Alarm management on an inpatient surgical unit

Abstract

Alarm fatigue is a rapidly growing problem in hospitals across the nation, contributing to missed care opportunities and patient safety events. The purpose of the improvement project was to refine the use of audible alarms on an inpatient surgical unit by decreasing the frequency of false and non-actionable alarms, in turn decreasing clinician alarm fatigue and, ultimately, improving patient safety. The biggest culprit of false alarms we found on this type of unit that is of particular concern is the pulse oximetry alarm. Evidence from the literature indicated that capnography was superior to pulse oximetry in the detection of respiratory depression. Although capnography monitoring equipment was available, the current policy on monitoring patients post-operatively at the community hospital in Montana required the use of pulse oximetry and did not include the use of capnography. After determining that there was a gap in practice, an evidence-based practice project was implemented to include the use of capnography for monitoring patients post-operatively. By ensuring that audible alarms are specific to the patient condition, decreasing the frequency of false and non-actionable alarms, alarm fatigue should be lessened. Two policies were put in place that included the use of capnography, one directed at the monitoring of patients using patient-controlled analgesia and one directed at the monitoring of all high-risk patients receiving opioid analgesia. Education of staff regarding the practice change was multi-faceted and included both in-person and online education of the policy changes and both the cognitive and psychomotor aspects on the use of capnography. Additionally, competency validation was assessed in both the cognitive and psychomotor domains. Full assessment of the results of the practice change will take place in 2017.