Caregiver Alarm Fatigue
A subtle problem has been growing inside the modern hospital environment. The trend towards increased usage of alert/alarm generating patient monitors seems like a logical step towards better patient care. It certainly makes sense that the more caregivers can know about patients’ conditions the better they can react should an emergency arise. However, there have been multiple incidents that suggest that this is simply not the case.
The most high profile incident occurred in January when a patient at Massachusetts General Hospital (MGH) died of a cardiac arrest. As it turned out, the patient’s cardiac arrest monitor had been in alarm mode for over 20 minutes before the patient died, yet nurses failed to notice the scrolling tickertape notices in the hallway or the beeps in the central nursing station. In addition, an unknown person had completely turned off the separate audible alarm on the physical bedside monitor the night before.
So what exactly causes this disconnect between caregivers and monitoring technology? Alarm fatigue. As more monitoring devices are added into the hospital environment, each additional alert adds weight until nurses feel overwhelmed. As a result, caregivers experience alarm fatigue. Alarm fatigue is the condition where caregivers begin to give up trying to manage the onslaught of alerts, and start to ignore them instead. In extreme cases, such as the situation at MGH, caregivers begin turning down the volume of audible alerts or even turning off alerts completely.
Preventing Alarm Fatigue
Stopping alarm fatigue isn’t simple. Obviously, eliminating alerts/alarms isn’t an acceptable solution, since that would defeat the purpose of patient monitoring devices. Yet something must be done or the problem will only continue to develop as the hospital environment gets more complex.
The solution lies not in eliminating alerts, but in more efficient management of them. Without an automatic and organized approach to managing alerts, caregivers are forced to juggle them manually. Manual management of alerts can be effective, as long as the number of alerts stays at a reasonable level. However, as more alerts are added to the environment, an alert management system becomes more necessary.
Developing an Effective Alert Management System
Today, new technologies such as Dalcon Alert include an Alert Management System designed to help caregivers organize alerts. Dalcon Alert’s Alert Management System automatically tracks all active alerts. Active alerts are displayed on a large screen monitor at the nursing station and are automatically updated in realtime with alert type, location, and length of duration. The alert queue is designed to allow caregivers to quickly prioritize active alerts, and canceled alerts are automatically removed from the queue.
Reducing Unnecessary Alerts
In addition, Dalcon Alert allows nurses to receive alerts via text message to wireless phones. A successful Alert Management System involves quality design. As a result, caregivers should only be receiving relevant alerts.
For example, caregivers should only receive non-critical alerts from their assigned patients, not from each patient on an entire floor. Because Dalcon Alert utilizes wireless phones assigned to each caregiver, relevant alerts can be tailored to the individual caregiver.
Because all alerts are managed by the Alert Management System, non-critical monitoring devices can have their audible alerts turned down in order to reduce hospital ambient noise. Any reduction in hospital ambient noise has been shown to increase the quality of patient care significantly.
Implementing Hourly Nurse Rounding
The benefits of hourly rounding can be very encouraging for hospitals considering implementing the program. However, according to the Studer Group, the hospital consulting organization credited with first documenting the benefits of hourly nurse rounding, hospitals should not attempt to execute the program halfheartedly. Having the nurses merely get “face-time” in with the patients each hour is not enough. In order for hospitals to see real results, the Studer Group advocates that nurses follow the following eight-step rounding procedure each time they enter a room during their hourly round:
- Use opening Key Words.
- Accomplish scheduled tasks.
- Address the “Three Ps”—pain, potty, position.
- Address additional comfort needs.
- Conduct environmental assessment.
- Ask, “Is there anything else I can do for you? I have time.”
- Tell each patient when you will be back.
- Document the round.
The most critical component, according to the Studer Group, for a successful hourly rounding implementation is maintenance. Nurse Managers must be committed to the program, and must continually validate the program or it quickly falls apart. Validation consists of not only making sure that nurses are consistently making hourly rounds, but also that they are faithfully following rounding procedure.
Trust but Verify
The Studer Group suggests that nurse managers execute a “trust but verify” policy. It is important that nurses do not perceive that they are being “checked up on” by their managers because they are untrustworthy. Instead, managers need to communicate that they are simply double checking to make sure activities do not “fall through the cracks” and that bad habits are not formed.
Hourly Nurse Rounding Validation through Technology
Dalcon provides a solution to help hospitals implement nurse rounding as a part of its Dalcon Alert Remote Patient Monitoring system.
Dalcon Alert captures patient monitoring device alerts and sends them to wireless phones carried by hospital staff via text message. In addition to monitoring patient device alerts, Dalcon Alert also sends periodical bed turn alerts to staff as well as rounding reminder alerts. Nurses cancel their rounding reminder alert via Dalcon Alert’s Remote Alarm Monitor at the patient bedside. As a result, hourly rounding is assured. However, it is still the responsibility of the nurse managers to confirm that nurses are following rounding procedure accurately and diligently.
The Benefits of Hourly Nurse Rounding
Hourly nurse rounding seems counter-intuitive. At first glance, adding a major task to an already demanding job in order to decrease workload doesn’t make sense.
Yet researchers have found that adding an hourly nurse rounding program in hospitals makes a dramatic impact in two important areas:
- Significantly increased staff productivity and satisfaction.
- Significantly increased quality of patient care and patient satisfaction.
The fact that hourly nurse rounding actually decreases staff workload comes as a surprise to many. Yet consideration of the impact of hourly rounding on the work environment quickly explains this phenomenon.
In a traditional acute care setting, nurses typically are conditioned to react to patient problems and requests instead of focusing on preventing them. This strategy of inconsistency creates a high stress environment. Because nurses are not proactively resolving patient needs, patients learn to rely heavily on their nurse call buttons to get assistance. Due to the interrupting and distracting nature of nurse calls, as nurse calls increase, staff productivity usually goes down.
Reducing these resource-consuming nurse calls is the first area hourly rounding pays off. As patients learn to expect nurses at specific times throughout the day, they begin to rely less on the nurse call system, using it for urgent needs only.
The effects are dramatic. A recent study across 27 nursing units in 14 hospitals by the Studer Group, a hospital consulting organization, showed that hourly rounding decreased nurse calls by almost 40%. In addition, patient falls were reduced by 50%. According to Christine Meade, PhD and chief researcher of the study, “It’s essentially like adding the time of one full-time RN to complement the staff for a week because of the hours not used answering call lights — and the patients love it.”
A secondary benefit of hourly rounding is the increase in the quality of patient care. Patients feel like their needs are better cared for when patient care is provided proactively instead of as a reaction. Also, Because hourly rounding takes care of all non-urgent patient needs, the nurse call system can regain its sense of urgency. As a result, nurse call response times are drastically reduced.
Implementing Hourly Rounding with New Technology
Dalcon Alert, Dalcon’s Remote Patient Monitoring and Alert Management solution, has hourly rounding alerts built into the system. Dalcon Alert captures patient monitoring device alerts and sends them via text message to wireless phones carried by facility staff. In addition to these monitoring device alerts, Dalcon Alert also sends periodic bed turn reminder alerts and nurse rounding alerts.
Because Dalcon Alert hourly rounding alerts can only be canceled via the Remote Alarm Monitor (RAM) at the patient’s bedside, accidental staff negligence of rounding is eliminated.
