Nurses must remain vigilant and alert for the slightest changes in patients’ conditions, but unfortunately mistakes can and do happen.
The Fatigue Factor: Too Many Alarms, Too Little Downtime for Both Nurses & Patients!
Bells, Whistles, Trouble
An overabundance of beeps and chirps on critical care units has led to alarm fatigue — tuning out the sounds that are supposed to alert nurses to a patient’s need for care. In some cases, it has led to nurses turning off alarms, resulting in deadly consequences.
More and more devices sound alerts to warn nurses about heart rhythm changes, an empty IV bag or a patient getting out of bed. “It’s amazing how many alarms occur and how nurses can multitask, hear the alarms and react to them,” says Maria Cvach, RN, MS, CCRN, assistant director of nursing and clinical standards at The Johns Hopkins Hospital in Baltimore.
A cardiac patient requiring continuous heart rate and rhythm monitoring at Massachusetts General Hospital in Boston died in January after developing a lethal arrhythmia for 22 minutes and asystole for 17 minutes before being found by staff members who were unable to resuscitate the patient, according to a report released in April by the Centers for Medicare & Medicaid Services.
Investigators found the bedside alarm volume had been turned off; however, two beeps sounded on the central nurses’ station cardiac monitors and digital displays in the hallways signaled “HR LO.”
Nurses told CMS investigators they did not remember hearing the alarm or seeing the HR LO display. They also said they were “experiencing alarm fatigue and a desensitization to alarms after hearing them throughout the workday,” according to the report...
Hiring someone to watch the monitors at a central location is a best practice, but many hospitals cannot afford that, Cvach says. Next best is to customize alarms and assess trends to determine the fidelity or accuracy of the alarm... customizable changes to the alarms designed to decrease alerts, such as changing the default settings to a parameter appropriate for the patient — as in the case of a patient with COPD who has a baseline oxygen saturation of 85%. In some cases, eliminating similar alarms is necessary, such as for high heart rate and tachycardia, which assess similar abnormalities differently.
Rest for the Weary
Although alarm fatigue recently has been in the forefront, a constant concern in past years regarding RNs has been general fatigue — a concern rooted in the long shifts and short rest periods between shifts characteristic of RNs’ schedules — and its connection to medical errors.
“There’s research that tells us when we work more hours than we should, patient safety is an issue,” says Linda Plank, a lecturer at Baylor University’s Dallas-based Louise Herrington School of Nursing. “An exhausted nurse is more likely to make errors in giving medication or in judgment calls.”
A seminal study by Australians Drew Dawson and Kathryn Reid in 1997 showed after 17 hours of wakefulness, performance can deteriorate to the equivalent of a blood alcohol concentration of 0.05%...
When nurses understand the risks, they will feel good about putting the patient first and refusing that extra shift. Gelinas agrees, indicating nurses want to do the right thing, but many remain unaware of the effect of fatigue and other human factors.
“Nurses are very ethical and moral, and if they know they are working impaired, they will step back,” Gelinas says. “We need to increase the awareness of the critical association between human factors and safety. It becomes even more critical in ICU.”
http://news.nurse.com/article/20100906/NAT...
An overabundance of beeps and chirps on critical care units has led to alarm fatigue — tuning out the sounds that are supposed to alert nurses to a patient’s need for care. In some cases, it has led to nurses turning off alarms, resulting in deadly consequences.
More and more devices sound alerts to warn nurses about heart rhythm changes, an empty IV bag or a patient getting out of bed. “It’s amazing how many alarms occur and how nurses can multitask, hear the alarms and react to them,” says Maria Cvach, RN, MS, CCRN, assistant director of nursing and clinical standards at The Johns Hopkins Hospital in Baltimore.
A cardiac patient requiring continuous heart rate and rhythm monitoring at Massachusetts General Hospital in Boston died in January after developing a lethal arrhythmia for 22 minutes and asystole for 17 minutes before being found by staff members who were unable to resuscitate the patient, according to a report released in April by the Centers for Medicare & Medicaid Services.
Investigators found the bedside alarm volume had been turned off; however, two beeps sounded on the central nurses’ station cardiac monitors and digital displays in the hallways signaled “HR LO.”
Nurses told CMS investigators they did not remember hearing the alarm or seeing the HR LO display. They also said they were “experiencing alarm fatigue and a desensitization to alarms after hearing them throughout the workday,” according to the report...
Hiring someone to watch the monitors at a central location is a best practice, but many hospitals cannot afford that, Cvach says. Next best is to customize alarms and assess trends to determine the fidelity or accuracy of the alarm... customizable changes to the alarms designed to decrease alerts, such as changing the default settings to a parameter appropriate for the patient — as in the case of a patient with COPD who has a baseline oxygen saturation of 85%. In some cases, eliminating similar alarms is necessary, such as for high heart rate and tachycardia, which assess similar abnormalities differently.
Rest for the Weary
Although alarm fatigue recently has been in the forefront, a constant concern in past years regarding RNs has been general fatigue — a concern rooted in the long shifts and short rest periods between shifts characteristic of RNs’ schedules — and its connection to medical errors.
“There’s research that tells us when we work more hours than we should, patient safety is an issue,” says Linda Plank, a lecturer at Baylor University’s Dallas-based Louise Herrington School of Nursing. “An exhausted nurse is more likely to make errors in giving medication or in judgment calls.”
A seminal study by Australians Drew Dawson and Kathryn Reid in 1997 showed after 17 hours of wakefulness, performance can deteriorate to the equivalent of a blood alcohol concentration of 0.05%...
When nurses understand the risks, they will feel good about putting the patient first and refusing that extra shift. Gelinas agrees, indicating nurses want to do the right thing, but many remain unaware of the effect of fatigue and other human factors.
“Nurses are very ethical and moral, and if they know they are working impaired, they will step back,” Gelinas says. “We need to increase the awareness of the critical association between human factors and safety. It becomes even more critical in ICU.”
http://news.nurse.com/article/20100906/NAT...
