Research: Use of Monitor Watchers in Hospitals: Characteristics, Training, and Practices

Abstract

Monitor watchers, or personnel whose job it is to watch the central cardiac monitor and alert clinicians of patient events, are used in many hospitals. Monitor watchers may be used to improve timely response to alarms and combat the effects of alarm fatigue. However, little research has been done on the use of monitor watchers, and their practices have not been well described. Therefore, the purpose of our study was to examine the use of monitor watchers and their characteristics, training, and practices. Participants were recruited to complete an online survey on monitor watcher practice via two professional nursing organizations. A total of 413 responded to the survey, including 411 nurses and two non-nurse professionals, and 61% reported that their hospital used monitor watchers. Of these, 60% indicated that their hospitals have been using monitor watchers for more than 10 years, and 62% said that the monitor watchers were located remotely from the patient care unit. Many (68%) reported that monitor watchers worked 12-hour shifts, and a majority said that monitor watchers were required to have a certificate in electrocardiographic monitoring (67%) and be high school graduates (64%). Most (70%) respondents reported that monitor watchers alerted the nurse of an event via a mobile phone carried by the nurse. The results of this survey revealed that monitor watcher practices varied widely. Further research is needed to determine if the use of monitor watchers has an impact on patient outcomes.

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

“…Despite the lack of studies to support the benefit of human monitor surveillance, national surveys revealed that this alarm notification strategy is used in 47% to 61% of hospitals. 432 Monitor watchers may be based on the unit, in a nearby ICU, or in a central remote loca tion where monitors are watched from multiple patient care units. Methods to communicate from a centralized telemetry monitoring area to a bedside caregiver have been studied.…”

“…The minimum educational preparation of moni tor watchers, the content and length of orientation, and the frequency of ongoing education and compe tency evaluations vary widely. 432 An MDDS, also known as middleware, can integrate multiple alarms from various medical devices such as monitors, patient call systems, ventilators, and infusion pumps. An MDDS uses alarm escalation rules that al low closedloop communication.…”

Monitor Watchers and Alarm Fatigue: Cautious Optimism

“…Although effectiveness of monitor watchers on patient outcomes has not been demonstrated conclusively, 1 as many as 60% of United States hospitals may be using monitor watchers in some capacity. 2 Presumed benefits of monitor watchers include prompt recognition of changes in patients' conditions and the potential to reduce alarm fatigue among hospital staff. Alarm fatigue is desensitization resulting from overexposure to alarm signals that are either invalid or clinically irrelevant.…”

“…In free-text responses to our national monitor watcher survey, nurses expressed frustration over redundant calls from monitor watchers for invalid and irrelevant alarms. 2 Research suggests that monitor watchers may not identify potentially dangerous alarms with complete accuracy. In a recent study reported in The Journal of the American Medical Society (JAMA), monitor watchers missed about 18% of patients with detectable rhythm or rate changes on telemetry in the hour before an emergency response team was activated.…”

“…The content and frequency of in-service training required also varies. 2 These differing requirements may influence monitor watchers' ability to interpret alarms.…”