Alarm in Coronary Care Unit - Essay Example

Alarm in Coronary Care Unit Name: Lecturer: Course: Date: DESCRIPTION: At one time while working at the coronary care unit, I obtained a report for a post-operative patient. She had just undergone routine surgery and was not able undergo an extubation of because of prolonged periods of temporary cessation of respiration, a symptom characterising apnea. I quickly understood that this is the reason the surgeon in charge had decided that it would be in the patient’s best interest to be left intubated during the night. I received the patient and, as required, put the technology for routine physiological monitoring. Already, the sequential compression device (SCD), electrocardiogram (ECG), intravenous pumps, Pulse oximetry, capnography, blood pressure, mechanical ventilator, and the BIS monitor were in placed intact. All through my shift, several false alarms emanated from the unit as well as other units. This caused extreme distraction. Ultimately, I became fatigued by the alarms even as I martially responded by either adjusting or muting several of these alarms. Regrettably though, by muting the alarms, I missed numerous critical alarms. Alarm asystole started showing on the monitor. I rushed hurriedly rushed to fix the issue. Unfortunately, the patient’s condition developed into a cardiac arrest. It later took some 35 minutes for the pulse to return. Later, a check at the monitoring systems confirmed that the patient had become apneic severally before eventually becoming hypoxic with a 66 pulse oximetry. The methodical analysis of the entire incident later indicated conclusively that it was caused by alarm fatigue. While other nurses were happy with my response, I knew that I had endangered the safety of some patients. FEELING From the incident, I perceived alarm fatigue to be a critical emerging issue that hospitals have not given attention, despite the severe patient safety issues they are associated with, including the risks of increasing patient mortality. The supposed alarm fatigue had arisen out of becoming desensitized to the multiple alarms that went off in my designated unit as well as other units. Although I was uncertain of the likely risks, I felt that false alarms all need to be turned off or even muted, despite their perceived roles of notifying other clinicians, and I of the impending patient danger. I was particularly affected by the phenomenon, especially after the dilemmas associated with the apparent lack of a clear distinction between what should be viewed to be a false and a genuine alarm. I feel that such situations would always make it difficult for health practitioners to tell between a true emergency and a false one. Indeed, this perspective is shared by Japsen & Sendelbach (2013, p.1) in their discussion regarding the difficulties in differentiating the different alarm sounds within a hospital setting, particularly during instances of alarm fatigue. They noted that an average amount of alarms within a coronary care unit had scaled from 6, as of 1983, to nearly 40 in 2011. An additional review by the Joint Commission TJC (2013, p.1) also contended that the amount of alarm signals per patient each successive day may scale to more than a hundred, dependent on the particular unit within the hospital, which translates to thousands of alarms that go off on each unit a day. These show the gravity of the issue. Therefore, after deep contemplation, I felt there is a need for a strategy for managing alarm systems and alarm fatigue. EVALUATION After an evaluation of the incident, I though it would be appropriate to keep some alarms off inorder in order to offer a calm environment in order to minimise patient tense and incidents of alarm fatigue. As all patients at the CCU have cardiac complication, they may develop MI and therefore need sufficient rest in order to cut myocardial oxygen demand. Still, it could also amount to a wrong action as the patient are in critical emergency conditions that could be effectively monitored using the alarms. Basing on this perspective, I believe the alarms are crucial as they call a clinician’s attention at abnormal changes occuring in patient hemodynamic status, or alternatively, to assist in maintaining continous obeservation. In such a situation therefore, the clinicians need to be able to minimise the alarm sound, by controlling the volume provided they can maintain continous obeservation. During a discusson with a surgeon at my unit, we arrived at a consensus that there is a great need to have a strategy or plan in place at the facility. He, too, showed an interest in having quality improvement efforts regarding alarm fatigues implemented at the hospital. Hence, having the amount of false alarms are reduved and the cultures surrounding alarm fatigue are changed remain at the centre of my evaluation. At any rate, the basic intervention for such a scenarion remains quality improvement efforts through training. Since my experience at the coronary care unit showed that alarm fatigue can result to a catastrophic