Clinical Alarm Fatigue Discussion

Clinical Alarm Fatigue Discussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Clinical Alarm Fatigue Discussion For this week’s discussion, think of the various alarms you have observed in the clinical setting. Use the article posted for this week and at least one other supporting reference (text or other assigned readings) to discuss how a built in alarm system can be helpful and how alarm fatigue could result in a patient safety risk of error and patient harm. Clinical Alarm Fatigue Discussion What have you witnessed in the clinical setting related to alarm fatigue and what steps would be needed to correct this situation? Your initial responses are due by 11:55 p.m. Eastern Time on Wednesday,July 1 and should be between 100-150 words. The initial posting should be a statement of your point of view on the question, supported by the required readings. You are also required to post a response to at least one of your fellow classmates by 11:55 p.m. Eastern Time on Sunday, July7 and should be between 50-75 words each. The responses should also be a substantive response that demonstrates a comprehension of the reading material. Responses such as “I agree” or “I disagree” are not acceptable or will not be counted as a response. Clinical Alarm Fatigue Discussion alarm_fatigue.docx alarm_fatigue.pdf For this week’s discussion, think of the various alarms you have observed in the clinical setting. Use the article posted for this week and at least one other supporting reference (text or other assigned readings) to discuss how a built-in alarm system can be helpful and how alarm fatigue could result in a patient safety risk of error and patient harm. What have you witnessed in the clinical setting related to alarm fatigue and what steps would be needed to correct this situation? Your initial responses are due Wednesday,July 1 and should be between 150-250 words. The initial posting should be a statement of your point of view on the question, supported by the required readings. You are also required to post a response to at least one of your fellow classmates and should be between 75-100 words each. The responses should also be a substantive response that demonstrates a comprehension of the reading material. Responses such as “I agree” or “I disagree” are not acceptable or will not be counted as a response. Exploring the Evidence Tamara Kear, Department Editor Alarm Fatigue and Patient Safety Alicia M. Horkan ver the past two decades, medical errors occurring within healthcare organizations have increased with the resultant consequences ranging from minor to catastrophic for healthcare recipients (Edwards & Furlan, 2010; Hutter, 2008; James, 2013). Alarm fatigue is increasingly being identified as a patient safety issue. Clinical Alarm Fatigue Discussion The Joint Commission, the American Association of Critical-Care Nurses (AACN), the Food and Drug Administration (FDA), the ECRI Institute, and the Association for the Advancement of Medical Instrumentation (AAMI) have all identified the need to address alarm management and alarm fatigue. In 2011, AAMI convened a Medical Device Alarms Summit, and after the summit, created an alarm best practices workgroup to address the problem of clinical alarm fatigue. In 2012, 2013, and 2014, the ECRI Institute identified clinical alarm hazards as the top potential danger area in hospitals and health systems (ECRI, 2013). In 2013, The Joint Commission issued a sentinel event alert on alarm-related events, citing 98 clinical alarm-related events that were reported between 2009 and 2012 (80 patients died, 13 individuals experienced permanent loss of function, and five events led to unexpected additional health care and extended hospital stay). Alarm fatigue was described as the most common contributory factor for alarm-related events. Improving the safety of clinical alarm systems is one of The Joint Commission’s 2014 National Patient Safety Goals for hospitals and critical access hospitals, and requires hospitals to establish alarm system safety as an organization priority. AACN has also issued a practice alert on alarm management, including the identification and prevention of alarm fatigue (AACN, 2013). Clinical Alarm Fatigue Discussion Nurses in clinical areas of healthcare are inundated with a cacophony of beeps, buzzers, and other tones that desensitize nurses to urgency of alarm response. Serious adverse medical events may occur due to inappropriate alarm response and intervention. Hemodialysis centers have numerous alarms that may desensitize nurses and technicians to the urgency of alarm response. The focus of this article is the effect of alarm fatigue on professionals in