Fighting Alarm Fatigue for Nurses in 5 Steps

Healthcare, We Have a Problem:

Alarm fatigue is a serious threat to patient safety.

The American Association of Critical-Care Nurses (AACN) defines alarm fatigue as a sensory overload that occurs when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarm sounds and an increased rate of missed alarms. False alarms are a strong contributor, making up 72-99% of all alarms and numbing care teams to signals meant to indicate patient danger.1

Essentially, devices and processes that were designed to protect and support patients in specific ways have compiled over time to create a cacophony of ever-sounding silos in healthcare. Sadly, the discord cannot be safely silenced. Fortunately, it can be well-orchestrated.

Let’s explore how integrating disparate, noisy alert and alarm systems can help fight alarm fatigue for nurses and care teams.

Where is all the noise coming from?

In short, disconnected legacy systems with outdated hardware and devices combine with overlapping, suboptimal workflows to create the noise fueling alarm fatigue. A few factors that add to the chaos and make it difficult for clinicians to determine the relevance and urgency of alarms include:

  • Nurse Call Systems: Patients sometimes use nurse call for non-clinical requests, such as a glass of water, which could be redirected to another team member.
  • Critical Lab Results: Upon notification, nurses in some settings are responsible for tracking down the appropriate physician to relay critical results, pulling the nurse away from the bedside.
  • Patient Monitoring Devices: It can be difficult to infer the risk level and urgency of various patient device alarms, and to know if other team members are responding or can respond more quickly.

Above are just a few of many systems that can trigger nondescript beeping sounds, which all begin to sound alike and blur together. The result? Just to find out where an alarm is coming from and what it indicates, a nurse has to leave the current task to investigate.

The nurse is forced to assign priority (current task versus potential patient threat) based on assumption in an environment where up to 99% of alarms are false, yet assuming an alarm is false puts a patient at risk. Constant decisions like these in a fast-paced, high-stakes environment contribute to mistakes, alarm fatigue, clinician burnout, patient risk, and many other potential consequences.

5 Steps to Fight Alarm Fatigue:

1. Integrate all alerts and alarms to reduce noise.

To start, put all alerts and alarms in one place that nurses and care teams can check on the go—an integrated app accessible from any device across all locations.

2. Increase mobility to decrease footwork.

For organizations that haven’t already deployed a mobile device strategy for nurses, smartphones will greatly enhance the effectiveness of an integrated solution. Being able to check alerts at the bedside and on the move reduces extra footwork and detours for staff.

3. Use shift schedules to inform smart routing.

The ideal solution should also integrate with shift and on-call schedules across the organization, using schedules to route alerts and alarms directly to the right clinicians. Smart routing like PerfectServe’s Dynamic Intelligent Routing reduces irrelevant noise while using built-in escalation policies to ensure urgent alerts are addressed within set timeframes.

4. Delay nonurgent notifications to reduce interruptions.

The ability to delay nonurgent alerts to be delivered at set intervals can greatly reduce distractions for clinicians during patient care. By minimizing multitasking, nurses and other care team members are able to complete tasks more efficiently and maximize their focus on patients at the bedside.

5. Distinguish alert types by tone to simplify recognition.

Alarm fatigue and decision fatigue often go hand in hand. While most care team members wouldn’t actively choose to ignore an alert, the ability to know in an instant based on sound whether or not an alarm is urgent can help them respond appropriately more quickly.

The Bottom Line:

Excess noise makes it difficult for clinicians to administer safe and timely care. (It also does a number on patient experience, but that’s a topic for another post.) Remove the guesswork for nurses around whether to tune out the noise and focus on the patient at hand or interrupt each encounter to assess the latest (likely false) alarm.

Click below to begin fighting alarm fatigue.

