E-Folio- Essential III

E-Folio- Essential III

Jennifer Burrier
Frostburg State University
Bachelors of Nursing Program

E-Folio- Essential III

E-Folio Essential III

Essential III focuses on using current evidence into practice.

It is expected that

baccalaureate nurses have an ability to monitor outcomes of patients and have the skill to
identify issues in the nursing practice (Essentials of Baccalaureate Education for Professional
Nursing Practice). NURS402 Nursing Research & Evidence-Based Practice teaches the nursing
student to understand how evidence is developed and to use this knowledge to make clinical
judgements (Essentials of Baccalaureate Education for Professional Nursing Practice).
NURS402 Nursing Research and Evidence-Based Practice prepares the student to evaluate how
credible sources of information are, advocate for humane research, understand the research
process, understand how healthcare quality and safety measures are created and endorsed, and to
understand theory, practice and research (Essentials of Baccalaureate Education for Professional
Nursing Practice).
Exemplar
The Final Research Paper from NURS402 Nursing Research & Evidence-Based Practice
was chosen for the Exemplar. The paper- Evaluating Alarm Fatigue with Nursing Staff in a
Hospital Setting demonstrates how research was done to disseminate what problems with alarms
are in a hospital setting and what methods can be utilized to decrease alarm fatigue with hospital
staff. The paper was pertinent because in workingl in a hospital setting with cardiac/vitals/IV
pumps/call lights and other alarms that frequently make noise and it can be disruptive to staff and
the patients. Research was done to see what methods can be done to decrease the alarms and to
prevent reduction of sensitivity to the alarms ringing.

E-Folio- Essential III

Reflection
This class expanded knowledge about how research in the nursing field is done. It assisted in
ability to read research documentation and to evaluate the methods that were used. In the
Nursing Sector, Evidence Based Practice is necessary to apply research to clinical settings.
Research in alarm fatigue was applicable to work in the hospital setting and has assisted in
applying knowledge in caring for patients. Using the information technology that improves
patient outcomes assists in advocating for ways to decrease alarm frequencies so there is an
improvement in the quality of patient care, which is one of the goals in The Essentials of
Baccalaureate for Professional Nursing Practice. Another goal that was completed was being
able to evaluate data from relevant sources to improve quality of care.

References:
American Association of Colleges of Nursing. (2008). The Essentials of Baccalaureate
Education for Professional Nursing Practice

E-Folio- Essential III

Evaluating Alarm Fatigue with Nursing Staff in a Hospital Setting

Jennifer Burrier
Frostburg University
Bachelor of Nursing Program

E-Folio- Essential III

Evaluating Alarm Fatigue with Nursing Staff in a Hospital Setting

Clinical Problem
In working in a hospital setting, alarms are necessary to alert staff to changes in a patients status.
Patients can have alarms for their pulse ox, telemetry, beds, IV pumps, in addition to other
equipment they might have. Staff also might carry equipment, such as phones and pagers and
work with many other types of equipment during a shift. Often there are false alarms that might
condition staff to decrease urgency when they might hear the same alarm occur. Also staff might
become desensitized to the noises since the alarms might be overwhelming at times. This can
decrease the time that staff might check on patients and place the patients in danger.
PICO
How can nurses decrease alarm fatigue when working with patients in the hospital that have
equipment that alarm to make nurses aware of changes in a patients status?
The P stands for patient/population, which is the nurses/health care staff in a hospital setting that
have medical equipment that alarm to alert staff of changes in a patient status. The I is for
intervention, which is improving alarm notifications so staff are not overwhelmed with constant
alarming of equipment. The C is comparison, what is the current system used and how can it be
changed to improve patient care. The O represents outcome, which is strategies that can be used
to decrease the frequency of alarms so alarm fatigue is minimized.

Search Strategy

E-Folio- Essential III

Articles were searched by using the Frostburg Library online search with the Maryland College
Library Network. Search was done by finding Nursing Journals and choosing them to be from
2004 to present. EBSCO host CINAHL Plus w/full text. Alarm Fatigue was typed in for the
subject.
Literature Review
There have been sentinel events recorded since 1974 blaming alarm malfunctions for patient
deaths (Funk, et al., 2014). Between 2005-2008 the FDA reported 566 deaths that can be
contributed to problems with alarms (Funk, et al., 2014). The ERCI institute (organization that
improves safety and quality of patient care) listed alarms as a top technology hazard in 2012
(Tanner, T., 2013). A hospital staff member can be exposed to almost 1000 alarms per shift and
as much as 90% of the alarms could be unanswered (Sincox, A.K., and Nault, D.S., 2014).
When a person is inundated with so many alarms, they become insensitive to the alarms and tune
them out. Many organizations, such as the FDA and The Joint Commission joined forces in 2011
for a summit to address medical alarms from a multidisciplinary perspective to see how they
could increase patient safety (Tanner, T., 2013). The Joint Commission has set initiatives by
creating a Sentinel Event in two phases, Phase 1 was started in January 2014 to created
guidelines for alarms on medical equipment and Phase 2 will begin in January of 2016 (Sincox
A. K., and Nault, D.S., 2014).
Since alarms are very necessary to help indicate distress in patients, there are many Evidence
Based Practices suggested to help decrease alarm frequency. Advances in technology have
created smart alarms which measure multiple parameters and help decrease false alarms
(Cvach, M., 2012). Hospitals should education staff from many disciples to do alarm risk
assessment, strategize ways to reduce alarms and create protocols for alarm settings and the

