NR 439 Week 2 Discussion

Name

Chamberlain University

NR-439: RN Evidence-Based Practice

Prof. Name

Date

Week 2 Discussion Topic NR 439

Significant Nursing Clinical Issue

In my role on a telemetry step-down unit, I have observed a significant clinical challenge related to the multitude of alarms that sound throughout a typical workday. These alarms originate from various sources, including ventilators that may malfunction or become disconnected, call lights, bed alarms, and our recently implemented Avasys video monitors that monitor patients at high risk for falls. Additionally, alarms from IV pumps and the cardiac monitoring system contribute to a cacophony of sounds. The frequent activation of these alarms increases the risk of desensitization among nursing staff, potentially leading to delayed responses to critical alerts, which can adversely affect patient safety. To address this issue, our facility has trained specific team members to serve as monitor technicians dedicated to the continuous observation of patients’ cardiac rhythms.

According to Houser (2018), “Of primary importance to the selection of an approach is the nature of the research question” (p. 37). In developing my PICO(T) formatted clinical question, I have formulated the following inquiry:

PICO(T) Question:

In the context of a telemetry unit with ongoing cardiac monitoring, how can we minimize non-actionable alarms and prevent unnecessary interventions for cardiac monitoring?

Literature Review

In reviewing the literature, I encountered an article by Mary Jahrsdoerfer titled “Case Study: Reducing Interruption Fatigue through Improved Alarm Support.” This article discusses a study conducted on various hospital floors where modifications were made to the telemetry systems. These adjustments were tailored to meet the specific clinical needs of individual patients. Furthermore, the study emphasized the importance of changing cardiac leads daily, accompanied by appropriate skin preparation, to prevent artifacts that could trigger superfluous alarms. The researchers implemented alarm settings focused on life-threatening arrhythmias, including asystole, ventricular tachycardia, ventricular fibrillation, extreme tachycardia, extreme bradycardia, apnea, and oxygen desaturation (Jahrsdoerfer, 2016, p. 111). The results indicated a notable reduction in alarm frequency, achieving a decrease of up to 25% by customizing alarm settings for each patient. This quasi-experimental study encompassed an analysis of an ICU unit, a progressive care unit, and two telemetry units, totaling 52 beds.