This article discusses the intervention of CEASE in an ICU/SDU to help decrease alarm fatigue and increase patient safety and satisfaction. This study looked at a 36 bed ICU/SDU in an urban magnet-designated hospital in the western region of the United States. The purpose of this study was to describe the effect of implementing CEASE, a nurse-driven, evidence-based, patient-customized monitoring bundle on alarm fatigue. CEASE is an acronym for Communication, Electrodes (daily changes), Appropriateness (evaluation), Setup alarm parameters (patient customization), and Education (ongoing). This study was designed with these three research questions in mind: (1) In a 36-bed intensive care unit/step-down unit (ICU/SDU) with continuous hemodynamic and respiratory monitoring, does application of an evidence-based, patient-customized monitoring bundle compared with existing monitoring practice lead to less alarm fatigue as measured by the number of hemodynamic and respiratory monitoring alarms? (2) In a 36-bed ICU/SDU with continuous hemodynamic and respiratory monitoring, does the application of an evidence-based, patient-customized monitoring bundle compared with existing monitoring practice leads to less alarm fatigue as measured by the duration of alarms? and (3) In a 36-bed ICU/SDU with continuous hemodynamic and respiratory monitoring, does the application of an evidence-based, patient-customized monitoring bundle compared with existing monitoring practice lead to less alarm fatigue as measured by nurse perception? The time frame for this study was six months with data being loaded onto an excel sheet every thirty days. The pre-interventional data was collected two months before the study and the post-interventional data was two months after the intervention.
Lewis, Carmencita Lorenzo BSN, RN, CCRN; Oster, Cynthia A. Ph.D., RN, APRN, MBA, ACNS-BC, ANP, FAAN Research Outcomes of Implementing CEASE, Dimensions of Critical Care Nursing: 5/6 2019 – Volume 38 – Issue 3 – p 160-173 DOI: 10.1097/DCC.0000000000000357
Hi, I found the concept of alarm fatigue to be interesting. I don’t work in an area where there are many alarms but I have the opportunity to float to NICU and often go home with a headache from the many alarms. I can imagine that multiple alarms do not aide in the healing of patients. I read a study on preventing alarm fatigue and “As many as 76% of physiological monitor alarms are overlooked as clinically insignificant by nursing staff.”(Clemens,Lewis,Wilson & Beene, 2019). “Reduction strategies may decrease nurses’ stress levels related to cognitive workloads and improve patient outcomes preventing alarm fatigue.”(Clemens,Lewis,Wilson & Beene, 2019). What a scary problem alarm fatigue is in interfering with patient safety. A stressed nursing staff can not possibly give adequate patient care in conditions of excessive alarms. Thank you for sharing this topic. The need for evidence based customized monitoring bundles to be implemented in critical care areas as your article states can reduce alarm fatigue and increase patient safety.
Clemens, A., Lewis, Deborah, Wilson, Marisa, & Beene, Murielle. (2019). Effectiveness of Physiological Alarm Management Strategies to Prevent Alarm Fatigue. ProQuest Dissertations Publishing.
Thank you, Karen, yes alarm fatigue is very real. When you have more than one patient you are monitoring it can become difficult trying to find the alarm sounding and address the needs. I can’t tell you how many times I have woken up in the night thinking I was hearing alarms. Sometimes the alarms go off for very minimal issues not related to patient care. If you have an infusion pump that alarms when someone just slightly moves their arm even when there is no occlusion present it can cause the nurse to become complacent and she could miss something very important thinking it was just this type of minimal issue.
Hi Andrea, I enjoyed reading your Journal Club article post. Unfortunately, I was unable to access your Journal club critique form, but I was able to find the article online. I chose your Journal Club Article post to reply to because I believe that alarm fatigue is a very real, very serious threat to patient safety. I work in a long term care facility and so we hear call lights all day long, constantly. I realize that the amount of alarms we hear at my facility likely pales in comparison to the amount of alarms and ICU nurse hears daily. However, the implications are the same. Patient safety is compromised by alarm fatigue. Ideally, an alarm should be acknowledged and addressed immediately but in reality, sometimes that just isn’t possible. I can see this as a source of moral distress for nurses. There is nothing worse than knowing your patient needs your help and not being able to help them! One study done in a long-term acute care hospital showed that many staff found some alarms not helpful because of the increased incidence of false alarms (Baker & Rodger, 2020). It is frustrating for staff and patients both to hear to the constant sound of alarms. Perhaps as advancements in technology are made, a new more efficient method will be developed for a better alarm system. Thanks for sharing!
References
Baker, K., & Rodger, J. (2020). Assessing causes of alarm fatigue in long-term acute care and its impact on identifying clinical changes in patient conditions. Informatics in Medicine Unlocked, 18. doi:10.1016/j.imu.2020.100300
Thank you, Amy. I’m sorry you couldn’t see my critique, I’m not sure what happened there it was opening when I posted it. Gotta love technology. I agree alarm fatigue is a very real issue. It can cause many patient safety issues in that nurses can become complacent with sensitive alarms and could miss something that could be detrimental to the patient. There are many times alarms go off and it may have gone off several times in the shift, every time you have gone in it has been something like the patient has just moved their arm and it bumped the catheter to where it alarmed for occlusion. It has been checked and flushed and verified that there is no occlusion. The nurse may start to ignore the alarm missing a critical need for the patient.
I enjoyed reading your post! Working in the ER, I can see how alarm fatigue effects nurses, especially nurses sitting at monitors all day. However, I did not realize how detrimental to patients is actually was until further research. “72% to 99% of clinical alarms are false. When clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarms and missed alarms” (Sendelbach & Funk, 2013). Looking at how many times alarms go off in the ER that are false, it made me open my eyes to how we as nurses can easily brush off the alarms.
Sendelbach, S., & Funk, M. (2013). Alarm Fatigue. AACN Advanced Critical Care, 24(4), 378-386. doi:10.1097/nci.0b013e3182a903f9
It is really easy to brush alarms, especially when it seems like every patient’s alarm has sounded that day and there has been nothing wrong with them. Sometimes you hear them so much that you start being able to ignore them and this as you have learned can have serious consequences to the patient.