By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.
“Will you please silence that alarm?!” The nurse is on the phone, and can’t reach the screaming cardiac monitor. It’s a normal request, considering that we’re working together in an ICU and the alarm has been ringing for awhile.
But her request for silencing the alarm isn’t issued to me; she’s talking to the unit clerk. Stuck in my patient’s room, I watch as this untrained staff member taps the flashing rectangle on the unit’s central monitor. Without having first been appropriately evaluated, the ringing disappears, along with the words “Multifocal PVCs.”
Later, the same unit clerk absentmindedly turns off a sounding alarm, without encouragement from a nurse. I’m floating today, and although I’ve just met her, I can’t help but ask, “Do you know what that alarm was saying? Was it accurate?”
She is clearly startled by my admonishment, but I persist. “A lot of the alarms around here do seem to be false, but what if this one wasn’t? Do you have the training to know the difference, and to report it?”
If looks could kill, the one that meets my gaze is certainly homicidal, but it’s paired with a grumbled promise to never touch the screen again. So maybe my point has stuck.
The Joint Commission wouldn’t have made improving the safety of alarm systems a 2015 National Patient Safety Goal if danger weren’t lurking, and with a direct link between response rate and our belief in an alarm’s reliability, it’s clear that nurses need to take ownership of alarm safety. A comfortable unit clerk silencing an alarm might be indicative of an alarm-saturated culture; she’s not the only person I’ve watched turning off this source of potentially life-saving information without as much as a glance—distracted nurses, uninterested interns, social workers.
We have become accustomed to an excess of alarm inaccuracies. We are so weary of the constant stimuli that we do little to understand the many functions of our alarms, edit them for each patient, or sharpen our use of these signals so that they serve their intended purpose—to tell us when help is urgently needed.
In “Combating Alarm Fatigue” (February issue), we report on an initiative focused on cardiac monitor alarms in one hospital that resulted in a marked decrease in the overall number of alarms per day and an improvement in the accuracy of these alarms. Using an interdisciplinary task force, researchers implemented simple, direct protocols—they edited which parameters made sense for each patient, ensured that electrodes were fresh and placed well, and discontinued cardiac monitoring that wasn’t needed. When they started the study, 95% of alarms each day were false; at completion, the number was reduced to 50%.
It may be easy to silence an alarm. But to tap into a screen and change the default settings to safe, effective parameters unique to each patient, or troubleshoot a persistent patient-specific glitch, or to know how to rearrange electrodes for better readings not only requires purpose but skill.
The unit clerk started talking to me again, even though it took a few months. The other day I was floated to her unit at a time when she wasn’t working. When an alarm rang over and over in error, I noticed the unit clerk on duty hover over the monitor with finger poised and say to the nurses, “Hey! This alarm is going off. I don’t know what it means. Should I silence it?” Not quite perfect, but it seemed like progress.