the clinical setting with potential or actual patient safety being compromised. However, the effect on patients in the hemodialysis center or who dialyze at home should also be addressed. Consider the following hypothetical experience that may occur in a chronic hemodialysis center: O Alicia M. Horkan, MSN, RN, CNN, is an Assistant Director, Dialysis Services, Dialysis Center, Colquitt Regional Medical Center, Moultrie, GA; a member of ANNA’s Peach Chapter; and a current member of ANNA’s Research Committee. She may be contacted directly via email at [email protected] Nephrology Nursing Journal January-February 2014 Copyright 2014 American Nephrology Nurses’ Association Horkan, A.M. (2014). Alarm fatigue and patient safety. Nephrology Nursing Journal, 41(1), 83-85. Retrieved fromhttp://www.prolibraries.com/anna/?select=session& sessionID=2975 Key Words: Alarm fatigue, patient safety, medical errors, false alarms, nuisance alarms. A 36-year-old female receives hemodialysis through a right forearm arteriovenous fistula (AVF). The nurses working in the hemodialysis unit are busy administering medications and preparing for the next shift of patients. Machine alarms have been sounding intermittently on various patients throughout the shift. The female patient’s venous pressure alarm is triggered, and her nurse promptly resets the alarm and returns to her previous task. The venous pressure alarm continues to be triggered with nurses resetting the alarm three separate times. The fourth time the alarm sounds and the nurse responds, the patient complains of pain in her right arm.Clinical Alarm Fatigue Discussion The nurse assesses the access arm and discovers severe edema of the right forearm from an infiltration of the venous needle. Due to the severity of the infiltration, treatment is stopped. The patient’s blood cannot be returned, which leads to a drop in the patient’s hemoglobin and the patient requiring the placement of a temporary central venous catheter for dialysis while swelling associated with infiltration resolves. One may question: Did alarm fatigue contribute to compromising the safety of this patient? What Is Alarm Fatigue? Alarm fatigue occurs when staff members are exposed to a large number of alarms causing sensory overload leading to slow or non-existent response to alarms. Desensitation causes staff members to become Exploring the Evidence is a department in the Nephrology Nursing Journal designed to provide a summary of evidence-based research reports related to contemporary nephrology nursing practice issues. Content for this department is provided by members of the ANNA Research Committee. Committee members review the current literature related to a clinical practice topic and provide a summary of the evidence and implications for best practice. Readers are invited to submit questions or topic areas that pertain to evidence-based nephrology practice issues. Address correspondence to: Tamara Kear, Exploring the Evidence Department Editor, ANNA National Office, East Holly Avenue/Box 56, Pitman, NJ 08071-0056; (856) 256-2320; or via e-mail at [email protected] The opinions and assertions contained herein are the private views of the contributors and do not necessarily reflect the views of the American Nephrology Nurses’ Association. Clinical Alarm Fatigue Discussion Vol. 41, No. 1 83 Exploring the Evidence complacent about alarms, which can impact patient safety, potentially leading to life-threatening patient events (Cvach, 2012). Staff members in acute and chronic hemodialysis facilities are subjected to alarms related to venous and/or arterial pressure, blood pressure, heart rate, air in lines, conductivity, and equipment malfunction. During acute dialysis, nurses are exposed to additional alarms, such as ventilator alarms, pulse oximetry alarms, and cardiac monitoring alarms. Andel, Davidow, Hollander, and Moreno (2012) reported that preventable medical errors are among the top 10 causes of death in healthcare facilities. Complacency of staff members about the myriad of alarms heard in a typical day has the potential to increase the number of preventable medical errors in a dialysis facility. Literature Review In 2013, The Joint Commission released a sentinel event alert regarding the safety of medical device alarms. Major factors identified as a result of alarm fatigue leading to sentinel events were inappropriate alarm settings, alarms turned off, malfunctioning alarm systems, and audibility of alarms not sufficient to be heard throughout a patient care unit. False or nuisance alarms are created when alarm thresholds are set too tight and are triggered appropriately, but may be clinically insignificant (Cvach, 2012). Evidence