Hello Professor Graham and Classmates,
As a nurse, you have many responsibilities. Nurses are multitaskers they monitor the patients, medications, equipment, and much more while documenting everything that has been done. “Most technologies are designed by people unfamiliar with nurses’ workflow, and they fail to appreciate the multitude of other devices the nurse is simultaneously managing” (Ruppel & Funk, 2018). Therefore, due to these designers not understanding what a nurse’s role is the technology that we use does not always fit well with the nursing roles. Multitasking is overwhelming and nursing is a hard job in general adding the two can cause errors. Bed alarms are designed to alarm when the patient is moving off the bed. The alarm can also go off when the patient makes certain movements not just moving off the bed. For example, a nurse working a unit with several patients. One of the patients has a bed alarm and tends to make it go off on purpose multiples times. When the nurse arrives, the patient asks her about her day but does not need assistance. At the end of the night the nurse is busy when that patients bed alarm goes off, but the nurse ignores it because of what she experienced all day. “This alarm fatigue is compounded by the number of potential false alarms during a nurses’ work shift” (Hebda, Hunter, & Czar, 2019). The patient had called the nurse to ask for assistance to the bathroom. When the nurse did not respond the patient went alone and fell on the way and broke his leg. This is an ethical because there was a poor patient outcome due to unknown distraction and continuous false alarms. One of the nursing ethical guiding principles is “nonmaleficence: the obligation for doing no intentional harm” (Hebda, Hunter, & Czar, 2019). The nurse did not do intentional harm but cause harm due to the intentional disregard of the bed alarm.
“Alarms are by intent interruptive. Interruptions are typically considered to have a negative effect on patient safety. However, interruptions have been associated with an increased risk of errors” (Ruppel & Funk, 2018). The evidence shows that alarms are used to help patients, but they are a risk for negative patient safety. There is still need for research on how to join the two worlds where they can work together. One way is the lessen the nurses workload so that she does not feel overwhelmed to the point where they ignore their patients.
References
Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of informatics for nurses & healthcare professionals (6th ed.). Pearson. Ruppel, H., & Funk, M. (2018). Nurse–Technology Interactions and Patient Safety. Critical Care Nursing Clinics of North America,30(2), 203-213. doi:10.1016/j.cnc.2018.02.003
Week 6 Discussion Post:
When I imagine a hospital, I picture bright white lights in the halls and patient rooms, the smell of Clorox wipes or germicidal wipes, and then the sound of never-ending beeping alarms. Even my patients have complained about the sound IV pumps make when alarming about downstream or upstream occlusions, or when an infusion is complete. I do believe alarms are useful in preventing harm to patients. In my time as a nurse, I have noticed many situations in which alarm fatigue or lack of alarms has caused poor outcomes for patients. One example that comes to mind, is when a patient who appeared to be medically stable, suffered an Anterior ST segment elevation myocardial infarction. The patient’s telemetry monitor did not alarm to the change in heart rhythm. The patient used the call light to ask for help because he became symptomatic of the MI he was experiencing. Upon review of the telemetry strips, the patient’s ST segment had changed for 12 minutes before the patient called for help. The patient did unfortunately pass away, but there were no legal repercussions since the patient’s death was not due to negligence. Had the telemetry monitor alarmed, and been silenced by a medical professional, then that would be considered negligence. This death took a toll on all of the healthcare team members including the physicians, nurses, CNAs, and telemetry technicians involved. At our hospital, the telemetry monitors have the same constant alarm sound for VTACH as for when the patient’s oxygen saturation decreases. The same rhythmic alarm sounds when a lead has been removed as when the monitor detects a PVC. Our textbook mentions how a nurse may experience alarm fatigue during their shift because of the high number of potential false alarms they hear (Hebda, Hunter, & Czar, 2019, p.12). I believe the solution to alarm fatigue is to change the sounds made by these alarms for different kinds of alerts. A deadly cardiac rhythm such as VTACH or severe bradycardia should have distinctly different alarm sound than the alert for an oxygen saturation of 88%, especially if the patient has COPD or another disease that may cause the patient to have consistently low oxygen saturations. According to the article, Alarm fatigue a top patient safety hazard, “85%-90% of alerts are false or nuisance alarms, indicating conditions that don’t require clinical interventions” (Jones, 2014, p. 178). In my opinion, 1 single PVC should not warrant a sound alarm, but it should show a visual alarm. Changing alarm sounds and tones may also be useful, such as verbal commands or different sounds for critical alerts vs routine alerts.
References
Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of informatics for nurses & healthcare professionals (6th ed.). Pearson.
Jones K. (2014). Alarm fatigue a top patient safety hazard. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 186(3), 178. https://doi.org/10.1503/cmaj.109-4696