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According to Sendelbach and Funk (2013), alarm fatigue can be defined as sensory over load that happens due to exposure to excessive number of alarms by clinicians and which can bring about alarm desensitization as well as missed alarms. A number of patient's cases of death have been reported in the past due to alarm fatigue (Sendelbach & Funk, 2013). This kind of fatigue and its results or consequences can be explained in terms of systems theory that involves inputs, throughput, output, event cycles and negative feedback.
Taking an example from the incident that happened at medical surgical unit of Washington Hospital Center where the majority of patients were hooked up to many pieces of equipment, a nurse adjusted the alarm setting to reflect the current condition of the patient after a heart rate monitor beeped without stopping. After a short time, another beep sounded. The electrode on the heart monitor of patient had slipped off (The Washington Post, n.d). The problem identified in this hospital unit is that alarms used to monitor have false default settings that amounts to alarm fatigue. This problem lies in the use of wrong input parameter settings for the alarm that results to transformation of input settings, resulting into negative feedback from the alarm that calls for the adjustment of input settings. The problem seems to be recurring and hence leading to a continuous cycle of events that involves repeated input adjustments and negative feedbacks.
In the context of systems theory, adjustment of setting was an input to the alarm in the form of professional know how characteristic of the nurse that was expected to produce good result. Therefore the adjustment setting was an introduction of fresh energy from the external environment with an aim of renewing the outcome of the alarm system. The adjustment becomes throughput to the alarm system due to transformation or processing of setting adjustment as an input (Meyer & O'BrienPallas, 2010). An example of setting adjustment that acts as an input is the change of parameter such as PVCs/minute from its default setting of 10bpm to 6bpm (Sowan et al., 2016). The output or the result of adjustment setting for the alarm was the safety of clinical outcome which is the reflection of the patient's current condition. The beeping alarm sound was the signal of negative feedback, alerting the nurse that the alarm setting did not reflect the patient's condition. In case the adjustment setting is made and the alarm keeps on beeping again, the nurse will know that the setting made to the alarm has not yet meet the standard and the negative feedback from the alarm will be used to correct or adjust the input settings and the cycle of events continues until the output of safety clinical outcome is achieved for the patient. The nurse and care recipient are also part of inputs to the subsystem of medical surgical unit. The safety clinical outcome achieved was thus an output from this subsystem.
In formulating the desired outcome, I will make sure that I aim at reducing alarm fatigue in the hospital unit by making accurate settings for the input parameters of the alarm. I will then use the negative feedback of the alarm to adjust the input settings in a cycle of events until I am able to detect the expected output in the form of safety clinical outcome. The goals that should facilitate this outcome include provision of quality healthcare services to patients. Another goal is to enhance patient's satisfaction with the services in the medical surgical unit of the hospital center. The objectives that would facilitate the outcome include making accurate default settings of the alarms used within the hospital unit, ensuring that the output from the alarm reflects the present condition of patient and to make sure that any negative feedback from the alarm is used appropriately as a corrective measure to adjust the input parameter of the alarm. The next objective is to ensure that the hospital provides required professional training to nurses on how to effectively use alarms to care for inpatients at the medical surgical unit of the hospital.
The above mentioned goals and objectives can be translated into a number of policies and procedures. The first policy is that every patient in the hospital unit is entitled to the right standard of healthcare he/she deserves. The second policy is that patients who feel unsatisfied with the healthcare services they receive have the right to file a complaint before the date of their discharge. The third policy is that nurses must ensure that the alarm used to monitor patients meeting the standard default setting for the cardiac monitors. The next policy is that no other employee in the hospital apart from nurses should pass through the patient's room when the alarm sounds. Nurses should also ensure that they have the right professional training standards and competency required to use alarms in monitoring patients at the medical surgical unit.
The relevant professional standards that the respective nurses will require include skills for the management of clinical alarm systems which are directly associated with patients. Another professional standard is the practice standards for electrocardiographic monitoring in the hospital environment. The next relevant standard is that hospitals must offer training concerning management of alarm system to all staff who are to be affected by their use. Other professional standards include skills in patient care technology and safety as well as clinical alarms and impacts on patient's safety.
Solving the problem of alarm fatigue will ensure that medical members team of the hospital delivers exceptional first healthcare to patients in terms of quality and excellence which is part of the mission for the hospital. In terms of hospital values, the hospital will be able to put patients first by striving to deliver their very best to patients. They will also be able to focus on service to patients by anticipating and meeting patient needs. Solving the problem will also show the aspect of integrity which is part of the hospital values whereby nurses will serve the patients according to the highest standards of ethics required of them.
Meyer, R. M., & O'BrienPallas, L. L. (2010). Nursing services delivery theory: an open system approach. Journal of Advanced Nursing, 66(12), 2828-2838.
Sendelbach, S., & Funk, M. (2013). Alarm Fatigue A Patient Safety Concern. AACN advanced critical care, 24(4), 378-386.
Sowan, A. K., Gomez, T. M., Tarriela, A. F., Reed, C. C., & Paper, B. M. (2016). Changes in default alarm settings and standard in-service are insufficient to improve alarm fatigue in an intensive care unit: A pilot project. JMIR human factors, 3(1).
Washington post.(nd).Too much noise from hospital alarms poses risk for patients. Retrieved from http://www.washingtonpost.com/sf/feature/wp/2013/07/07/too-much-noise-from-hospital-alarms-poses-risk-for-patients/?utm_term=.0ac971777c5a
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