 

Resources:
1. Alarm Fatigue: A Patient Safety Concern, American Association of Critical-Care Nurses (AACN) Advanced Critical Care, Sue Sendelbach, RN, PhD, CCNS and Marjorie Funk, RN, PhD, Oct. 2013: acnjournals.org/aacnacconline/article-abstract/24/4/378/14745/Alarm-FatigueA-Patient-Safety-Concern

Real-Time Data Entry for Better Patient Care

Real-Time Data Entry Header

It has always been recommended that charting take place as near to the care event as practical, with the key word being “practical.” In reality, clinicians and nurses often stay after shifts to do their charting because entry is not seamless during patient care.

The more time that passes between the health event and the data entry, the less detailed the data input becomes and the greater its risk of containing errors. Delayed data entry impacts patient outcomes and creates unnecessary administrative overhead.

Benefits of Real-Time Data Entry

“Real-time electronic data is a potential treasure trove of insights, which can be analysed to improve patient care and use nurses’ time more effectively.”
– Helen Glenister, Chief Operating Officer (COO) of The Learning Clinic1

Real-time data entry has been shown to improve patient care (particularly the identification of patients who may be deteriorating), free up more direct-care time for nurses and clinicians, and help hospitals better deploy staff and resources.

According to a study published in Nursing Times, the availability of up-to-date data can help nurses and clinicians spot patterns in data that indicate a patient is deteriorating or may have an infection.1 While some data points may automatically feed into the EHR, vital observational data from nurses and doctors are not automatically entered.

Timely electronic recording of all clinical data—including observations, assessments, and actions—gives the overall picture of a patient and provides a clear data trail in the event of a complaint or incident investigation. Real-time documentation and order entry during rounding also helps speed up care and minimize future interruptions.2

The benefits of real-time data entry are well known, but challenging to achieve in some hospitals.

Challenges to Real-Time Data Entry

Siloed technology systems, device mobility limitations, and logistical issues in some EHRs can be the biggest barriers to real-time charting.

“One nurse believes that since going live, EHRs have added 3 hours to a
12-hour shift.” – Laura A. Stokowski, RN, MS3

In order to chart data that is accurate, actionable, and timely, the care team must be supported with an integrated solution that allows for simplified real-time charting in the EHR/EMR.

How to Achieve Real-Time EHR Data Entry

Healthcare IT integration can be very complex, but the right technology can integrate disparate IT, clinical, telecom, and EMR/EHR systems to allow information to flow freely. The result is a cohesive, integrated communication ecosystem that ensures the right information is available at the right time to support quality patient-centered care.

An ideal solution will support real-time charting with:

  • Intelligent field mapping to reduce duplicate data entry.
  • Voice-to-text capability to speed up and simplify data entry.
  • An easy and elegant interface with all information available on a single platform; no switching between apps.
  • Easy transfer of clinical notes for rapid documentation.
  • Immediate delivery of critical lab and test results to the right clinician with date, time, recipient, delivery status, and read status auto-recorded to the EMR in accordance with Joint Commission requirements.

Next Steps for Getting Started

Explore how your team can combine real-time EHR data entry with seamless care coordination in one integrated solution by speaking with a clinical communication specialist.

 

Resources:
1. How real-time data can improve patient care, Nursing Times, Sep. 21, 2015: nursingtimes.net/clinical-archive/patient-safety/how-real-time-data-can-improve-patient-care-21-09-2015/
2. How Hospitalists Can Improve Efficiency on Inpatient Wards, The Hospitalist, Rajesh Chandra, MD, FHM, et. al., May 2014: the-hospitalist.org/hospitalist/article/126231/how-hospitalists-can-improve-efficiency-inpatient-wards
3. Electronic Nursing Documentation: Charting New Territory, Medscape, Sep. 12, 2013: medscape.com/viewarticle/810573

Managing the surprisingly troublesome impact of real-time healthcare on clinical decision-making

We live in an age of instant gratification. From the texts we send friends and family to the orders we place on Amazon.com, we’ve come to expect immediate results: instant responses, next-day shipping, etc.

