Alarm Management and Fatigue in Nursing

Abstract

The proposed project aims at finding a lasting resolution to alarm fatigue and alarm management specifically in the nursing field. The project thus would be of use, as it will recommend the possible measures to be implemented to solve the problem. The proposal also will reduce the number of patient related injury’s/deaths in hospitals. The proposal will start with an introduction and a statement of the problem that would highlight the gap that exists between false alarms and the effects concerning noise and death. The study will also highlight the set objectives of the project and the possible limitation that may hinder the achievement of project’s goals. The project will also highlight the resolution strategy. The resolution strategy is based on the Iowa’s evidence-based nursing practice model. The model is based on the following steps: statement of the problem, analysis of the problem, evidence of the identified problem and recommendation of the best alternative measure to solve the problem. The project also will highlight an implementation plan that is based on the essentials of baccalaureate education for professional nursing practice. The proposal will end with a thorough review of scholar’s works that are relevant to our study of alarm management and fatigue in nursing. It will be of use to the project since it will result in the understanding of the asserted problem as well as suggesting another measure to solve the problem. With the achievement of the set objective, the project will be submitted to the executive review committee in hopes of making it common practice.

Alarm Management and Fatigue in Nursing

Introduction and Background

The proposal aims at highlighting the measures that should be implemented in the management of clinical alarms so as to avoid the weariness and delayed response to alarms in hospitals especially in the intensive care unit (ICU). It would in turn, lead to the minimization of the number of patient’s injuries and/or deaths caused by alarm fatigue that results in delayed responses to hospital alarms (McCormack et al., 2010).

Statement of the Problem

The advancement of modern technology has resulted in the application of scientific machines and equipment in the health community. The application of these machines and equipment is aimed at improving the quality of health care delivered. These machines and equipment have brought new ways to monitor patients’ vital signs and enhance delivery of interventional procedures such as: x-rays, nuclear medicine, and ultrasounds. However, some scientific equipment such as physiological monitors have proved to been ineffective to a certain degree. The point is made that by enhancing health care to patients using these monitors it also contributes to the deterioration or death of a patient as a result of the noise made by the alarms in the hospital by create a fatigue to the nurses to respond to them. The noise made by the alarms also creates an undesirable hospital environment for the patients, families, and nursing. The actual alarms fail to enhance an improvement of patient’s health condition because of the multitude of alarm rings. Among the alarms sounding in a hospital, less than 20% are an indication of the need to check the condition of the patients. More than 80% of the hospital alarms going off are as a result of obsolete alarms, improper setting of the alarms, and poor nursing detection of the alarm monitors (Hockley et al., 2010).

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Fatigue and non-response to hospital alarms by the nurses can be attributed to the increased number of irrelevant alarms sounding. It has become an annoyance to nurses and many silence the alarms before attending to the patient. Other nurses also opt in disabling the alarm system so as to avoid the occurrence of irrelevant alarms in their hospitals. It has resulted in deterioration of patient’s conditions and death. Thus, there exists a gap between patient’s health condition and response to alarms. The proposal hence aims to bridge the gap so as to improve the health condition of patients in hospitals. Following the statement of the problem, the following PICO question is developed with considerations of Population, Intervention, Comparison, and Outcome. This will be of use since it will help in bridging the gap between alarm fatigue and effect to the patients.

P: what is the target population? Intensive care unit or critical care nurses

I: what is the intervention of interest? A reevaluation of the current policy and procedure regarding alarm limits as well as increased education about alarm management

C: what is the comparison of interest? Comparison of current evidence-base practice for monitoring alarms in place for intensive care unit and critical care areas

O: what is the outcome of interest? A decreased alarm burden and desensitization

Literature Review

Shuchisnigdha et al. (2015) highlight that with the increased rate of 80-99% of false alarms in hospitals, desensitization and overload begin to take shape in the nurses’ attitudes. As a result, nurses do not respond to any alarms. This is attributed to the inappropriate setting of the monitor’s alarms and possibly outdated or defective monitors. The health condition of patients in hospitals begins to deteriorate, as the nurses do not respond to alarms sounding in relation to the increased number of the false alarms. Thus when there is a genuine alarm sound it is normally not attended to as the hospital staff generalize it to be a false alarm. It in turn commonly results in and increased suffering of the patients when they require attention. The alarms also create a noise pollution in the hospitals. It is because with hospitals encountering approximately 1,300 alarm signals per day that this creates an unfavorable condition for the patients and the nurses. Consequently, this results in a decreased quality of health care. This situation accumulates into massive death or worsening of patient’s condition. A study conducted within a neonatal intensive care unit resulted with 228 thousand alarms in a five-month period for about 13 patients per day (Pul et al., 2014).