E-Folio- Essential III

responses to them (Cvach, M., 2012). Nurses should have training to set alarm parameters
specified to the individual patient so the alarms are meaningful (Graham, K.C., and Cvach, M.,
2010). Staff should have proper skin preparation for ECG leads and ensure they are on properly
to decrease false alarms (Cvach, M., 2012).

Practice Recommendations
1. Health care staff need to be educated on alarm fatigue. Alarm fatigue is due to alarm
desensitization and in 2012 was named the main medical device technology hazard by the ECRI
Institute. (Cvach, 2012). Staff, patients and families can hear up to 700 alarms per patient a day
and it is estimated that 80-99% of the alarms are insignificant (Cvach, 2012). Between 2005 and
2008 the FDA used a database called MAUDE (Manufacturer and User Facility Device
Experience) to attribute patient death from devices with monitoring alarms, they reported 566
deaths (Czach, 2012).
2. Many health organizations are implementing standards/procedures and setting goals to reduce
frequency of alarms and protecting patients so there are not sentinel events. Sentinel events due
to alarms have been reported since 1974 (Funk, et al, 2014). The Joint Commission has created
a Sentinel Event requiring hospitals to use guidelines for alarms on equipment (Sincox, A.K and
Nault, D.S., 2014). The Joint Commission has two phases of the Sentinel Event, Phase 1 started
in January 2014 and Phase 2 will be implemented in January 2016 (Sincox, A.K, and Nault, D.S.,
2014). The FDA, Association for the Advancement of Medical Instrumentation, the American
College of Clinical Engineering, the ECRI Institute, and the Joint Commission met in October
2011 for the Clinical Alarms Summit to join forces in addressing this problem (Funk, et al.,
2014).

E-Folio- Essential III

3. The Joint Commission and ACCN have specific nursing actions to prevent alarm malfunction.
Changing ECG electrodes daily and using good skin preparation techniques help reduce faulty
ECG reading/alarm warnings (Sincox, A.K., and Nault, D.S., 2014). Have alarms set properly,
tested regularly, and discourage users to turn off alarms completely (Tanner, T. 2013). Staff
should try to individual alarms to the patient by setting specific parameters (Graham, K.C., and
Cvach, M., 2010). New technology- alarm enhancement technology uses additional ways to
signal that monitors are alarming by directly paging or phoning staff (Cvach, M., 2012). Educate
staff on monitoring equipment and designate who has authorization to set alarm parameters
(Sincox, A.K., and Nault, D.S., 2014)
Conclusion
Although it may be a transition to change methods and incorporate new ideas from Evidence
Based Practices, it is a process and can take some time to develop the new procedures (Schmidt,
N.A., and Brown, J.M., 2012). Stakeholder involvement also helps identify what are the
changes, who is involved, assists with implementation with change and helps decreased
misunderstandings (Schmidt, N.A., and Brown, J.M., 2012), Communication is vital and it takes
flexibility, self-awareness, critical thinking and change agents to help facilitate changes in the
process (Schmidt, N.A., and Brown, J.M., 2012). Although additional research needs to be done
to help implement changes in alarm frequency, there are many noise reduction strategies than can
be done to decrease alarm fatigue and improve patient care.

