Battling alarm fatigue

As nurses took a seat in the BIDMC auditorium, a beeping noise in the background could be heard every few seconds. Natalie Fealy, RN, took her place behind the podium and asked the crowd if they remembered hearing anything as they settled in for Nursing Grand Rounds.

Most of the crowd acknowledged the noise, but several had not heard it. The sound had been an actual recording from a floor of the "leads-off alarm," the alarm meant to alert clinicians when a patient's lead wires measuring their vital signs fall off. Alarm fatigue occurs when a clinician becomes desensitized to the sound and fails to respond. This national problem is being addressed on a local level at BIDMC, said Tricia Bourie, RN.

"We are being thoughtful about the changes we are making," said Bourie, who sits on BIDMC's Telemetry Task Force.

Telemetry involves attaching lead wires to a patient to monitor their heart rate, blood pressure and other vital responses. An alarm sounds if the patient's measurements are too high or too low or if the wires detach from the patient.

Some practice changes to emerge from the task force include additional monitors being installed in the back hallways so that all patients' vitals could be accessed at different points along the unit.

Nursing leadership is also reminding staff about the importance of a two-person telemetry initiation when a patient arrives on the floor. This involves a nurse and a patient care technician calling the nurse's station to give the room number of the patient, the telemetry box number and two patient identifiers to ensure the correct patient is being monitored.

"One change we asked from nurses was that they do not turn an alarm off from the desk," said Linda Denekamp, RN. "When you respond to a leads-off alarm, once you reattach the leads, the alarm turns itself off. If you turn the alarm off from the desk and then get distracted on your way to the patient's room, you run the risk of forgetting to respond to that original alarm."

Further changes are also in the works, according to Bourie. She said alarm sounds will be changed to prevent desensitization. Instead of having an alarm sound when a battery is low, a visual cue will be used instead. Varying sounds will be used for alarms that signify a patient getting up from their bed or chair versus a drop in their blood-oxygen level.

Electrodes connecting the lead wires to a patient will now be changed daily to prevent loss of stickiness and leads-off alarms. All patient care technicians underwent a telemetry competency test to ensure they were aware of the daily electrode replacement and the proper place to affix lead wires. The medical center also switched to snap lead sets, which stay on a patient better, decreasing the number of leads-off alarms.

Changes to Provider Order Entry orders for telemetry, a review of alarm defaults and purchasing the latest in telemetry technology are all on the horizon as well. The latest advances in telemetry technology allow nurses to query alarms for a unit, display information in waveform and show if lead wires are connected.

"We do not want to overwhelm our nurses with information, but we do want to ensure we are providing the best and safest patient care," Bourie said.