Primary Author: | Gayle H. Dasher |
Co-Principal Investigators/Collaborators: | N/A |
Organization: | CHRISTUS Santa Rosa Health System |
Abstract
Purpose
1) Identify staff practices impacting alarm management. 2) Design a strategy for education that will provide training on evidence-based guidelines.
Background
In 2012, alarm fatigue was identified as the number one problem with medical devices. Alarm fatigue leads to delayed responses, missed alarms, and patient safety events (ECRI Institute, 2013). In 2013 The Joint Commission issued a National Patient Safety Goal addressing alarm management. Organizations are expected to (1) establish alarm safety as a priority; (2) identify the most important alarm signals to manage; (3) establish policies and procedures for managing alarms; and (4) educate staff about the purpose and proper operation of alarm systems for which they are responsible (TJC, 2013). An organization must determine how staff modify alarms, types of alarms impacted, practices used to make modifications, frequency of alarm events, and challenges in responding to alarms. A strategy for education staff about alarm challenges and developing organizational standards for making modifications is needed to address the issue (AACN, 2013).
Materials & Methods
A 10-question survey addressing alarm management in the organization was developed and distributed to each clinical staff member through specific service line groups. In this way, data was collected for practices seen in similar patient care areas, i.e. ICU, telemetry/IMCU, medical/surgical, emergency department, labor and delivery.
Results
Preliminary results indicate that staff nurses are modifying a wide variety of alarms in the clinical setting. However, the lack of knowledge regarding evidence-based practices for making modifications is impacting patient safety and quality outcomes.
Conclusion
Exercising the appropriate means for managing alarms is essential to ensure timely response, safe patient care, and quality outcomes. Formulating a strategy for ensuring the use of evidence-based guidelines requires baseline knowledge of current practices. This information then contributes to development of appropriate educational strategies that can be designed for specific patient care units.
Bibliography
- ECRI Institute: Top 10 health technology hazards for 2013. Health Devices. 2012; 41(11): 1-23. Available at https://www.ecri.org/FormsPages/ECRI-Institute-2013-Top-10-Hazards.aspx<...
- Association for the Advancement of Medical instrumentation Foundation/Healthcare Technology Safety Institute (AAMI Foundation/HTSI). Safety Innovations: Using data to drive alarm improvement efforts. The Johns Hopkins Hospital experience. Available at http://www.aami.org/htsi/SI_Series/Johns_Hopkins_White_Paper.pdf.
- Joint Commission Perspectives (2013). The Joint Commission announces 2014 National Patient Safety Goal. 33(7), 1-3.
- American Association of Critical Care Nurses (2013). AACN Practice Alert: Alarm management. AACN Evidence-based Practice Resources Work Group, April, 2013.
© Improvement Science Research Network, 2012
The ISRN published this as received and with permission from the author(s).