A recent survey of nurses has found that continuous patient monitoring of patient vital signs may not only improve health and safety, but may be done without associated alarm fatigue.
Terri Watkins MSN, Lynn Whisman BSN, MBA, FACHE and Pamela Booker MSN, CNOR, all clinicians from LifePoint Health, conducted a survey to assess nursing experience with continuous patient monitoring in two medical/surgical units – a 49-bed acute care facility in Utah and a 175-bed full-service hospital in Alabama.
The continuous patient monitoring system provided continuous display of SpO2, heart rate (HR), systolic and diastolic blood pressure (BP) and respiration rate (RR). After four weeks of using continuous patient monitoring, nurses were asked to rate their experience with monitoring – strongly agree, agree, neutral, disagree or strongly disagree.
Three of the questions related to patient safety:
- The number of alarms/alerts was appropriate.
- Being able to view my patient’s posture from the central station increased his/her safety.
- I am satisfied with the performance of the monitor and believe it provides valuable data that will enhance patient safety.
The number of alarms that sound at patients’ bedsides has been cited as a hindrance to use of continuous patient monitoring. A survey conducted by the Physician-Patient Alliance for Health & Safety revealed that about 90 percent of hospitals believed reducing false alarms would increase use of patient monitoring devices (such as pulse oximetry and capnography).
The Joint Commission (TJC) has made better alarm management a national patient safety goal. In Sentinel Event Alert #50 “Medical device alarm safety in hospitals”, TJC said:
The number of alarm signals per patient per day can reach several hundred depending on the unit within the hospital, translating to thousands of alarm signals on every unit and tens of thousands of alarm signals throughout the hospital every day. It is estimated that between 85 and 99 percent of alarm signals do not require clinical intervention, such as when alarm conditions are set too tight; default settings are not adjusted for the individual patient or for the patient population; ECG electrodes have dried out; or sensors are mispositioned. As a result, clinicians become desensitized or immune to the sounds, and are overwhelmed by information – in short, they suffer from “alarm fatigue.” In response to this constant barrage of noise, clinicians may turn down the volume of the alarm, turn it off, or adjust the alarm settings outside the limits that are safe and appropriate for the patient – all of which can have serious, often fatal, consequences.
Of the 98 alarm-related events reported to the The Joint Commission’s Sentinel Event database, 80 resulted in death, 13 in permanent loss of function, and five in unexpected additional care or extended stay.
Managing the number of alarms is therefore critical – not only for the safety of patients, but for effective and efficient patient care and nursing workflow.
On average, using the continuous patient monitoring system, both units experienced 8-10 alarms per patient, per day. 92 percent of the nurses agreed that the number of alarms and alerts were appropriate; 54% strongly agreed. The actual numbers of alarms are shown in the chart below:
Moreover, all of the nurses surveyed agreed that continuous patient monitoring will help enhance patient safety. Examples of alert-initiated interventions are shown below:
The researchers concluded:
This study demonstrated that continuous, multi-parameter patient monitoring could be performed on medical/surgical units with a small and appropriate level of audible alerts. Continuous vital sign assessment may, in some cases, have initiated nursing interventions that prevented failure-to-rescue events. Nurses surveyed unanimously agreed that continuous vital sign surveillance will help enhance patient safety.