Dissemination Project Reflection

For this project, my group and I were focused on finding a topic that our unit, R2 at Maine Medical Center, was focusing on themselves. We looked at their own advancements, tools, and GEMBA walks for the floor and piled together what we thought would work best. We came up with the topic of “Increasing Patient Safety by Decreasing Nurse Alarm Fatigue.” Being on the unit ourselves has given us an inside look on how the floor manages problems that occur due to alarm fatigue, and how many alrms and bells go off every shift. We knew it was important to see what we could find to help educate the floor staff on ways to improve. While searching the databases for this topic, several studies, journals, and articles came up. This is a common topic to be discussed, and a lot of them focus on the floor weare on which is a cardiac telemetry unit. ICU is also a unit that is focused on highly as well. When we began compiling information necessary to propse our ideas, we found some great education tools and advancements that can be suggested to the floor for implementation. We also found ways to educate them on their personal health and how alarm fatigue is affecting their everyday work lives. Patient safety is and always should be the nurses number one priority, but how can a nurse take care of others when they are not caring for themselves. Our group is still meeting and putting together a pocket size pamphlet for the floor nurses to carry around with them during their shift. This will have the education and suggestion on how to prioritze alarms and which ones, as well as how to take a second for themselves and their health. Below is our proposal for our dissemination project.

Proposal

Title: Increasing Patient Safety By Decreasing Nurse Alarm Fatigue

Background of practice/clinical problem: Alarm fatigue (AF) has been an increasing concern among healthcare professionals, the Joint Commission, and the FDA (Alsaad, Alman, Thompson, Park, Monteau, & Maniaci, 2017). Recognized as a national healthcare problem, AF is among the top ten technology complications in hospitals. Cardiac telemetry (CT) monitoring without clinical indication is a significant factor in creating unnecessary alarms, increased AF, and increased healthcare costs (Alsaad et al, 2017). Internal data from an alarm fatigue risk assessment found most alarms were due to telemetry monitors (Zadvinskis, Schweitzer, Murry, & Wood, 2018). There has been an adjustment to the perspective on the way nurses view alarms. Managing alarms was viewed as another task added to the nurse’s list of things to do, instead of a tool guiding prompt patient assessment and intervention (Srinivasa, Mankoo, & Kerr, 2017). According to previous studies, no more than six alarms were possible for one ICU patient in 1983, opposed to at least forty types of alarms per ICU patient in 2011. In addition, 65% of 23 sentinel events happened due to the misuse and dysfunction of alarms (Cho, Kim, Lee, & Cho, 2016). Between 2005 and 2008, the US FDA reported a total of 566 alarm-related patient deaths due to nurses not answering these alarms on time. It is important that nurses care for themselves and decrease this alarm fatigue to ensure patient safety is the main priority in their practice (Babski-Reeves, Shanmugham, & Strawderman 2018).

Project aim: The aim of this project is to enhance patient experience and safety by declining alarm fatigue in nurses on R2 medical telemetry unit at Maine Medical Center. With this, there will be the recommendation and education of new protocols and systems for the unit to utilize each day. It is recommended that the floor implements a pilot study based on evidence provided.

Methods: A primary meta-analysis using evidence-based studies was analyzed to reduce alarm fatigue in nurses, therefore increasing patient safety.

Findings/conclusions/implications for practice: AF was found to be associated with unclear protocol regarding the use of CT monitors (Alsaad et al., 2017). Cho et al. conducted a survey of the nurses demonstrating false alarms as the leading obstacle for proper management of alarms (2016). Excessive clinical alarms often overwhelmed medical staff due to the “cry wolf” effect resulting in significant AF and decreased response to alarms. Nurses struggled to distinguish alarms that require immediate attention due to the many different manufacturers and alarm types (Cho et al., 2016). With the implementation of defined CT protocol use and cessation of non-immediate alarms, Alsaad et al. found a decrease in fewer alarms and therefore a decrease in AF (2017). CT monitoring was determined based on two admission categories: Progressive care unit status (PCU) and medical-surgical status. All PCU status warranted for CT monitoring due to potential deterioration overtime whereas med-surg did not always require to be on CT monitoring. CT protocol was a detailed step-list on necessity as well as standard protocol for electrode placement and replacement (Alsaad et al., 2017).

Implementation plan: This dissemination plan will be presented to the med-surg telemetry unit at Maine Medical Center. The researched information will be organized into a pamphlet that will be distributed throughout the floor to medical professionals. As evidenced by Alsaad et al’s findings (2017), this pamphlet will discuss methods to decrease alarm fatigue and patient injuries through evidence-based protocols previously implemented and researched in article findings.

Method of evaluating outcome: We will measure the efficacy of the education related to increasing patient safety by decreasing alarm fatigue provided to the nursing team and health professional staff by posing the question: “Do you as a healthcare professional feel as though you understand this material and do you plan to make a change in your practice to increase patient safety as well as your physical well-being? Yes or No?”

References

Alsaad, A. A., Alman, C. R., Thompson, K. M., Park, S. H., Monteau, R. E., & Maniaci, M. J. (2017). A multidisciplinary approach to reducing alarm fatigue and cost through appropriate use of cardiac telemetry. Postgraduate Medical Journal, 93(1101), 430. doi:http://dx.doi.org.une.idm.oclc.org/10.1136/postgradmedj-2016-134764

Babski-Reeves, K., Bian, L., Shanmugham, M., & Strawderman, L. (2018). Alarm-Related Workload in Default and Modified Alarm Settings and The Relationship Between Alarm Workload, Alarm Response Rate, and Care Provider Experience: Quantification and Comparison Study. JMIR human factors, 5(4), e11704. https://doi.org/10.2196/11704

Cho, O. M., Kim, H., Lee, Y. W., & Cho, I. (2016). Clinical Alarms in Intensive Care Units: Perceived Obstacles of Alarm Management and Alarm Fatigue in Nurses. Healthcare informatics research, 22(1), 46–53. https://doi.org/10.4258/hir.2016.22.1.46

Srinivasa, E., Mankoo, J., & Kerr, C. (2017). An evidence-based approach to reducing cardiac telemetry alarm fatigue. Worldviews on Evidence-Based Nursing, 14(4), 265-273. doi: 10.1111/wvn.12200

Zadvinskis, I. M., Schweitzer, K., Murry, T., & Wood, T. (2018). Tele talks: Nurse‐Led discussions regarding need and duration of cardiac telemetry may impact alarm fatigue, empower nurses, and reduce cost. Worldviews on Evidence-Based Nursing, 15(4), 323-325. doi:http://dx.doi.org.une.idm.oclc.org/10.1111/wvn.12294