Your input on your nursing assistants and alarm responsibilities...

[enzati]

My hospital managers are looking into what our official stance should be on our PCA's (patient care assistants- they all have their State tested nursing aide certification - but otherwise all experience is on the job training) addressing alarms. (We are mainly interested in pulse ox alarms).

Right now, it is acceptable to a PCA to address and respond to an alarm, and then let the RN know if there is concern. This is extremely helpful in getting to the alarm quickly, and reducing alarm fatigue in our nurses. But obviously this can bring up some issues, not the least of which is that it is an unlicensed person "deciding" if help is needed. Of course, if the patient is disconnected and simply in the bathroom, that does not require help. But what if the person is just sleeping but desatting just a little? Should they call the nurse, or make the decision that help isn't needed?

Can anyone give me some feedback on the policy in your institution? Thank you!!!

[psu_213, BSN, RN]

Right now, it is acceptable to a PCA to address and respond to an alarm, and then let the RN know if there is concern.

I guess it depends on your definition of "address." In the context of someone sleeping, I don't really have a big deal with the PCA giving the pt a slight nudge and having them breath more deeply, resulting in an increase in sats. On the other hand, I have had aides say to me, "they were only stating [sic] 89% so I turned up their oxygen." There are times when a sat of 89% while sleeping is better than increasing the oxygen (for a COPD pt for example). This is not to mention the scope of practice limitations of an unlicensed staff member increasing oxygen.

I think it is legit for a PCA/PCT/CNA/etc. to check on the nature of an alarm, make sure the equipment is set up correctly--for example, is the probe correctly positioned?--and if the situation is not quickly (such as, within 10 seconds) corrected, a nurse is immediately notified.

[macawake, MSN]

The policy of my hospital might not be of much help to you since I'm in another country. Anyway, our policy is that no one but an RN is allowed to change a setting (including oxygen) or silence any alarm from a monitoring device or for example an iv pump.

You mention alarm fatigue. Do you get many "false" alarms? I'm guessing that the alarm goes off if the probe is disconnected or if the SpO2 drops below 90?

The scenario where the patient removed the probe due to a bathroom visit is the only scenario where I'd feel comfortable with allowing a PCA make a judgement. Yes, I realize I have some control issues.. but I'd really want the person making the clinical judgement to be knowledgeable in respiratory physiology and the disease processes that might affect saturation and ventilation. I'm not sure if that is included in a PCA's education? Deciding whether to notify the RN or not, does require an assessment of the situation. The PCA would probably do a fine job most of the time but if something is missed I assume the RN is still responsible?

You say that the policy today is that a PCA can respond and address an alarm and let the RN know if there is concern. Is "concern" clearly defined or is it based on the individual PCA's assessment of the situation?

[psu_213, BSN, RN]

You mention alarm fatigue. Do you get many "false" alarms? I'm guessing that the alarm goes off if the probe is disconnected or if the SpO2 drops below 90?

Along with false alarms, it is faulty alarm parameters. Let's say for HR, the alarm is set to go off if the HR is above 120. If someone is in A fib with RVR, the might go above 120 frequently until it is under control. The nurse is not going to run in to the room if they "hit" 123, yet the alarm will blare. In this case, the parameter should be set to, say 140 so that it will only alarm at a HR where there is alarm amongst the staff. If it is not reset the alarm goes off over and over. As an example: one time, a staff member might say to themselves, that is only Mr. Jones in the 120s again. It is ignored for a period of time and, unfortunately, it was going off because Mrs. Harris is in V fib. Parameters need to be tailored to each patient to make them more effective.

[jadelpn, LPN, EMT-B]

If an alarm goes off, I always feel better going to check myself. Then make any necessary changes to parameters if indiciated. Or to fix IV's that need it.

Too many times alarms go off and they are silenced without intervention. And that is not ideal. So I like when the PCT alerts me if I am not in the general vicinity, so that I can intervene right away.