What is it?

Alarm Fatigue

Alarm fatigue occurs when clinical personnel fail to respond appropriately to alarms due to excessive or inability to understand the priority or critical nature of alarms. As a result, clinical personnel will be desensitized to alarms, and will ignore them and even turning them off.

Alarm Fatigue

Why is it important?2004 study showed 1,511

undetected status changes ending in death or rescue activities per 10,000 admissions

JCAHO recognized Alarm Fatigue as critical and integrated such into their accreditation standards

The number of deaths caused by alarm fatigue has increased from 189 in 2001 to 449 in 2004

Alarm Fatigue

Causes?Studies have shown as many as

99% of ICU alarms are false or non-critical alarms.

These are called nuisance alarms and are the leading contributor to alarm fatigue

Alarm Fatigue

Causes?Alarms fail to function as expected

It is difficult to distinguish which machine's alarm is going off

Nurses may block out noise in order to concentrate on current task.

Alarm Fatigue

Nurses Problems?Nurses have an overabundance of

notifying devices (nurse calls, pagers, phones, overhead pagers, and monitor alarms)

Lower patient to nurse ratios increase the number of relevant alarms per nurse

Monitors with undirected alarms alert all nurses instead of specific nurses

Alarm Fatigue

Nuisance Alarms?Many nuisance alarms can be

avoided by maintenance and adjustments such as battery changes and new sensors

2005 John Hopkins Hospital study observed 16,934 alarms over 18 days in one unit

Maintenance was performed and settings were adjusted resulting in 43% decrease

Alarm Fatigue

How can we Improve?Tiered response system would

allow for quicker response time and delegation

Actionable/tailored alarms would create less nuisance alarms

The combination of all alerts to one device, "Smart alarms" to monitor multiple device in relation to each other

Alarm Fatigue

What are the Obstacles? There is little or no coordination

between manufacturers including limited standards

Manufacturers prefer a proprietary product

Alarm acoustics bare no relationship to type of alarm

Most alarms are on or off with no variation in level for type of alert

Alarm Fatigue

Current Efforts?Third party vendors are pushing

for FDA regulation on monitor interface

iTouches and iPhones have been used to integrate alarms and notifications along with communication between nurses

Devices have been developed to provide data to specific nurses about specific patients from multiple devices allowing real-time use.

Alarm Fatigue

Action?Evaluate equipment with excessive

alarms that desensitize staff

Standardize alarm management

Gage the reliability of secondary notification devices and assess new systems of alarm management

Determine staff educational needs on alarm devices

Central Line InfectionAlso called Central venous

catheter (CVC)

Placed into large vein in neck, chest, or groin

Used mainly to administer drugs or obtain blood tests

Central Line Infection

Why it is important2006 study showed that 48% of

the 4 million ICU patients that year received indwelling catheters

Approximately 200,000 contract bloodstream infection

15-20% mortality rate

Cost $3,700 to $29,000 per infection

Central Line Infection

Causes (Procedural)Because of routine nature of

procedure, physicians only think partial drapes are needed over full-sized drapes

In a study, the perceived need for full-sized drapes was 22%.

Documented use of full-sized drapes was 44%

Central Line Infection

Causes (Infections) Catheter insertion breaks the skin,

creating an open pathway for organisms to enter bloodstream

Accessing the catheter for medication admin, flushing, and tubing changes introduces microorganisms into the lumen

Infection elsewhere can also lead to bloodstream related infection

Contaminated fluid or medications

Central Line Infection

How can we Improve?Integrating a guideline for surgery

procedures

Apply minimum guidelines for sterilizing catheters and surgical areas

Utilize nurses to run down a checklist to make sure all personnel and procedures abide by these guidelines

Central Line Infection

SpecificsHand Hygiene

Maximal barrier precautions upon insertion and effective protective dressing

Chlorhexidine skin antisepsis

Optimal catheter site selection

Daily Review of central line necessity

Alarm Fatigue

What are the Obstacles?

Not enough evidence-based data to create guidelines

Difficult to empower nurses with the final verdict of guidelines

Constant replacement of CVCs doesn’t necessarily reduce risk of infection

Central Line Infection

Current EffortsDevelopment of evidence-graded

guidelines for prevention

Implement instructional courses given to physicians and staff to refresh importance of reducing infection

Hands on approach with courses bundled with multiple modules covering all aspects of improvement

Central Line Infection

Action?Develop well-defined procedural

guidelines using evidence-based data

Continue to keep physicians informed with courses to refresh techniques for surgical procedures

Find new ways to reduce infection, such as alternative insertion sites

Central Line Infection

OutcomesAfter multifaceted intervention

study, rate of infection decresed from 11.3/1000 to 0/1000 from 1st

Estimated cost savings of $63,000 and up to $800,000

Use of full-sized drapes increased from 44% to 65%