Clinical Alarm Systems: A Case Study

The Dangers of Clinical Alarm Systems

The act of doing good, also known as beneficence, is a major role of the nurse. No matter what a nurse does, he or she must demonstrate beneficence in everything he or she does. However, healthcare agencies are not perfect and there are some topics that the Joint Commission has decided could be improved on. They have formulated a list of goals focused primarily on improving nursing care. This list is called the National Patient Safety Goals. One of these goals focuses on reducing the harm associated with clinical alarm systems. This is an immensely important topic, as there have been reports of major injury and even death due to the misuse of alarm systems. However, by following the guidelines demonstrated by the Joint Commission a healthcare agency is able to greatly reduce the risk of alarm associated accidents. When managing alarms in a clinical setting, it is crucial to practice beneficence in

order to prevent negligence by the nurse and keep the patient’s safety and health as a top priority.
The goal of alarm management’s main focus is to focus on clinical alarm systems that have the most direct relationship to patient safety (The Joint Commission, 2016). In some settings, a specific alarm may be difficult to detect. Also, in many critical care settings, alarms may go off multiple times in an hour. This excessive exposure to alarms can lead to alarm fatigue, in which a nurse does not respond to an alarm immediately or is able to ‘block it out.’ This is extremely dangerous and can lead to serious injury or even death. Recently, this has taken the life of a high school girl. In addition to failed physical assessments, the nurses responsible for her care after a tonsillectomy also misused her equipment. Her condition deteriorated, but the machine alarms were unable to alert the staff because they had been muted. Sadly, she passed away 15 days later due to brain damage (Sendelbach et al., 2015). This is just one out of many stories showing the way in which nurses handle alarms needs to change.
An article written by Carol Lukasewicz mentions an interview with a nurse named Jackie. In this interview, she states “Over the past few years, the patients have become sicker, and it’s now a constant bombardment of alarms, beeps, and jingles. It can feel overwhelming, especially when the unit is busy. When I’m trying to get work done, I think sometimes I just block out the noise,” (Lukasewicz et al., 2015). This statement is sure to raise many red flags, however, in an average intensive care unit there may be as many as six hundred alarms buzzing per patient each day (Lukasewicz et al., 2015). A nurse working in this type of environment is expected to demonstrate beneficence as a top priority through making accurate judgements of alarms, educating staff about how the alarm systems work, and establishing policies or procedures about managing alarms (The Joint Commission, 2016).
A 2013 research study proved extremely successful with implementing an alarm management policy.

With the goal of reducing unnecessary electrocardiograph signals on a cardiovascular unit, the average number of signals per day was able to be decreased from 28.5 to only 3.29 (Sendelbach et al., 2015). This was able to be accomplished by combining several different approaches to nuisance alarm reduction. Those implementing the study completely eliminated duplicative alarms, customized alarms, changed EKG electrodes daily, standardized skin preparation, and used EKG leads that could be disposed of (Sendelbach et al., 2015). This study proves that bundling many approaches together to safely reduce unwanted alarms has the capability to completely change the frequency of alarms in a nursing unit. When others units implement the same management policy, it is crucial to make sure each nurse is still doing physical assessments and checking vitals regularly to prevent malfunction of alarms as well as be aware of the condition each patient is

in.
Frequent alarms, especially in intensive care or other critical units, have been known to lead to negligence by the nurse. It is because of this that the Joint Commission included it as a National Patient Safety Goal. However, through being beneficent and keeping the patient as a top priority, it has been proven possible to greatly reduce the frequency of unnecessary alarms while still abiding by safe standards. Being aware of how alarms work, educating others, and implementing a system that works are all ways that have been proven to reduce alarm frequency (The Joint Commission, 2016). Less frequent alarms reduce the risk of alarm fatigue, leading to a safer work environment and a better healthcare system overall.

References
Lukasewicz, C. L., & Andersson Mattox, E. (2015). Patient Safety. Understanding Clinical Alarm Safety. Critical Care Nurse, 35(4), 45-57. doi:10.4037/ccn2015113
Sendelbach, S., Wahl, S., Anthony, A., & Shotts, P. (2015). Stop the Noise: A Quality Improvement Project to Decrease Electrocardiographic Nuisance Alarms. Critical Care Nurse, 35(4), 15-23. doi:10.4037/ccn2015858