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Alarm fatigue as a concept analysis
Alarm fatigue literature review
Alarm fatigue literature review
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Alarm fatigue is a growing problem that causes nurses to feel overwhelmed and not perform to the best of their abilities. Many people don’t understand the concept of alarm fatigue until they are in a hospital and hear the different noises going on first hand. Alarm fatigue occurs when nurses or other health care members have sensory overload due to the alarms, which then lead to ignoring the alarms raising concerns with patient safety (Horkan, 2014).
While nurses are working on a floor there are many different machines that have alarms such as IV pumps, ventilator machines, ECG’s, vital machines, call lights, and pagers. New nurses have shown a lack of response efforts to combat these alarms from a proposed desensitization and sensory overload of the alarm noise (Cvach, 2012). This is a patient safety concern due to what the alarms purpose is which in turn leads to varying amounts of potentially severe consqeunces if not answered promptly. Between 2009 and 2012 the joint commission stated that there were 80 patient deaths, 13 permanent losses of function, and 5 events that led to extended hospital stays (Horkan, 2014). It is important for nurses to recognize alarm fatigue and find interventions to help keep patients from being injured.
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A hemodialysis floor has increased alarm fatigue from all of the monitors that are connected to the patient.
Nurses that can use medical equipment with alarm systems properly can reduce the number of times alarms are set off which will then allow nurses to be more attentive to true alarms (Horkan, 2014). For dialysis patients the venous and arterial pressure alarms can be minimized by observing access sites and tubing for kinking or clotting of the blood (Horkan 2014). Alarm fatigue can further be minimized by hourly rounding by the nurse and or assistive personal. This will promote a better patient care setting by being aware of changes in
conditions. Alarm fatigue started by nurses always responding to alarms going off and realizing they were false alarms and did not need immediate attention. Repeated false alarms contribute to mistrust and lack of response to the patients (Cvach, 2012). An example of alarm fatigue and patient safety is an infusion pump sending off a warning signal when the medication is not being infused and if the nurse ignores it then it can become infiltrated spilling medication on the bed and having to discontinue that IV line. Nurses need to be able to overcome alarm fatigue by interventions such as hourly rounding and checking on the patient. Hospitals can help with alarm fatigue by customizing alarms based on the patients needs and if they are not answered then a visual identification can get the nurses attention (Cvach, 2012). There is current research on alarms being set at high priority (indicating an urgent problem), medium priority (indicating a dangerous situation) and a low priority (indicating that attention is needed) (Cvach, 2012). This would be a good idea as long as patients are explained the system in place as well. Alarm fatigue is a growing problem that needs attention; this is just one way that technology can fix the problem it created early on. (Something like that.. needs little more info) Nurses all over the world experience alarm fatigue. More research studies are needed to find the right interventions to help keep nurses aware of alarms going off and to prevent patients from further harm.
Patients expect instant response to call lights due to today’s technological advancements. This can negatively impact nurse stress and cause contempt toward the patient. However, the expectation to respond promptly improves safety and encourages frequent rounding. Also, aiming for high patient satisfaction scores on the HCAHPS/Press Ganey by fulfilling patient requests can overshadow safe, efficient, and necessary healthcare. Although patient satisfaction is important, ultimately, the patient’s health takes precedence over satisfying patient and family requests, especially when those requests are unnecessary, harmful, or take away from the plan of care (Junewicz & Youngner, 2015). The HCAHPS/Press Ganey survey focuses on the patient’s perception of care. The problem with this aspect of the survey is that the first and foremost goal of nurses should not be to increase a patient’s score based on perception. According to an article in Health Facilities Management, the nurse’s top priority is to provide the safest, most quality care possible for patients with the resources they are given (Hurst, 2013). Once this has been accomplished, the nurse can then help the patient realize that the most
Human factors are derived from construction and adapted to a system of development in health care by carefully examining the relationship between people, environment, and technology. The consideration of human factors acknowledges the capability or inability to perform a precise task while executing multiple functions at once. Human factors provide an organized method to prevent errors and create exceptional efficiency. Careful attention must be exercised in all levels of care such as the physical, social, and external environment. It is also vital to carefully consider the type of work completed and the quality of performance. Applying human factors to the structure of healthcare can help reduce risks and improve outcomes for patients. This includes physical, behavioral, and cognitive performance which is important to a successful health care system that can prevent