NR 361 Distractors in our Environments

NR 361 Distractors in our Environments

NR 361 Distractors in our Environments

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

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Thank you for sharing your perspective on the difficulties nurses face with the distraction of false alarms when added

NR 361 Distractors in our Environments
NR 361 Distractors in our Environments

to their busy schedule. You mentioned multitasking; nurses frequently cannot avoid multitasking on really busy shifts but there is a growing body of literature that identifies multitasking as less productive than we conventionally think. A time and motion study by Yen, Kelley, Lopetegui, Rosado, Migliore, Chipps, & Buck (2017) showed a concern that such multitasking, promoted by current media/cultural norms, can actually interfere with the amount and quality of time spent with patients.

  • Interestingly, a study of college students by Lepp, Barkley, Karpinski,  & Singh (2019) found that multitasking can produce negative consequences for learning, particularly in an online environment.

References:

Lepp, A., Barkley, J. E., Karpinski, A. C., & Singh, S. (2019). College students’ multitasking behavior in online versus face-to-face courses. SAGE Open, 9, 1-9. doi:10.1177/2158244018824505

Yen, P. Y., Kelley, M., Lopetegui, M., Rosado, A. L., Migliore, E. M., Chipps, E. M., & Buck, J. (2017). Understanding and visualizing multitasking and task switching activities: A time motion study to capture nursing workflow.   (Links to an external site.)Links to an external site.American Medical Informatics Association  (Links to an external site.)Links to an external site.Annual Symposium Proceedings, AMIA Symposium, 2016, 1264-1273 (Links to an external site.)Links to an external site..

Nursing workflow is unique and it is very important that we have an input on any design that will impact our job’s workflow. A basic example we experienced at my hospital is when one of our telemetry units was remodeled and the nurses were not asked for any input. The flow of the nurse’s station was so dysfunctional, it was set up like a classroom. The computers were set up in rows so close together that it made it virtually impossible to respond quickly to alarms or any urgent situation for that matter. We had to practically climb over one another. This added to a decrease in response time to alarms which was an increase for patient risk of injury. It was a costly mistake and the unit was redesigned. Now the trend is to consult the individual unit to better understand the needs of the particular specialty in regards to its workflow. Luckily there was a lot of nursing input considered when my facility chose to go with a new operating system. We chose Epic.

Bed alarm fatigue is also an issue at my workplace. One thing that helps, aside from making sure staff is deactivating the alarm prior to getting patients up, is the alarm sensitivity buttons. Our bed alarm sensitivity can be adjusted based on weight or increased risk. I can appreciate your suggestion of a decreased ratio however, I don’t believe I will experience that anytime soon.

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 canadienne186(3), 178. https://doi.org/10.1503/cmaj.109-4696