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According to Drew et al. (2014) research carried out in the United States for 12,671 alarms in a hospital, 88.8% of them were false alarms. Only 11.2% of the alarms were genuine. Their research highlighted the source of the false alarms to be inappropriate alarm settings, non-actionable events, and persistent atrial fibrillation. A hospital in Tokyo, Japan conducted a study with 18 patients for 2,697 worked hours and concluded 11,591 alarms sounded with only 6.4% of them necessitating an appropriate response (Inokuchi et al., 2013). These factors lead to increased alarms in the hospital making it hard for the nurses to identify a real alarm from the false alarms.

A Resolution Strategy

The proposal aims at using the Iowa evidence-based nursing practice model. The models strategies will enhance a standing resolution for alarm fatigue (Burns et al., 2010). To enhance the effectiveness of the Iowa model, it is recommended that the model is communicated to the relevant nurses especially those attending to patients in the intensive care unit. The model’s strategies are in sync in relation to solving our problem. The model’s first step is to acquire a statement of the problem. It will enhance the identification of the problem that exists with the effectiveness of hospital’s alarms. With this, the problem brought about by false alarms such as absolute monitors and improper setting of the alarms will be identified. During this first stage of the model, the topic is selected. Also, there will be the formulation of a team that will involve the nurses and patients in the intensive care unit. Combining patients and staff will enhance the collection of data relevant to the topic under consideration.

The next stage of the model is to analyze or conduct a systematic review of the performance of the alarms. Studying other literature from other writers and scholars enhances this step bringing to light the problems facing the field of nursing specifically. The next step involves the collection of evidence, meaning carrying out scientific and statistical analysis. It enhances the identification of where the source of the problem is. It will also draw attention to the source of the problem and the structuring of alternative measures to curb the problem. The fourth stage of the model is the recommendation/dissemination stage. It involves the selection of the best-measured solution based on a cost-benefits analysis, ensuring that the appropriate actions are taken into account, recommending, and implementing (Melnyk et al., 2011). The Iowa model is adequate in ensuring proper measures are implemented in eradicating fatigue brought about by false alarms in the hospital. The final stage of the model will be to evaluate, interpret, and disseminate the results. Dissemination will occur through the appropriate channels and include: presentations, posters, and peer discussions.

An Implementation Plan

The essentials of baccalaureate education for professional nursing practice have resulted in drastic changes in healthcare delivery since sanctioned by the America Association of Colleges of Nursing (AACN, 1998). According to Wasson, Nelson and Godfrey (2007), the increasing awareness of the importance of changing the healthcare systems has become a turning point for cultivating healthcare outcomes. The only body of healthcare noted to hold the capability of transforming healthcare to a secure, a better cost effective system, and better quality services are the nurses. However, despite the efforts of enrollment of nurses globally in baccalaureate nursing programs since 2001 (Fang, Htut, & Bednash, 2008), there is a future risk of a shortage of nurses. The demand in the nursing profession is projected to rise more than the available number of nurses. This risk calls for initiatives to curb and hinder this future disaster. The implementation plan entails the discussion of the essentials of baccalaureate education for professional nursing practices. Implementation plans also will involve ways to improve the entry level of nurses in the practice (Mailloux, 2011).

Improvement of liberal education is one of the major implementation plans of baccalaureate nursing practices. This liberal education should be facilitated in such a way it takes into consideration the diversity of the global healthcare improvement purposes. The professional nurses practicing in the diverse environment should be sensitive and understand the wide culture diversities within healthcare (Hickey, 2010). The study of a second language and appreciation of the diversity are some of the vital aspects of liberal education that need to be implemented so as to improve the growth in appreciation of the different culture and ethics (Hockley et al., 2010). Besides, liberal education should incorporate different aspects such as biological sciences, behavioral and natural sciences in the curriculum of nursing to facilitate the understanding of others and oneself. Studying these aspects also facilitates the understanding of health issues in details, forms, and processes of diseases.