Appendix A

E-Folio- Essential III

Individual Evidence Summary

#

Author

Year

Evidence
Type

Sample
Size

Results
Recommendation

Limitations

Strength/
Quality

Czach, Maria 2012

EBP,
Integrativ
e Review

Tanner,Tanya 2013

Non
Experime
ntal

Studies that were

reviewed were only in
English
Publications were only
from 1/1/200010/1/2011
Not able to see any in
article

4/A

Limit excessive false

alarms
Noise reduction
strategies
Need more research
on outcomes
Staff should verify
appropriate and
individualized alarm
settings are set
Limit excessive
alarms

Sincox, A.K
and Nault,
D.S

Independe
nt Study

Have less different

alarm sounds- too
many different types
create more
confusion
Try to ensure
equipment is secured
properly to decrease
alarms going off
frequently

Not able to see any in

article

3/B

Two
surveys

Decrease false
alarms

Only represents a small

fraction of clinicians in
the field

3/B

2005-2006
-1327
responses

Have hospitals pay

more attention to
patient safety issue

2014

Non
expermim
ental

Funk,
Marjorie, et
al

2014

Qualitativ
e, online
survey

2011
4278
responses

3/B

E-Folio- Essential III

Graham, K
and Cvach,
Maria

2010

Bell, L

2010

Experime
ntal

Study on
small unit
at hospital
staffed
with 30
nurses that
was the test
unit
Opinions/l
0
iterary
review

Reduce critical care

alarms by adjusting
defaults, parameters
and limits
Implement
interdisciplinary
monitor policy

Only represents small

fraction of clinicians in
the field, only one
hospital- limited in
equipment alarms

2/B

Decrease false
alarms, train staff
properly, review
alarm settings with
Biomedical
Engineering
Department

Not able to see in

article

5/B

Appendix B
Overall Evidence Summation
Level of
Evidence
I Czach, Maria
Level 3
EBP/Integrativ
e Review
Nonexperimental
and Quasiexperimental

Number of
Studies
Review of
72 articles
that used
research
and nonresearch
studies

Summary of Findings
More research is needed on ways to set monitor
levels/limits to decrease alarm frequency but to
allow alarms to function properly in alerting staff
of changes in patient status.
1. The research evidence had 5 themes
Excessive alarms/how staff were
effected
Staff responsiveness to alarms
Alarm sounds/volume levels
Technology that helps reduce false
alarms
Alarm notification systems
2. The non-research studies had two themes
Ways to reduce desensitization to
alarms
Prioritizing alarm
systems/notifications

Overall
Quality

E-Folio- Essential III

II Tanner,
Tanya
Level 3
Nonexperimental
III Sincox,
A.K. and
Nault, D.S.
Level 3
Nonexperimental

IV Funk,
Marjorie, et al
Level 3
Qualitative

V Graham, K.
and Cvach,
Maria
Level 2
Quasiexperimental

2 studies
using
survey
responses
in
healthcare
workers
1 study in
a medical
progressiv
e care unit
in a
hospital
setting

As many as 99% of alarms in a hospital unit are

false alarms. The alarms sound even if the patient
is not in any danger. Nurses need to be educated
on alarm fatigue, ways to prevent it and how it can
effect patient care
Informative article to make RNs aware of alarm
fatigue. Explains The Joint Commissions
requirements for hospitals to make guidelines for
alarms/equipment in 2 phases- phase 1 by 1/2014
and phase 2 by 1/2016
Also has ACCN and Joint Commission actions that
nurses can do to prevent alarms, such as prepping
patients skin for electrodes to stay on, suggests
setting alarms specific to each patient
Online survey conducted in two different time
periods (2005-2006 and 2011) on healthcare
workers attitudes/priorities to alarms in the work
setting. Not much had changed in the years
between the two surveys. False alarms continue to
occur and sentinel events can occur due to alarm
fatigue
Alarm frequency was reduced 43% in comparison
to baseline data. Alarms were decreased by
changing alarm defaults, customizing parameter
limits/levels on monitors and instilling an
interdisciplinary policy on monitors.

References
Bell, L. (2010). Monitor Alarm Fatigue. American Journal of Critical care, 19(1), 38-38.
Funk, M., Clark, T., Bauld, T., Ott, J., & Coss, P. (2014). Attitudes and Practices Related to
Clinical Alarms. American Journal of Critical care, 23(3), 9-18.
Graham, K., & Cvach, M. (2010). Monitor Alarm Fatigue: Standardizing Use of Physiological

E-Folio- Essential III

Monitors and Decreasing Nuisance Alarms. American Journal of Critical care, 19(1),
28-34.
Sincox, A. K., & Nault, D. (2014). Raising the Alarm. Michigan : Patient Care at Risk from Too
Many... Bells, Beeps & Buzzers, 25, 11-15.
Maria, C. (2012). Monitor Alarm Fatigue An Integrative Review. Biomedical Instrumentation &
Technology, 30, 268-277.
Tanner, T. (2013). The Problem of Alarm Fatigue. Nursing for Women's Health, 17(2), 153-157.
Schmidt, N.A., and Brown, J.M., (2012). Evidence-Based Practice for Nurses- Appraisal and
Application of Research. 2nd edition. Massachusetts. Jones and Bartlett Learning

APA formatting by BibMe.org.