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Nurse Alarms

Short clip of the sounds and alarms the patients at Parkview Hopsital use to alert the nurses to their needs.

Chad Ryan | The Journal Gazette
Missy Wallace and Ben Escobedo walk along a sixth-floor hall at Parkview Regional Medical Center. Patient alarms will flash above nurses’ heads and audible alarms will chime to alert the nurses to the patients’ needs.

Stricter rules for alarms set for hospitals in 2014

Patient neglect, fatigue to alerts cause for change

Chad Ryan | The Journal Gazette
An alarm light outside a patient room on the sixth floor of Parkview Hospital lights up to alert nurses to the patient’s needs.

Advanced technology in the typical hospital room makes it easier than ever to treat patients.

But those same alerts are being blamed for overwhelming some health care workers, prompting them to ignore or silence the shrill tones that can signal critical situations.

It’s called alarm fatigue, and it’s a serious problem, according to at least one health care credentialing organization.

In a 3 1/2 -year period ending June 2012, 98 serious alarm-related events were reported to The Joint Commission. The events, which happened in all health care settings, included 80 that ended in the patient’s death.

In 13 other cases, patients lost physical or mental functions as a result of delayed staff response to alarms.

Depending on the hospital unit, each patient’s room can generate several hundred alarms each day, according to the Chicago-based organization.

Local hospital officials say they are actively addressing the challenge of keeping patients safe by using alarms while trying not to overwhelm nurses with almost constant noise.

Their approach eliminates some of the non-emergency situations that trigger alarms.

Problem’s scope

The Joint Commission is requiring hospitals, starting in January, to identify the alarms that pose the biggest safety risks by unnecessarily adding noise or being ignored. By 2016, hospitals must decide who has the authority to turn off alarms.

The parents of Mariah Edwards won a $6 million malpractice settlement after their 17-year-old daughter died last year after a tonsillectomy at a Pennsylvania surgery center.

After the surgery, the high school junior was given a potent painkiller that slowed her breathing. By the time nurses checked on her 25 minutes later, she had suffered profound and irreversible brain injury. She died 15 days later.

A nurse said in her deposition that the alarm on the respiratory monitor was muted. After Edwards’ death, the center announced several changes, including that alarms would no longer be muted.

The Joint Commission estimates that only about 1in10 alarm-related incidents are reported as part of a voluntary program.

Officials estimate there were close to 1,000 alarm incidents in which patients died, were injured or faced those risks during the 3 1/2 years when 98 events were reported.

The ECRI Institute, a Pennsylvania-based patient-safety organization, listed alarm hazards as the No. 1 issue on its annual list of the top 10 health-technology dangers for 2012 and 2013.

“I think the main reason is the large growth in the use of monitors that have alarm-based features and the number of alarms that clinicians are needing to deal with,” said Jim Keller, ECRI’s vice president for health-technology evaluation and safety.

7 alarm types

Devices alert nurses whenever a cardiac patient’s heartbeat gets too fast or a respiratory patient’s breathing gets too shallow. Pressure-sensitive bed mats warn staff when an unsteady patient tries to get out of bed.

Additional beeps and tones signal when the fluid in an IV bag gets low or a patient needs help in the bathroom.

In all, at least seven different types of alerts can be found in each room – though many patients don’t need all seven.

Experts have estimated that 85 percent to 99 percent of patient alarms don’t require staff response.

As a result, the commission reported, some staff members turn down alarm volume, turn off alarms or reset alarm parameters outside safe limits.

Health care providers have long been aware of the potential for alarm fatigue, said Judy Boerger, senior vice president and chief nursing executive for Parkview Health.

When they were planning to open Parkview Regional Medical Center, officials spent hours with staff in trial and error – listening to the tones of various alarms to choose the sounds that wouldn’t fade into white noise, she said.

Lutheran Health Network officials also say alarms are a useful tool that must be handled carefully.

Diane Springer, Lutheran Hospital’s chief nursing officer, was shocked to read about nurses turning off alarms in other hospitals.

“I can’t imagine having that capability or even wanting it,” she said.

Boerger agreed, saying, “That is absolutely not appropriate.”

Setting standards

Education is critical to using technology effectively, the nursing leaders said.

That means training staff how to use the devices and preparing patients for the sounds those machines make.

Some alarms can be averted by setting the monitor to sound an alert only if the reading falls outside the patient’s personal parameters for heart rate or blood pressure. Otherwise, a patient with high blood pressure could repeatedly trip the alarm even when the reading is typical for him.

An IV monitor is set up to beep whenever a prescription bag nears empty. But they don’t always need to know when a one-dose antibiotic is done.

“Some of it is knowing how to use the technology properly,” Boerger said.

Also, alarms can be reduced by carefully placing IV lines. If it’s inside the elbow, the flow can become blocked every time a patient bends his or her arm, she said.

During rounds nurses can change a saline bag that’s getting very low, averting another alarm.

Springer said hourly visits to patient rooms help Lutheran’s caregivers intervene in situations that might lead to a false alarm.

Parkview and Lutheran staff try to teach patients and their families about various sounds to help reduce the anxiety they might feel from hearing them.

Both health care systems use standardized tones for each type of alarm. The Joint Commission alert suggested different tones and pitches for various alarms, which allows staff to know immediately whether a situation is critical.

A nurse can’t adjust a tone or how rapidly it sounds because that could confuse nurses working the next shift. They also can’t turn alarms off completely.

Springer said the staff can’t turn off a light from the nurses’ station, so they have to check on a patient in person.

Exploring options

Another tactic is to divert non-critical alerts to other forms of communication, Boerger said.

When appropriate, such as when a lab result is ready, staff will send a message that makes a nurse’s cellphone vibrate rather than triggering another alarm.

“We’ve tried to limit the – I’ll say nuisance – alarms,” she said.

Some alerts show up on the electronic medical records monitor. And sometimes lights are illuminated outside a patient’s room.

“You really want to be discerning in using those alarms and understanding them,” Boerger said.

While it’s important to reduce the number of alarms when possible, staff needs to be alerted to critical situations.

Reducing patient falls is a Parkview priority, so a shrill alarm sounds and a light flashes outside of the room when a patient at risk of falling moves around too much on the pressure-sensitive bed mat.

sslater@jg.net

The Washington Post contributed to this story.

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