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16
NOV / DEC 2013
I
Healthcare Journal of NEW ORLEANS
alarm fatigue
EJGH is looking at adding multi-colored
light displays outside patient rooms and at
North Oaks the standard patient call light
flashes if an alarm is sounding in the room.
Newer technology allows alarms to be tied
in directly to a communication device worn
by the nurse responsible for that patient.This
direct notification of the clinicians assigned
to a patient can cut down on some of the
alarm “noise” in the unit and also reduces the
possibility of a critical alarm being missed.
“We are evaluating our nurse call systemand
that’s part of what we are looking at with that,
but we are also replacing phones, so we are
transitioning systems,” said Brewer.
In some units, particularly telemetry units,
a central location, often called the war room,
is set up with dedicated personnel watch-
ing all monitors and relaying alarms to the
appropriate staff. Central monitoring can be
an important feature in units with multiple
alarms sounding constantly and even with
new technology, can provide a fallback to
ensure someone is responding. However,
even central monitoring can lead to alarm
fatigue. “On our current telemetry unit the
monitor techs that were monitoring equip-
ment were all in the nurse’s station, so it
was pretty noisy,” said SMH’s Johnson. “Our
new cardiology wing was designed so that
the monitors are in an enclosed room and
it isolates the noise from everybody else.”
Similarly, when North Oaks implemented
a centralized monitoring system last year,
“We had to think about that as we did the
planning—howwould those tones and alarms
sound for the staff that was taking care of
those patients?” saidWelch.
Luckily, the technology that allows for
individual notifications of alarms is becom-
ing fairly sophisticated, providing the nurse
with a fair amount of detail as towhat is going
on with the patient and, more and more,
those devices are directly networked with
the monitoring systems. The nurse can also
indicate whether she is responding, notify
others to respond, or see if someone else
has responded. Toups indicated that STPH
is researching these types of technologies as
they upgrade patientmonitors in the hospital.
A
“no pass zone”
makes it everyone’s
responsibility to stop and investigate
if an alarm is sounding in a patient
room. This responsibility extends to all
staff, including non-clinical workers,
housekeeping etc.
Even though improved personal notification
technology or better unit design in newer
facilities may have eliminated the need for
this approach, it’s another great failsafewhen
built into the hospital’s patient care culture.
“We have a no pass zone policy,”said Brewer.
“In ICU it’s a little bit different because you
have somany people in there and the nurses
are really sitting outside the rooms.”
Nurses are not the only ones who expe-
rience alarm fatigue. In units where hun-
dreds of alarms are sounding every day, it
is natural that patients and their families
might also grow weary or frustrated, par-
ticularly if those alarms are preventing rest,
or if hospital staff is perceived to be slow in
“There is technology out there where we can
have alarms go directly to the nurse on a
smart phone or other device. Those are not
things we have in place yet, but those are cer-
tainly things that our new equipment allows
us to look at for the future,” she said.
According to Carol McCullough, CNO,
Slidell Memorial Hosptial, SMH is the first
hospital in the nation to use the Vital Sync™
virtual patientmonitoring platform(2.0) from
Covidien. It wirelessly sends ventilator, pulse
oximeter, and capnography data to devices
of the clinical staff’s choice, whether that is
a central station or a web-enabled mobile
device, such as a laptop, tablet or smartphone.
Others use HIPAAapproved text messaging,
paging, or other direct nurse call devices that
can provide detailed information about the
alarm to that nurse or staff member.
While some units, like ICUs, have a high
nurse to patient ratio and alarm response
assignments are pretty clear, in other larger
unitsmany local hospitals have implemented
an additional alarm management policy to
support assigned staff.A“no pass zone”makes
it everyone’s responsibility to stop and investi-
gate if an alarm is sounding in a patient room.
This responsibility extends to all staff, includ-
ing non-clinical workers, housekeeping, etc.