errors. A well-designed health care system can anticipate errors before they occur and not after the mistake has been committed. A culture of safety in nursing demands strong leadership that pays attention to variations in workloads, preventing interruptions at work, promotes communication and courtesy for everyone involved. Implementing a structure of human factors will guide research and provide a better understanding of a nurse’s complicated work environment. Nurses today are face challenges that affect patient safety such as heavy workloads, distractions, multiple tasks, and inadequate staffing. Poor communication and failure to comply with proper protocols can also adversely affect patient safety. Understanding human factors can help nurses prevent errors and improve quality of care. In order to standardize care the crew resource management program was
Hospitalized patients are often hooked up to monitoring devices such as heart monitors, which monitor the electric activity of the heart, or connected to a physiological monitor so their vital signs are constantly being measured. These monitors are intended to continuously assess the patients’ status, and alarm if the patients’ status drops below what is considered normal. The increased use of monitoring devices has created a new phenomenon known as alarm fatigue. According to the ECRI institute (2011), “alarm fatigue occurs when the sheer number of alarms overwhelms staff and they become desensitized to the alarms resulting in delayed alarm response and missed alarms-often resulting in patient harm or even death.” Alarm fatigue has become a major problem within the nursing community and has already had a negative impact on patient safety. Due to the adverse effects alarm fatigue is having on quality patient care, there has been a call to action to find solutions that may deter alarm fatigue. Evidence-based practices involving quality improvement initiatives have been put into effect. The problem has also gained national attention from such institutions as the Food and Drug Administration (FDA) and The Joint Commission (TJC).
I think shortages of nurses can also be a factor in why nurses are overworked and stressed. In most hospitals you can’t even tell if there is a nurse shortage, the nurses run around from patient to patient I’m trying to still provide the same quality care. My aunt is a registered nurse for Northeast medical center and I asked her out of the previously 11 listed reasons nurses are stressed which do you experience the most. She replied, “I have to say that I experience number one which is work overload the most. When I started working as a nurse 37 years ago there were three separate shifts throughout a day and there’s could work instead of the two 7am-7pm. The nursed patient ratio was a lot lower we got to spend time with the patients we had during the day and provide individual attention. You didn’t feel overwhelmed because the hospital had enough nurses. Now they nurses doing e same amount of work as two or three nurses combined, and are still expected to do
The nursing profession is a profession where people put their trust in you to provide care that is not only effective, ethical, and moral, but safe. Not all health situations are simple or by the book. Not all hospitals have the same nurse-patient ratios, equipment, supplies, or support available, but all nurses have “the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm” (ANA, 2009). When arriving at work for a shift, nurses must ensure that the assignment is safe for not only the patients, but also for themselves. There are times when this is not the situation. In these cases, the nurse has the right to invoke Safe Harbor, because according the ANA, nurses also “have the professional right to accept, reject or object in writing to any patient assignment that puts patient or themselves at serious risk for harm” (ANA, 2009).
...hological preparation. After a nurse is done working their regular shift being forced to work overtime can out them a greater right of medical mistake in part due to fatigue and tiredness consequently putting the patient at high risk of complications.
In the recent past, nursing has come to the forefront as a popular career amongst students across the globe. The demand for nurses has kept increasing gradually over the years. In fact, the number of registered nurses does not meet the demand of the private and public health sector. This phenomenon has resulted in a situation where the available registered nurses have to work extra hours in order to meet the patients’ needs. With this in mind, the issue of nurse fatigue has come up as a common problem in nursing. According to the Canadian Nurses Association (CNA), nurse fatigue is “a feeling of tiredness” that penetrates a persons physical, mental and emotional realms limiting their ability to function normally. Fatigue does not just involve sleepiness as has been assumed before. It involves utter exhaustion that is not easily mitigated through rest. When nurses ignore the signs of fatigue, they risk the development of chronic fatigue and other health problems that may not be easily treated. Additionally, fatigue may cause nurses to lose more time at work as they may have to be away from work for several days to treat it. The issue of nurse fatigue has permeated the nursing profession to the extent of causing errors in the work performed by nurses. Fatigue causes a decrease in a nurse’s ability to make accurate decisions for themselves and their patients. It is therefore important to find ways to curb nurse fatigue such that it is no longer a problem. Nurse fatigue is a danger to the patients, organizations and to the nurses themselves and must be mitigated adequately.
