Download Change ECG electrodes daily. (Level E) Customize alarm

Alarm
Management
IMPLEMENTING
EVIDENCE BASED
PRACTICE TO
REDUCE THE
FREQUENCY OF
PHYSIOLOGICAL
ALARMS
Julie Zimmerman, RN, MS, CCRN, CNS
Albert Lobato, Telemetry Technician
Mark Miller, RN, USD CNS Graduate Student
The Joint Commission
2014 National Patient Safety Goal 6
REDUCE THE HARM ASSOCIATED WITH CLINICAL ALARM SYSTEMS
Clinical alarm systems are intended to alert caregivers of potential patient
problems, but if they are not properly managed, they can compromise patient
safety.
CONCERNS:
▪ Numerous Alarms & Alarm devices
▪ Increased exposure to alarms
▪ Staff desensitization
▪ Delayed responses & missed alarm signals
▪ Improper modification/disabling of alarms
▪ Non-Actionable alarm settings/limits
Alarms – The Problem
Palomar Health Medical Device Alarm Safety Committee, 2013.
American Association of Critical Care Nurses Alarm
Management Recommendations
Expected Practice
Provide proper skin preparation for ECG electrodes. (Level B)
Change ECG electrodes daily. (Level E)
Customize alarm parameters and levels on ECG monitors. (Level E)
Customize delay and threshold settings on oxygen saturation via pulse
oximetry (SpO2) monitors. (Level E)
▪ Provide initial and ongoing education about devices with alarms. (Level E)
▪ Establish interprofessional teams to address issues related to alarms, such
as the development of policies and procedures. (Level E)
▪ Monitor only those patients with clinical indications for monitoring. (Level C)
▪
▪
▪
▪
AACN Best Practice Alert, May 2013.
HOW ARE WE DOING? ALARM FREQUENCY
Data collection on 10 patients admitted for at least 24 hours on:
2 East, 10 East CCU, and TICU
800
700
600
500
400
300
200
100
0
500
450
400
LOW
350
ALERT
300
YELLOW 250
HIGH
200
ALERT
150
RED
100
TOTAL IN 50
24HRS
0
2 East
10 East
CCU
TICU
HOW ARE WE DOING? CURRENT ECG PRACTICE
Staff Survey Results from 2 East, 10 East CCU, and TICU
2 EAST PILOT
PRACTICE CHANGES & NURSING ACTIONS
▪
▪
▪
▪
▪
Provide proper skin preparation for ECG electrodes.
Properly apply and replace ECG electrodes daily.
Individualize alarm parameters
Ensure patient/patient family alarm education
Promote Alarm Safety- Audibility, Practices, Communication
&
Palomar Health Medical Device Alarm Safety Committee, 2013.
Proper Skin Preparation
▪ Clip excess hair at ECG electrode sites
▪ Wash the isolated electrode area with
soap and water.
▪ Use a rough washcloth or gauze to
roughen a small area of the skin.
▪ Ensure electrode sites have properly
dried.
▪ Do not use alcohol for skin preparation.
Palomar Health Medical Device Alarm Safety Committee, 2013.
IMPROVED
CONDUCTIVITY
1. Remove part of the
stratum corneum to
allow for electrical
signals to travel to the
electrode.
2. Scratch the stratum
granulosum to reduce
motion artifact.
FIVE-LEAD SYSTEM
Correct 5 – Lead ECG Electrode Placement
RA – white electrode – Place where
the Right arm joins the torso. (below R
clavicle, 2nd ICS, R MCL)
RL – green electrode – At the level of
the lowest rib. (R lower ribcage, 8th
ICS, R MCL)
V1
LA – black electrode – Place where
the Left arm joins the torso. (below L
clavicle, 2nd ICS, L MCL)
V3
LL – red electrode –At the level of the
lowest rib. (L lower ribcage, 8th ICS, L
MCL)
V or Chest – brown electrode –
placed in V1 (4th ICS, R SB) or V3
position (midway btwn 4th &5th ICS)
R= right, L= left, ICS = intercostal space,
MCL – midclavicular line,
SB= sternal border
Correct ECG Electrode Placement
5 Lead ECG
Site Selection:
▪ Avoid bony prominences
▪ Avoid fatty areas
▪ Avoid major muscles
Palomar Health Medical Device Alarm Safety Committee, 2013.
BEFORE AND AFTER:
Proper ECG prep & placement
Palomar Health Medical Device Alarm Safety Committee, 2013.
Individualize Alarm Parameters
o Personalize alarms to meet the needs of individual patients.
o Consider patient’s medical condition, status changes, and
activity levels.
o Adjust alarms within 1 hour of assuming care.
▪ Individualization of physiological alarm parameters, conducted
on a PCU/IMU resulted in a 43% reduction in critical monitor
alarms. Additionally, clinical evidence demonstrates
personalizing patient alarms reduces the number of false
alarms.
MCP 572.1 Management of Clinical Alarms in Patient Care Settings
UCSD Medical Center Practice Guidelines for Assessment and Reassessment, Clinical
Alarms
Promote Alarm Safety:
AUDIBILITY
o Confirm ALL clinical alarms are audible from outside
patient rooms.
***EVEN when patient doors are closed***
PRACTICES
Disconnecting patients from physiological monitors:
o Constitutes a change in a patient’s level of ordered care
o Can only occur with a required physician/provider order OR,
o Only when essential for direct patient care or safety.
o Is performed solely by qualified healthcare personnel.
o Must NOT be performed by patients/patient family members.
Promote Alarm Safety:
COMMUNICATION
Conduct proper communication with the telemetry technicians.
o Guidance on when to call/notify telemetry technicians:
1)
2)
3)
4)
5)
6)
When disconnecting patients from the physiological monitors.
Before administration of intravenous cardiac medications/drips.
Prior to patient transportation/transfer off of a unit.
Upon returning to the unit.
Preceding pacemaker interrogation.
Prior to admission or discharge.
Tedx Alarm Video
Click on the link above to the Tedx Alarm Video.
This may illicit an emotional response.
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