events, including patient mortality, I opine that reducing the number of false alarms is. Through effective training on the categories of alarm signals, readjusting the sensitivity and thresholds of the alarms, and customising the parameter settings can be effective strategies. critical. From this evaluation, it is in my belief that developing a relatively safe patient care environment is possible when the amount of false alarms within the critical care setting are reduced significantly. A positive remark from my case scenario is that I noticed a wrong application of technology and attempted to correct it. I was also concerned about the issue and informed the surgeon in charge. Additionally, the case scenario provides me with a motivation to face up to the challenges of studying CCU technologies in order to learn to operate them to improve patient safety during emergencies. Still, it is unfortunate that my knowledge on the alarm systems is wanting, and I still need training on the different alarm signals if I have to identify the false alarms. However, the problem is prevalent. Indeed, a conversation with fellow members of staff after the incident showed that a majority of them were less conversant with the alarm signals and the possibility of alarm fatigue. Most of them argued that muting or adjusting an alarm was the right action. ANALYSIS: The number of false alarms going off at the coronary care unit is evidently out of control. After my experience showed the potential patient mortality due to alarm fatigue, I was left appalled by the comments by other nurses, who recommended that all the alarms at the CCU should always be kept off to ensure sufficient rest of the patients, as it may cause fatigue and anxiety to patients with cardiac problems. In my opinion therefore, the rate of false alarms and their potential to cause patient mortality cannot be understated. Indeed, statistics from the Manufacturer and User Facility Device Experience (MAUDE) indicate that up to 566 reports of patient mortality between 2005 and 2008 were reported in the United States, due to problems with managing the alarms (Bridi et al 2014, p.1035). In 2013, another study by the Emergency Care Research Institute (ECRI) listed alarms as the leading technology that causes danger to patients, such as cardiac arrhythmias, cardio-respiratory arrest, and in some cases death (Bridi et al 2014 , p.1035). These serve to ring the question of whether the alarms are actually suitable in the CCU. While the questions sounds paradoxical, it has been treated with significance in scholarly researchers, which have seemed to agree that the occurrence of a large number of alarms imply potential risks, such as injuries, to the patient safety and integrity in critical care units (Tinker et al 1989; Cooper et al 1984, p.34,41). According to Schmid et al (2013, p.6), such risks are not only because of the organic disorders that come about given the high noise levels in addition to their potential to lead the clinicians into getting desensitized. On the contrary, it reduces their alertness, a situation known as alarm fatigue. Laura (2010, p.16) also remarks that alarm fatigue is prevalent in situations where multiple alarms get to envelope other clinically important alarm, hence leading the staff to disable, ignore, or mute certain significant alarms. Sendelbach and Funk (2013, p.379) were concerned that such scenarios need careful handling as they compromise the patient safety. Similar opinion is shared by Kamat (2002, p.267) in his analysis that lack of response to clinically vital alarms can lead to severe situations, such as worsening the patients’ clinical conditions. Researchers have also agreed that a coronary care unit has a high incidence of false alarms because of the monitoring systems that have low specificity and high sensitivity (Moon 2004, p.3,4; Clarke 2015, p.18). Indeed, these may have been the causes of false alarms in my unit. Technically, such alarms have low clinical significance and need technical solutions, including reprogramming, readjusting, and training (Ensslin 2014, p.4; Bell 2010, p.38). I also acknowledge that since the alarm sounds are not standardised, specifically as regards the proper urgent alarm, the possibility of confusing the alarm sounds is also apparent. Block et al (2000) also mentioned the problem of standardising alarms and noted that it can cause additional strain to members of staff who attempt to differentiate them. For instance, the clinically significant alarms may be confused to be false alarms. This may cause the staff to ignore or even disable them. Chambrin (2001, p.2) added that in addition to the lack of standardising the alarm sounds, other issues such as poor monitoring of the alarm systems and the mode of alarm generation are additional complexities that add to the risks to patients’ safety. In respect to training, Schmid et al (2013) posit that the lack of training on handling alarm systems in addition to a lack of adherence with standards for alarm programming and configuring poses additional