The idea of immediacy in healthcare communications is not new. In fact, in 2015, healthcare analyst Gartner outlined a vision for what it dubbed the “real-time health system”—a landscape where healthcare professionals will be constantly aware of what’s happening within their systems and with their patients.

As a person living in the digital age, you’ve probably experienced real-time awareness in other parts of your life: the repetitive dings of received text messages, the intermittent beeps of calendar alerts, the near-constant hum as your smartphone vibrates over and over to let you know your mother, children and cousins have uploaded photos to Facebook, Instagram and Snapchat. In fact, as I’m typing this piece, I’ve heard alerts for two personal text messages that I’ve yet to look at (the temptation is maddening), four work-related emails (that I did have to stop and look at), a notification that someone commented on a thread I replied to on Facebook and more.

While there’s definitely a benefit to each of us knowing what’s happening in our expanded universe in real time—and we can easily draw a direct line to the benefits that doctors, nurses and patients would experience if they could communicate instantaneously while coordinating care—the influx of information is simply overwhelming.

And when alarm fatigue sets in, important messages get missed, the communication cycle breaks down and what was once a valuable resource becomes a liability. Overwhelmed and inundated clinicians cannot optimally use their invaluable expertise to make effective clinical decisions that deliver great health outcomes.

Aggregating, analyzing and managing the distribution of clinical information

Managing the flow of data and alert fatigue is a real challenge that clinicians and the IT teams that support them need to understand. Clinicians need “just the facts, ma’am,” so to speak, and they need to know which set of facts pertain directly to them and the patients for whom they are caring. Receiving more than enough information is not always a good thing, especially when the situation calls for fast thinking and quick decisions.

Investments made in technologies implemented over the past several years have enabled healthcare as an industry to generate very large amounts of digitized clinical information. The challenge is to aggregate this patient data in real time to generate new knowledge about a patient and distribute it in a way that does not inundate the clinician recipients with unnecessary information. Physicians and nurses should receive information they need in order to act in that moment. Everything else is noise.


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Implementing communication-driven workflows

Once new knowledge is made available and deemed relevant to a given clinical situation, it’s important to enable workflows that drive this information to the right care team members, who can take action in that moment. Hospital-based communication workflows must encompass all modalities, adhere to strict security mandates and facilitate reliable exchanges among clinicians across boundaries (e.g., acute, pre-acute and post-acute care settings). This kind of clinical integration is the future of healthcare communications.

If clinicians are inundated with unnecessary information, messages and alerts, combined with a communication workflow that creates barriers to a) finding the right care team member to contact, b) finding the contact method that the clinician prefers and c) knowing whether the intended recipient received the message, the workflow is flawed and is inhibiting the decision-making that leads to higher standards of patient care.

Leveraging clinical expertise

The personal judgment of experienced healthcare professionals is irreplaceable in effective, real-time decision-making. Technological advances are no doubt improving healthcare, but human intuition can never be replaced by a new device or software. However, that intuition can be inhibited by technologies if they are not strategically implemented and managed. In this sense, real-time healthcare could, ironically, be eroding quality.

To truly leverage the hundreds of collective years of clinical expertise housed in the minds of your hospital’s medical staff—the expertise that yields great outcomes—you must remove the barriers to effective communication. Collecting patient data in real time is an important part of that. But analyzing and aggregating that data into digestible, valuable pieces of information that can be easily shared and collaborated on is the follow-through that is often overlooked.

The gravitation toward instant gratification isn’t going away. And it’s important to understand that the concept doesn’t apply simply to generating patient data as healthcare events are occurring, but also to the ability to extract the significant portions and begin collaborating with the broader care team to interpret the data and derive a plan to deliver high-value care.

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The Important Role Nurses Play in Care Transition and Reducing Readmissions

In its simplest form, “care transition” is defined as a hospital discharge or movement from one care setting to another. The risk that readmissions pose to patient safety requires that transitional care processes are under constant evaluation.