Designing and implementation of patient-centered care is another vital implementation plan to improve the baccalaureate nursing practices. Forces such as accessibility of information by the patient, dynamism inpatient demography, changing the technology of care purposes, and scientific innovation especially in genetics and genomic negatively affect the nurses in meeting their goals. For the nurses to be able to adapt immediately to the changing needs, patient-centered care needs to be implemented in a way that the nurses develop a partnership with the patients. Patient-centered care should also implement in a way to harness customer services provision by nurses (Burns et al. 2010).

Conclusion

From the literature, it is evident that the implementation of the Iowa model and Baccalaureate education for professional nursing practice in nursing are most significant in solving the problem under consideration. Hence, they should be an integral part of the nursing field. There should be an installation of modern alarm monitors and appropriate setting of the alarms enhanced so as eradicate false alarms in hospitals.

References

• Burns, N., & Grove, S. K. (2010). Understanding nursing research: Building an evidence-based practice. Amsterdam: Elsevier Health Sciences.
• Drew, B. J., Harris, P., Zegre-Hemsey, J. K., Mammone, T., Schindler, D., et al. (2014). Insights into the problem of alarm fatigue with physiologic monitor devices: A comprehensive observational study of consecutive intensive care unit patients. PLoS ONE PLoS ONE, 9(10), e110274. doi:doi:10.1371/journal.pone.0110274
• Fang, D., Htut, A., & Bednash, G. D. (2008). 2007-2008 enrollment in baccalaureate and graduate programs in nursing. Washington, DC: American Association of Colleges of Nursing.
• Graham, K. C., & Cvach, M. (2010). Monitor alarm fatigue: standardizing the use of physiological monitors and decreasing nuisance alarms. American Journal of Critical Care, 19(1), 28-34.
• Hickey, M. T. (2010). Baccalaureate nursing graduates perceptions of their clinical instructional experiences and preparation for practice. Journal of Professional Nursing, 26(1), 35-41.
• Hockley, J., Watson, J., Oxenham, D., & Murray, S. A. (2010). The integrated implementation of two end-of-life care tools in nursing care homes in the UK: An in-depth evaluation. Palliative Medicine, 24(8), 828-838.
• Inokuchi, R., Sato, H., Nanjo, Y., Echigo, M., Tanaka, A., Ishii, T., et al. (2013). The proportion of clinically relevant alarms decreases as patient clinical severity decreases in intensive care units: a pilot study. BMJ Open, 3(9), e003354. http://doi.org/10.1136/bmjopen-2013-003354
• Mailloux, C. G. (2011). Using the essentials of baccalaureate education for professional nursing practice (2008) as a framework for curriculum revision. Journal of Professional Nursing, 27(6), 385-389.
• McCormack, B., Dewing, J., Breslin, L., Coyne‐Nevin, A., Kennedy, K., Manning, M., … & Slater, P. (2010). Developing person‐centred practice: nursing outcomes arising from changes to the care environment in residential settings for older people. International Journal of Older People Nursing, 5(2), 93-107.
• Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. ‎Philadelphia: Lippincott Williams & Wilkins.
• Pul, C., Dijkman, W., Mortel, H. Bogaart, J., Mohns, T., Andriessen, P. (2014). Alarm management in an ICU environment. Retrieved from http://www.smarthealth-ami.id.tue.nl/SHHE2014/submissions/shhe2014_submission_6.pdf
• Shuchisnigdha, Deb. David Claudio (2015). Alarm fatigue and its influence on staff Performance. 5 Howick Place, London.
• Wasson, J. H., Anders, S. G., Moore, G. L., Ho, L., Nelson, E. C., Godfrey, M. M., & Batalden, P. B. (2008). Clinical microsystems, part 2. Learning from micro practices about providing patients the care they want and need. Joint Commission Journal on Quality and Patient Safety, 34(8), 445-452.