challenges. What these imply is that the nurses (my colleagues at the hospital) are wrong in their argument that switching off the alarms is appropriate. On the contrary, I believe that the nurses should respond to all the alarms, rather than ignore them. Additionally, rather, than switch off the alarm, reducing their volumes may limit the irrigation caused to the patients. Even so, there should be appropriate training on alarm use. In addition, the programming of the alarms should ensure that they limit the likelihood of false alarms. Conclusion Based on personal experiences and a review of literature, it is clear that hospitals need effective strategies to handle issues of alarm fatigue. There is sufficient data validating the risks of alarm fatigue, including patient mortality and cardiac arrest. I also attested to this through my experience, by pinpointing the technological and physiological errors that can contribute to the false alarms. While alarms are in my view life-saving devices, the issue of false alarms has limited its efficiency, and had developed into a safety concern. The experience at the coronary care unit reinforced my knowledge that configuration and programming of the alarm’s volume, and multi-parametric monitors needs to be integrated into the unit as patients with severe cardiac problems rely on the alarm for therapeutic purposes, and improved safety. Hence, appropriate use of the alarm system may prevent alarm fatigue, hence safeguarding patient safety. Action plan I intend to recommend to the management the need for training of the nursing staff on appropriate use of the alarms -- including how to ensure effective configuration and programming of the alarm’s volume, and multi-parametric monitors. This will ensure Appropriate patient monitoring at the CCU, the nurses will as well appreciate the significance of responding to alarms, rather than ignoring them or disabling them. The training will also ensure over-familiarization with alarm sounds as well as reduce trivialization. It will also ensure a multidisciplinary team approach to managing the alarming system. I also intend to recommend to the hospital’s management the need to standardise the alarm policy, to ensure it also integrates a standardised response time to alarms within a designated unit, and the alarm parameters a specific patient’s setting. I therefore intend to undertake personal researches on alarm systems and prevention of false alarms. Through observation, I will also observe alarm management criteria in other department. This will ensure that I gain deeper insight in the topical area. In future, it is my belief that when I face a similar experience, I would handle the alarms effectively, avoid alarm fatigue, and at the same time heighten my awareness to integrate my new knowledge into routine nursing practice. I will also use a multidisciplinary team approach, by consulting with other nurses in other units, the surgeon, and the technical team. I will also adjust the alarms to appropriate volume and monitor settings to ensure minimal interference with patient safety. References Bell, L 2010, "Monitor Alarm Fatigue," Am J Crit Care vol 19 no 1, p38 Block F, Rouse J, Hakala M & Thomson C 2000, “A proposed new set of alarm sounds which satisfy standards and rationale to encode source information,” J Clin Monit vol 16, pp541-546 Bridi, A, Louro, T & Silva, R 2014, "Clinical Alarms in intensive care: implications of alarm fatigue for the safety of patients," Rev Lat Am Enfermagem, vol 22 no 6, pp1034–1040. Chambrin, M 2001, "Alarms in the intensive care unit: how can the number of false alarms be reduced?" Crit Care, vol 5 no 4, pp184–188. Clarke, G 2015, Signal Quality Analysis in Pulse Oximetry: Modelling and Detection of Motion Artifact, viewed 7 Jan 2015, Cooper, J, Newbower, R & Kitz, R 1984, "An Analysis of Major Errors and Equipment Failures in Anesthesia amangement: Considerations for Prevention and Detection," anesthesiology vol 60, pp.34-42 Ensslin, P 2014, "Do you hear what I hear? Combating alarm fatigue," American Nurse Today vol 9 no 11, Japsen, S., & Sendelbach, S. (2013). Alarm Management . American Associaation of Critical Care Nurses Kamat, V 2002, "Pulse Oximetry," Indian J. Anaesth, vol 46 no 4, 261-268 Laura, W 2010, "Alarm Fatigue Linked to Patient's Death," American Journal of Nursing, v ol 110 no 7, p16 Moon, B 2004, "Analysis of Pulse Oximetry Signals through Statistical Signal Processing Techniques," ECE 538 Statistical Signal Processing Schmid, F, Goepfert, M & Reuter, D 2013, "Patient monitoring alarms in the ICU and in the operating room," Critical Care vol 17, 216 Sendelbach, S & Funk, M 2013, "Alarm Fatigue: A Patient Safety Concern," AACN Advanced Critical Care, vol 24 , no 4 , pp. 378 - 386 The joint Commission (TJC) 2013, Sentinel Event Alert Issue 50: Medical device alarm safety in hospitals, viewed 7 Jan 2016, Tinker, J, Dull, D, Caplan, R & Cheney, F 1989, "Role of monitoring devices in prevention of anesthetic Mishaps: A closed Chain Analysis," Anesthesiology vol 71, pp.541-546 Read More