Nurses are the linchpin in clinical communication and coordination of patient care and thus are best equipped to coordinate a successful transition. The bedside nurse, for example, may understand a great deal more about the patient’s needs as they travel through the care continuum than other care team members. And when those needs are communicated effectively, the nurse is given the opportunity to extend to the patient high-value care beyond organizational boundaries through clinical communication.

Nurses create transitional care plans by compiling all the pertinent patient information and creating instructions to be followed. Then they share the plan in detail with all members of the new care team so that the handoff is seamless for both the patient and the new unit or facility.

The most important factor in transition of care is communication during the handoff process.

What to communicate and when

The goal of the handoff is to safely transfer the patient from one care setting to another (or to discharge the patient from the hospital completely) by exchanging the necessary information with, and by effectively transferring the responsibility of care to, either a new care team or the patient’s family.

It’s a lot to put on any nurse’s plate, but by standardizing and implementing an effective and comprehensive transition communication process, nurses can elevate patient safety, avoid adverse events that lead to costly readmissions and decrease patient anxiety during the transfer process.

It’s important to remember that the transfer process doesn’t apply only to moving a patient from an acute setting to the home or a post-acute environment. There are many different handoff scenarios within the same organization, unit and floor that need your close attention.

For example, nurses should be prepared to provide handoff communication:

  • At shift change
  • During a break
  • When patients are transferred within the hospital (e.g., from the ER to ICU, from radiology to the OR, etc.)

It’s extremely important for the purposes of continuity of care that the communication between the nurse and either the new team of clinicians or the family prepares them in such a way that they’re able to anticipate the patient’s needs and make timely decisions.

At a high level, to adequately prepare the new care team, the following should be included in the handoff communication:

  • Patient care instructions
  • Treatment description
  • Medication history
  • Services received
  • Any recent or anticipated changes

More specifically, and especially in the case of transfers to a new care team or facility, an effective care transition communication plan will include:

  • Patient’s name and age
  • Reason for admission
  • Pertinent co-morbidities
  • Code status
  • Current isolation or precautions
  • Elopement risk
  • Lab results—including any pending and/or abnormal findings
  • Relevant diagnostic studies
  • Fall risk assessment
  • Any assessment findings that are appropriate to the patient’s current health

Many times, nurses on the receiving team care for patients for whom they lack pertinent health data. For example, EKG results are often left out of the transition communication between hospitals and subacute rehabilitation facilities. In this case, if a patient has an episode of chest pain, the receiving team could conduct an EKG on their own, but without prior results to compare with, they can’t successfully rule out something dangerous, such as angina. So, they may err on the side of patient safety and send the patient back to the hospital, resulting in a readmission. However, if an EKG result is included in the transition communication, the receiving team can conduct an EKG on their own, compare the results with the EKG performed at the hospital, and determine whether there is an emergent need for a readmission or the issue is something they can safely handle in their own setting.

Pay extra close attention to medication communications

While including all pertinent test results in the handoff communication is extremely important, there’s another area that needs special attention, because it causes more admissions than any other factor: medication.

It’s estimated that 30% of hospitalized patients have at least one discrepancy on discharge medication reconciliation. Communicating medication details is an area that poses the greatest risk for error as well as the greatest opportunity to effect a positive outcome. In fact, over 66% of emergency readmissions for patients over 65 years old are due to adverse medication events.

Breaches in handoff, such as failure to include specific details of the patient’s medication history and future dosage needs, have dire consequences.

However, defective handoffs are also known to cause problems beyond adverse events. Issues such as delays in care, inappropriate treatment, and increased length of stay arise when transition communication is not strategically planned and delivered.

There are many root causes of a defective handoff, but since nurses play the most important role in the transition communication process, you must strategically develop and communicate the transitional care plan—not only by considering what information you believe should be communicated, but by extending a dialogue to the receiving team and understanding what information they feel is necessary to provide the best follow-up care possible.

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