Tzeng H. & Yin C. (2010) Nurses' response time to call lights and fall occurrences. MEDSURG
Noise is unwanted sound. Over the past 50 years, sound levels in hospitals have increased,1-3 with all studies exceeding the recommendations from World Health Organization (WHO) Guidelines for Community Noise.4 In 2006 the Hospital Consumer Assessment of Healthcare Providers and Systems began surveying patients regarding their perspectives on hospital care. This survey specifically asks about noise: “During this hospital stay, how often was the area around your room quiet at night?” In 2013, the responses to this question were included in the calculation of a Value Based Purchasing score, which is linked to payments from the Centers for Medicare & Medicaid Services. To effectively carry out noise reducing interventions it is important to understand what we know about noise in the hospital. This article, which focuses on noise in the Intensive Care Unit (ICU), describes basic sound level measurement terminology, the effect of noise on critically ill patients and evidence-based strategies to which nurses can actively contribute to decrease or protect patients from noise.
Patient’s safety will be compromised because increase of patient to nurse ratio will lead to mistakes in delivering quality care. In 2007, the Agency for Healthcare Research and Quality (AHRQ) conducted a metanalysis and found that “shortage of registered nurses, in combination with increased workload, poses a potential threat to the quality of care… increases in registered nurse staffing was associated with a reduction in hospital-related mortality and failure to rescue as well as reduced length of stay.” Intense workload, stress, and dissatisfaction in one’s profession can lead to health problems. Researchers found that maintaining and improving a healthy work environment will facilitate safety, quality healthcare and promote a desirable professional avenue.
Factors such as, heavy workloads, stress, job dissatisfaction, frequent medical errors, and intention of leaving the job are all common for nurses to experience, especially during the nursing shortage crisis. Not only do the nurses suffer during a shortage, but the patients ' health outcomes suffer even more. For instance, there are higher rates of infectious diseases and adverse patient outcomes, such as urinary tract infections (UTIs), upper gastrointestinal bleeding, shock, pneumonia, prolonged hospital stays, failure to rescue, and mortality. As a result, this leads to higher re-admission rates for patients. Furthermore, high patient-to-nurse ratios cause heavy workloads due to an inadequate supply of nurses, an increased demand for nurses, a reduction in staffing and an increase in overtime, and a shortened length of stay for patients. Without the heavy workloads that nurses have to endure on a daily basis, there would more time for nurses to communicate more effectively with physicians, insurance companies, and patients and their families. Those heavy workloads are the result of hospitals reducing the nursing staff and implementing mandatory overtime policies just to meet unexpectedly high demands. Unfortunately, the nursing shortage has affected nurses ' mental and physical health. For example, the most common health concerns for nurses include cardiovascular health, occupational injuries and illnesses, and emotional and physical exhaustion. Therefore, safe-staffing ratios/levels have to become the main
Lippincott , Williams, & Wilkins, (2012). Sentinel event alert spotlights nurse fatigue. Clinical Rounds, 42(3), 27-29. doi: 10.1097/01.NURSE.0000411416.14033.f5
Historically, the nursing profession has been actively involved in the health promotion and disease prevention among the general public. However, while caring for others, nurses often neglect their personal safety, which ultimately results in the high level of work-related injuries. Failure to timely address risk factors for nursing can have dire consequences for patient outcomes, since it is often associated with increased medication errors and patient falls, poor quality of care, and permanent disability of the nursing staff (Stokowski, 2014).
On these occasions, I rely on my nursing assessment, evaluation, and interventions, collaborative skills, and scientific knowledge to make sound clinical judgments for the benefit of my patients. As a hemodialysis nurse, I will persevere to comply with innovation in nursing practice, EBP, research, and education. I believe growth requires generation of innovative, improved ideas and practices for the betterment of the organization and patient satisfaction. For this reason, I will embrace technological advancements; empower front line staff to embrace change and innovation; and motivate staff to be change agents on the floor with the aim to provide better quality of care for our
The nursing profession is constantly in a state of change becoming more complex over time. Registered nurses work to prevent disease, promote health and help patients cope. They develop and manage nursing care plans, instruct proper outpatient care, and help improve and maintain health within their community. They are educators of health governed by state laws. Registered nurses can work in many different settings which determine their daily job duties. Depending on their level of training a RN could work with geriatrics, in intensive care units, as an educator, as clinical study observers, a midwife, oncology, or palliative care. Hospital nurses make up the majority of the RN group. They work as staff nurses who carryout medical regimens and provide bedside care. Most registered nurses work in well-lighted comfortable facilities, work nights, weekends, and holidays, and spend a considerable amount of time on their feet. They have to be available at a moment’s notice. Nursing also has its hazards all employees of care facilities are at risk for infectious disease, radiation poisoning, back injuries, shocks from electrical equipment, and hazards posed by compressed gas. Nurses are the link between doctors and patients.