points to the primary cause of alarm fatigue as presence of nuisance alarms. Clinical Alarm Fatigue Discussion Nuisance alarms lead to alarm overload, which may be overwhelming for nurses. The prevalence of nuisance alarms within clinical settings has changed very little over the past 25 years (Edworthy, 2013). Korniewicz, Clark, and David (2008) conducted a national study to identify reasons healthcare providers failed to respond promptly and appropriately to medical device alarms. Nuisance alarms and false alarms were cited by respondents as problematic. Seventy-seven percent of respondents indicated that nuisance alarms disrupted patient care, while 81% indicated that nuisance alarms occurred frequently, reducing trust in alarms and hindering rather than improving patient safety. Harris, Manavizadeh, McPherson, and Smith (2011) have suggested that the frequency of nuisance alarms causes nurses to be desensitized, thus ignoring alarms that may have a clinical significance. McKinney (2013) notes that nurses are exposed to hundreds of alarms in the course of a normal work day. Further, 85% to 99% of alarms in critical care settings to which nurses are exposed may be classified as nuisance alarms that may hold no clinical significance for the patient. Evans, Shumate, and Lovelace (2011) found that the causes of nuisance alarms are multifaceted, including false alarms, technical alarms, and insufficient staff training on alarm systems. 84 Prevention of Alarm Fatigue Developing a safety culture embraced by staff members promotes identification of factors that may lead to patient harm (Stavrianopoulos, 2012). Clinical Alarm Fatigue Discussion Appropriate alarm settings have been found to decrease the number of alarms to which staff members are exposed, which has a positive effect on decreasing the incidence of alarm fatigue. Individualizing alarm thresholds to limits that are clinically appropriate for individual patients may decrease the incidence of nuisance alarms that are distracting for staff members and contribute to alarm fatigue (Cvach, 2012; Evans et al., 2011). Other authors have suggested that default alarm limits may not be appropriate for all patients, supporting the need for customization of alarms for patients (Gross, Dahl, & Neilson, 2011). Appropriately using equipment and utilizing the full capacity of the equipment may promote a quieter environment for patient care and for detection of significant clinical alarms (Korniewicz et al., 2008). Protocols for alarm settings and training of personnel on appropriate use of alarm systems will minimize effects of false or nuisance alarms (Welch, 2011). A list of alarm management resources is provided in Table 1. Application of evidence from previous studies into the hemodialysis setting is necessary to prevent alarm fatigue and promote patient safety. Effective use of medical equipment alarm systems may reduce the number of alarms, thereby allowing nurses to be more alert to true alarms (Korniewicz et al., 2008). Elimination of nuisance alarms may be a primary factor for preventing or minimizing alarm fatigue in dialysis settings. Blood pressure alarm settings may be individualized per patient according to a set protocol. Venous and arterial pressure alarms may be minimized through nurse diligence in observing access sites and dialyzers for signs of clotting, and administering heparin properly to decrease or eliminate clotting in the extracorporeal circuit. Clinical Alarm Fatigue Discussion When an alarm occurs, prompt response and correcting the cause of the alarm may decrease the number of alarms to which nephrology nurses and patient care technicians are exposed. Nephrology nurses influence the healthcare outcomes for individuals receiving dialysis and must remain alert to respond appropriately to medical devise alarms. A hypothetical situation was described at the beginning of the article in which a patient on hemodialysis experienced a severe infiltration due to inappropriate alarm response. Muting an alarm is not the answer. The access complication may have been avoided had the nurse had appropriately evaluated the cause of the first venous pressure alarm. Intervention at the time of the first alarm may have prevented the extensive infiltration of the AVF. Patient safety was further compromised by the resulting need for placement of a temporary central venous catheter for hemodialysis, which places the patient at high risk of infection or potentially developing central venous stenosis and the potential need for blood transfusions due to blood loss. Nephrology Nursing Journal January-February 2014 Vol. 41, No. 1 Table 1 Alarm Fatigue Resource List Resource Website American College