By Shawn Kennedy, AJN editor-in-chief
By Alan Cleaver/via Flickr
I saw the following headline this week: “LA woman dies in her cubicle at work; body is not discovered until the following day.” The article said it was unclear how she had died. I hope it was at the end of the day after everyone had left; I really hope they don’t find out that she died midday, amidst coworkers who were going about their business. Maybe they were so busy that they never noticed the silence from her cubicle.
This story reminded me of two articles I read recently. One was an article that will be published in the Emerging Infections department in our March issue, which goes live at the end of next week on ajnonline.com. “The Contact Precautions Controversy” examines the issues around placing patients on contact precautions and in isolation—an approach that many hospitals use almost routinely for some patients. (We covered this issue in a news piece last July as well.) Recent studies are raising questions about this practice and the risks to these patients, who often have fewer interactions, get less care, and may feel neglected because health care providers limit contact.
The other article is one that’s in the headlines now. The Boston Globe ran a story about an investigation into patient deaths that came about as a result of alarm fatigue. Alarm fatigue is a growing problem—health care workers are often bombarded with so many alarms that the sounds fade into background noise and critical incidents are missed. Having a monitor that sounds an alarm to alert nurses to a problem—traditionally a source of reassurance for patients—doesn’t necessarily mean someone will respond when you’re in need.
Nurses are the sentinels in hospitals, the ones patients rely on for safe passage through a hospital stay. Our patients can’t afford for us to be on autopilot, rushing to get tasks done without thinking and without being aware of what’s going on. Patients depend on our ability to look past the obvious and recognize the subtle, insidious changes that matter. This isn’t being dramatic—it’s a very real fact of what we do, and we can’t ever forget it.
False alarms from faulty equipment or incorrect alarm parameters are common. A nurse in the middle of caring for one patient has to decide whether to continue with the current patient or to stop, leave that patient, and go check an alarm that perhaps has been a false alarm the last five times it was checked. Nurse managers and administrators have a responsibility to ensure that those at the point of care have the resources—in the way of knowledge, functioning equipment, and enough staff—to be able to respond appropriately. High-tech equipment and monitors are just expensive junk if there’s no one to intervene when problems are detected.
Editor’s note: We’ve just noticed that a related post on the topic, published at the Center for Health Media and Policy at Hunter College, asks how coverage of this issue might affect the public image of nurses: “Are nurses getting an unfair hit here, or do these pieces point to systematic problems with overuse of monitors?”
Reminds me of a frustrating shift on an inpatient hospice unit. My patient had CPAP for comfort. He was awake and aware, and several times an hour would take off the mask at times to give his face a break from the pressure. This would cause the alarm to go, irritating the patient (and other patients).
I called in the respiratory therapist to have the alarm disabled. They refused, saying the alarm was doing what was necessary. I explained that comfort was necessary for the patient, and his comfort required a silent machine. Went through many layers of nursing and respiratory management, with nursing always agreeing with me and respiratory agreeing with the RT. I got the hospital administration involved who agreed with me, but decided there needed to be a written policy that would take weeks (in which time the patient would get no benefit). And, that alarm went off 6-8 times an hour for 12 hours….
Thanks! I’ve always felt that nurses embody Harry Truman’s motto, “The buck stops here.” Nurses are often the last line of defense in catching errors.
What a great post. I’m sharing this with my colleagues. Nurses most definitely lead the charge in making sure patients remain safe throughout their hospital stay. During a recent surgery, I was so thankful for the kind and capable nursing staff. I felt completely safe in their care. Thanks again for the great blog!