct 2, 2014

Doesn't admin move conversations? I'm not sure how to.

Esme12, ASN, BSN, RN · Oct 2, 2014

thread moved to critical care nursing for best response.

SubSippi · Oct 3, 2014

How could there be a "pro" to alarm fatigue?

I always hear vent alarms, but my brain loves to tune out tele and IV pump alarms.

In CVICU, where the RN monitors each patient's telemetry, we adjust our alarm limits. In other parts of the hospital, telemetry is monitored in a separate room by tele techs. They have a standard set of alarm limits, that are not tailored to the patient, and are required to report to the RN if the patient is outside these limits. If the RN wants them changed, an order is needed. For example, I had a patient who would regular brady down to the low 40s/high 30s when sleeping. The tele tech was calling me every 2 minutes, and I couldn't just tell her that was normal for the patient and not to worry about it. I had to call a doc and get an order for to limit to be changed.

Here.I.Stand, BSN, RN · Oct 5, 2014

How could there be a "pro" to alarm fatigue?

I know, right? My first thought was there IS no pros to alarm fatigue. Alarm fatigue is bad for everyone.

JustAdmitToObs · Oct 5, 2014

I wish I could site your comments as references! I found one study that found that even if nurses didn't respond to alarms, hearing them prompted them to mentally "check-in" with the patient and then determine the urgency of the alarm.