of Clinical Engineering (ACCE) Healthcare Technology Foundation (HFT). (2007). Impact of Clinical Alarms on Patient Safety: A Report from the ACCE HTF. American Association of Critical Care Nurses (2013). Practice Alert: Alarm Management. Association for the Advancement of Medical Instrumentation (AAMI) (2011). Report from AAMI Alarm Summit 2011. http://thehtf.org/clinical.asp http://www.aacn.org/wd/practice/content/practicealerts/alarm-managementpractice-alert.pcms?menu=practice https://www.aami.org/publications/summits/2011_Alarms_Summit_ publication.pdf Association for the Advancement of Medical Instrumentation. (2013). Clinical Alarms. http://www.aami.org/htsi/alarms ECRI Institute. (2013). Alarm Safety Resource Site. The Joint Commission. (2014). National Patient Safety Goals. https://www.ecri.org/forms/pages/alarm_safety_resource.aspxClinical Alarm Fatigue Discussion http://www.jointcommission.org/standards_information/npsgs.aspx The Joint Commission. (2013). R3 Report – Requirement, Rationale, Reference- Alarm System Safety. http://www.jointcommission.org/r3_report_issue5/ Conclusion Nephrology nurses need to be aware of the potential consequences of alarm fatigue and implement processes to reduce or eliminate the incidence of alarm fatigue. Research indicates that alarms are a necessary component of ensuring patient safety. Development of alarm protocols and training of personnel may facilitate reduction of adverse events related to alarm fatigue. Evidence does not exist to support specific guidelines for individualizing alarm settings, which supports the need for research by nephrology nurses regarding safe parameters for alarms that may be customized for patients on dialysis. Reduction of alarm fatigue is a responsibility to be shared among all members of clinical staff and management. Nephrology nurses need to be aware that alarm management involves more than setting parameters. Patient assessment, monitoring, and appropriate intervention may be considered the first steps to alarm management, elimination of alarm fatigue, and ensuring patient safety. References American Association of Critical Care Nurses (AACN). (2013). Practice alert: Alarm management. Aliso Viejo, CA: Author. Retrieved from http://www.aacn.org/wd/practice/content/practicealerts/alarm-management-practicealert.pcms?menu=practice Andel, C., Davidow, S.L., Hollander, M., & Moreno, D.A. (2012). The economics of health care quality and medical errors. Journal of Health Care Finance, 39(1), 39-50. Cvach, M. (2012).Clinical Alarm Fatigue Discussion Monitor alarm fatigue: An integrative review. Biomedical Instrumentation & Technology, 48(4), 268-277. doi:10.2345/0899-8205-46.4.268 Nephrology Nursing Journal January-February 2014 ECRI Institute. (2013). 2014 hazards. Plymouth Meeting, PA: Author. Retrieved from https://www.ecri.org/2014hazards Edwards, B.D., & Furlan, G. (2010). How to apply the human factor to periodic safety update reports. Drug Safety, 33(10), 811-820. Edworthy, J. (2013). Medical audible alarms: A review. Journal of American Medical Informatics Association, 20(3), 581-589. doi:10.1136/amiajnl-2012-001061 Evans, M., Shumante, P., & Lovelace, S. (2011). Improving alarm responsiveness: How do we prevent alarm fatigue. Critical Care Nurse, 31(2), 13. Gross, B., Dahl, D., & Neilson, L. (2011). Physiologic monitoring load on medical-surgical floors of a community hospital. Biomedical Instrumentation & Technology, 45(2), 29-36. Harris, R.M., Manavizadeh, J., McPherson, D.J., & Smith, L. (2011). Do you hear bells? The increasing problem of alarm fatigue. Pennsylvania Nurse, 66(1), 10-13. Hutter, B.M. (2008). Risk regulation and health care. Health, Risk, & Safety, 10(1), 1-7. doi:10.1080/13698570701782338. James. J.T. (2013). A new, evidence-based estimate of patient harms associated with hospital care. Journal of Patient Safety, 9(3), 122-128. Korniewicz, D.M., Clark, T., & David, Y. (2008), A national online survey on the effectiveness of clinical alarms. American Journal of Critical Care, 17(1), 36-41. McKinney, M. (2013). Lives at risk: Hospitals face hurdles addressing alarm fatigue. Modern Healthcare, 43(15), 14-15. Stavrianopoulos, T. (2012). The development of patient safety culture. Health Science Journal, 6(2), 201-211. The Joint Commission. (2013). Sentinel event alert: Medical device alarm safety in hospitals. Chicago: Author. Retrieved from www.jointcommission.org/sentinel_event.aspx Welch, J. (2011). An evidence-based approach to reduce nuisance alarms and alarm fatigue. Biomedical Instrumentation & Technology, 45(2), 46-52. Vol. 41, No. 1 85 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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