... all patients receiving IV opioids should be monitored, but to use an IV push instead of PCA goes against the findings of many studies. For example, using a capnograph monitor with a smart alarm would decrease the incidence of false alarms ...
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Chicago, IL (PRWEB) November 15, 2012
According to ECRI Institute, an independent, nonprofit organization that researches the best approaches to improving the safety, quality, and cost-effectiveness of patient care, alarm hazards are the number-one health technology hazard for 2013.
In its report, Top 10 Health Technology Hazards for 2013, ECRI states:
Medical device alarms perform an essential patient safety function. Physiologic monitors, medical telemetry units, ventilators, infusion pumps, dialysis units, and a host of other medical devices sound alarms or issue alerts to warn caregivers of potential problems with the patient. The sheer number of alarms, however, has itself become problematic. The result is that caregivers can become overwhelmed trying to respond to the alarms, or they can become desensitized, which can lead to missed alarms or delayed response, placing patients at risk.
In a recent incident, a patient died “when nurses did not respond to alarms on his cardiac monitor.” Massachusetts General Hospital agreed, apologized to the patient’s family, and settled the case for $850,000. The Boston Globe reported, “Investigators concluded that alarm fatigue experienced by nurses working among constantly beeping monitors contributed to their inattention. Additionally, the volume for a separate audible crisis alarm on his bedside monitor had been turned off.”
“Alarm fatigue is a national problem. Excessive false alarms occur frequently and contribute to alarm desensitization, mistrust, and lack of caregiver response,” says Maria Cvach, MS, RN, CCRN (assistant director of nursing, clinical standards, The Johns Hopkins Hospital). “This may lead to staff disabling or ignoring alarm systems, which decreases patient safety.”
Cathy Carlson, PhD, RN (associate professor, Northern Illinois University School of Nursing & Health Studies) describes how she has seen alarms impact patient care, “It’s amazing what nurses can tune out. Nurses get very tired of having to go again and again into a patient’s room for false alarms. When this happens, caregivers may disable, silence, or even ignore alarms. These caregivers need to ask themselves what would happen if their patient experienced an adverse event or death, all because their failure to use a device or ignore an alarm. Instead of ignoring or not responding effectively to alarms, we need to use available technologies to reduce false alarms.”
One of the recommendations is to use a smart alarm technology. “Smart alarms” can reduce the number of false alarms by taking into account multiple parameters, rate of change, and signal quality.
Cvach explains further. “Rather than using raw data, technology can base alarms on physiologic trends detected over a period of time. Signal filtering, algorithms, and/or artificial intelligence systems process alarms using filters or morphologic and timing differences to reduce the number of alarms.”
Carlson provides an example where use of “smart alarms” could increase the use of patient monitoring, “Some physicians are preferring to use an IV push to administer opioids for pain management rather than PCA patient-controlled analgesia because the IV push does not require a capnograph monitor. As false alarms are often going off, these physicians see monitors as a hindrance to patient care. Using an IV push, however, not only ties up valuable nurses’ time and resources, but PCA has been shown to have significant benefits including improved pain management, increased patient satisfaction, and better pulmonary function. Frankly, all patients receiving IV opioids should be monitored, but to use an IV push instead of PCA goes against the findings of many studies. For example, using a capnograph monitor with a smart alarm would decrease the incidence of false alarms and, for the physicians I mentioned earlier, increase the use of PCA over IV push.”
For a discussion of how smart alarm technology can reduce false alarms and for the other three recommendations, please see http://www.ppahs.org
The Physician-Patient Alliance for Health & Safety (PPAHS) is an advocacy group devoted to improving patient health and safety. PPAHS supporters include physicians, patients, individuals, and organizations. PPAHS recently released a concise checklist that reminds caregivers of the essential steps needed to be taken to initiate Patient-Controlled Analgesia (PCA) with a patient and to continue to assess that patient’s use of PCA. For more information and to download the PCA safety checklist, please visit http://www.ppahs.org.