Proper Skin Preparation and Electrode Placement Decreases Alarms on a Telemetry Unit

Walsh-Irwin, Colleen; Jurgens, Corrine Y.

doi:10.1097/dcc.0000000000000108

Cited by 12 publications

(7 citation statements)

References 37 publications

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“…Our results also showed that nurses do not follow the unit protocol (ie, every 24 hours and if needed) when changing leads; enforcement of this policy should take place [ 11 ]. In a telemetry unit, proper skin preparation and electrode placement resulted in a significant reduction of ECG alarms [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Changes in Default Alarm Settings and Standard In-Service are Insufficient to Improve Alarm Fatigue in an Intensive Care Unit: A Pilot Project

et al. 2016

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BackgroundClinical alarm systems safety is a national concern, specifically in intensive care units (ICUs) where alarm rates are known to be the highest. Interventional projects that examined the effect of changing default alarm settings on overall alarm rate and on clinicians’ attitudes and practices toward clinical alarms and alarm fatigue are scarce.ObjectiveTo examine if (1) a change in default alarm settings of the cardiac monitors and (2) in-service nursing education on cardiac monitor use in an ICU would result in reducing alarm rate and in improving nurses’ attitudes and practices toward clinical alarms.MethodsThis quality improvement project took place in a 20-bed transplant/cardiac ICU with a total of 39 nurses. We implemented a unit-wide change of default alarm settings involving 17 parameters of the cardiac monitors. All nurses received an in-service education on monitor use. Alarm data were collected from the audit log of the cardiac monitors 10 weeks before and 10 weeks after the change in monitors’ parameters. Nurses’ attitudes and practices toward clinical alarms were measured using the Healthcare Technology Foundation National Clinical Alarms Survey, pre- and postintervention.ResultsAlarm rate was 87.86 alarms/patient day (a total of 64,500 alarms) at the preintervention period compared to 59.18 alarms/patient day (49,319 alarms) postintervention (P=.01). At baseline, Arterial Blood Pressure (ABP), Pair Premature Ventricular Contractions (PVCs), and Peripheral Capillary Oxygen Saturation (SpO2) alarms were the highest. ABP and SpO2 alarms remained among the top three at the postproject period. Out of the 39 ICU nurses, 24 (62%) provided complete pre- and postproject survey questionnaires. Compared to the preintervention survey, no remarkable changes in the postproject period were reported in nurses’ attitudes. Themes in the narrative data were related to poor usability of cardiac monitors and the frequent alarms. The data showed great variation among nurses in terms of changing alarm parameters and frequency of replacing patients' electrodes. Despite the in-service, 50% (12/24) of the nurses specified their need for more training on cardiac monitors in the postproject period.ConclusionsChanging default alarm settings and standard in-service education on cardiac monitor use are insufficient to improve alarm systems safety. Alarm management in ICUs is very complex, involving alarm management practices by clinicians, availability of unit policies and procedures, unit layout, complexity and usability of monitoring devices, and adequacy of training on system use. The complexity of the newer monitoring systems requires urgent usability testing and multidimensional interventions to improve alarm systems safety and to attain the Joint Commission National Patient Safety Goal on alarm systems safety in critical care units.

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Section: Discussionmentioning

confidence: 99%

Changes in Default Alarm Settings and Standard In-Service are Insufficient to Improve Alarm Fatigue in an Intensive Care Unit: A Pilot Project

et al. 2016

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“…Care alerts are tailored and programmed at implant by the implanting physician, allowing for more appropriate patient alert management and decrease potential ''alert fatigue,'' which may affect workflow efficiency and patient safety. 11 The initial LINQt ILR patient cohort (20%) was added to our regular ''virtual'' clinic device group, under ''ILR Patients.'' Incoming daily wireless data resulted in data avalanche and RM management challenges, necessitating a strategy for categorizing specific diagnoses alerts to streamline data and provide appropriate clinical follow-up care.…”

Section: Patientmentioning

confidence: 99%

Wireless LINQ™ Loop Recorders’ Premature Battery Depletion Status: One Clinic Experience

Ferrara¹

2016

JICRM

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Daily wireless transmissions from implantable loop recorders (ILRs) have become part of the arsenal in the field of arrhythmia surveillance and detection. Daily alerts from these devices allow for prompt medical patient management. Any device malfunction potentially affects clinical management. This case presentation highlights a device alert for premature battery depletion in LINQt loop recorders (Medtronic Inc., Minneapolis, MN).

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“…In numerous inpatient settings, implementing daily skin care and changes in electrode pads have resulted in a reduction in total nuisance alarms. [16][17][18][19][20] In the presence of excessive nonactionable cardiac monitoring alarms, something as basic as ensuring proper anatomic electrode placement can also make an impact. Even in a small study, a significant reduction in nuisance alarms could be demonstrated within the first 24 hours after initiation of a new protocol for electrode placement, which included evidence-based skin preparation prior to daily electrode changes.…”

mentioning

confidence: 99%

“…Even in a small study, a significant reduction in nuisance alarms could be demonstrated within the first 24 hours after initiation of a new protocol for electrode placement, which included evidence-based skin preparation prior to daily electrode changes. 19 Daily telemetry electrode change was one of the effective interventions introduced as part of a 2-year alarm management quality improvement (QI) project at a 580-bed hospital. 18 Strategies to address the issue of clinical alarm fatigue vary in scope.…”

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confidence: 99%

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Reducing Cardiac Telemetry Nuisance Alarms Through Evidence-Based Interventions

Karapas

Bobay

2021

Journal of Nursing Care Quality

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Background: Cardiac telemetry nuisance alarms due to leads off and poor signal increase staff workflow interruptions, decrease staff trust in technology, and can compromise patient safety. Local Problem: Interventions were directed at reducing nuisance alarms on a 32-bed, non–intensive care - a cardiac telemetry unit. Methods: A nursing staff education module with evidence-based practices for reducing nuisance alarms, a daily care protocol for patients on cardiac telemetry monitoring, and daily audits of protocol adherence were implemented. Results: Staff pre- and posttest comparisons on their knowledge relating to nuisance alarms and the evidence-based protocol demonstrated a significant mean increase of 3.02 (95% CI, 2.55-3.48). Daily audits for 7 weeks demonstrated an average of 58.46% staff adherence. Telemetry technician call volume reduction was 16% postimplementation, while nuisance alarms were not reduced significantly. Conclusions: This rapid-cycle, quality improvement process resulted in minimal reduction in nuisance alarms but improved staff awareness of the issue and reduced workflow interruptions.

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Proper Skin Preparation and Electrode Placement Decreases Alarms on a Telemetry Unit

Abstract: Proper skin preparation and ECG electrode placement reduced alarms. Reducing alarm frequency is vital to decreasing alarm fatigue and increasing patient safety.

Cited by 12 publications

References 37 publications

Changes in Default Alarm Settings and Standard In-Service are Insufficient to Improve Alarm Fatigue in an Intensive Care Unit: A Pilot Project

Changes in Default Alarm Settings and Standard In-Service are Insufficient to Improve Alarm Fatigue in an Intensive Care Unit: A Pilot Project

Wireless LINQ™ Loop Recorders’ Premature Battery Depletion Status: One Clinic Experience

Reducing Cardiac Telemetry Nuisance Alarms Through Evidence-Based Interventions

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