Alarm Fatigue and Other Challenges in Telemetry Nursing
Experts discuss trends and best practices in progressive care
Telemetry nursing, as with other specialties, presents a range of challenges for nurses aiming to provide the best care possible to their patients. Telemetry nurses work on step-down and progressive care units, monitoring patients who no longer need intensive care.
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Designed to alert nurses to a potentially dangerous situation, alarms have become a safety concern, as alarm fatigue sets in. Telemetry nurses hear the beeping of alarms so often, they begin to tune the sound out.
“The alarms go off all of the time to the point we start to assimilate that noise into our work flow,” explained Michele M. Pelter, RN, PhD, assistant professor at the University of California, San Francisco School of Nursing.
Too many false and/or nonactionable alarms result in clinician distraction and the possibility that an alarm may be ignored or missed; it’s the “cry wolf” phenomenon, added Maria Cvach DNP, RN, FAAN, Johns Hopkins Health System in Baltimore, speaking on behalf of the American Association of Critical-Care Nurses (AACN).
“Too many false/nonactionable alarms create the opposite effect,” Cvach explained.
Dealing with alarms
Cardiac monitors are highly sensitive so as not to miss a true event. High sensitivity results in many false and/or nonactionable alarms, said Cvach, who recommended using features that will decrease nuisance alarms, such as use of pediatric age profiles, delay features and reasonable signal average times, and allowing nurses to customize alarms for individual patients.
Pelter cautioned changing parameters should be a team decision, and nurses should never turn down or off an alarm. Good skin prep and electrode placement can cut down on some false alarms.
Sue Sendelbach, PhD, APRN CNS, FAHA, FAAN, at Abbott Northwestern Hospital in Minneapolis and an AACN member, suggested more research is needed, but nurses should use existing evidence, such as making premature ventricular contractions nonactionable. She also expressed a need for smart alarms, which could use several sources of data, such as an ECG and arterial line blood pressure, before sounding.
“[We need] continued discussions between clinicians, industry and regulatory bodies both in the development of new devices and alarms as well as current devices and alarms,” Sendelbach said.
On the alert for complications
Progressive care patients are moderately stable with a high risk of instability, said JoAnne Konick-McMahan, MSN, RN, PCCN, certification practice specialist, AACN Certification Corp. and a staff nurse on the intermediate care unit at Pinnacle Health System in Harrisburg, Penn. Nurses have to remain alert to subtle changes in every patient’s condition that might forewarn of a potentially serious change.
“Nurses in progressive care often care for patients with acute care needs, such as pneumonia and delirium, who also have multiple co-morbidities, mental health issues or chronic critical illnesses; so despite not being in a critical-care unit per se, these patients are often quite complex in their care need,” Konick-McMahan said.
Caring for sicker patients
Patients who may have received nursing care in critical-care units five years ago are often now cared for in telemetry or progressive care areas, Konick-McMahan said. Examples would be patients with diabetic ketoacidosis and patients with ventricular-assist devices.
“The length of stay for patients in progressive care units is much shorter than in critical care, so patient and family education starts on the first day of hospital stay, Konick-McMahan added. “Assuring that staff [nurses] have the knowledge base and time-management skills to provide the best care for patients such as these can be an ongoing challenge.”
The outlook for telemetry nursing jobs
The job outlook for progressive care nurses is good, Konick-McMahan reported.
“Health care systems are increasing the number of progressive care and telemetry beds to meet the nursing-care needs of patients with multiple chronic illnesses who are acutely ill,” she said.
In addition, many progressive-care level patients are now being cared for in other settings, such as long-term acute care hospitals, so the need for skilled and knowledgeable nurses is high, Konick-McMahan said.
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