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You may think that false alarms on cardiac monitors are a mere annoyance, but they put patients at risk, argues Rebecca A. Steinmann, RN, MS, CEN, CCRN. CCNS, ED clinical nurse specialist at Northwestern Memorial Hospital in Chicago.
"The problem is that staff become so accustomed to this background noise’ that they don’t respond immediately to the true life-threatening alarms," she says. (For more information on the side effects of noise, see ED Nursing, August 2001)
Although manufacturers have designated different visual patterns and sounds to the varying levels of alarm priorities, staff tend to disregard alarms, says Steinmann. "The vast majority of the time, the alarms are false alarms," she explains.
False alarms also add to the noise in the individual patient’s room, says Steinmann. "How would you feel if you were a family member hearing your mother’s cardiac monitor flash alarm messages, and wonder why no one from the nursing staff is coming in to the room to investigate the situation?" she asks.
Reducing the number of false alarms is absolutely critical to ensure that life-threatening alarms are immediately noted and acted upon, urges Steinmann. "This is both for patient physiologic safety and psychological comfort," she says.
Here are ways to prevent false alarms:
• Understand how the monitoring system works.
Steinmann recommends asking clinical nurse specialists or your facility’s "super users" to train ED nurses.
Staff should be required to demonstrate initial and ongoing competency with the monitoring system, says Steinmann. "Periodic inservices from the vendor can also be very beneficial for ongoing updates," she adds.
• Individualize alarms.
It’s not enough to simply attach the patient to the monitor, says Steinmann. "To reduce the number of false alarms, the alarms for each physiologic parameter being monitored should be individualized for each patient," she explains.
The monitors should be custom adjusted for every patient when they are attached, according to Michael Buelow, RN, CEN, an ED nurse at InteliStaf, a staff relief agency based in Phoenix.
"As is often the case, this task falls to the nurse," he says. "Most ED nurses, however, have never been taught the fine points of this. They just slap the patches on and use Lead II, no matter what."
Find a monitor lead that shows a smooth baseline and large positive (upward) QRSs, advises Buelow. "Usually this will be Lead II, but don’t hesitate to experiment with different leads to get what you need," he says.
Buelow recommends setting the height of the QRS complexes (using the "gain" or "size" adjustment) so they can be easily seen, but no taller than necessary.
When the gain is set very high, small muscle-movement artifact may also be amplified enough to cause false alarms, he explains.
• Immediately respond to every alarm.
Resist the urge to ignore an alarm, says Buelow. "If it is a false alarm, identify and correct the cause," he says. "There are even times when it may be appropriate to turn off the alarms as a last resort."
• Apply monitor patches to clean, dry, intact skin in the appropriate locations.
Cardiac monitoring systems work by collecting, amplifying, and displaying the tiny electrical activity of the heart. "Like any other electrical system, the cardiac monitor requires sturdy connections to complete the circuit," says Buelow.
Carefully consider the interface between the monitor patch and the skin, says Buelow. "This is the most common place for trouble," he says.
The most common noise producer is patient movement that the machine senses as tachycardia, Buelow explains. "To prevent this, one must carefully place the patches on clean, dry skin and select a lead that has a tall R-wave," he says.
Dirt, body oils, lotions, and Vick’s VapoRub all reduce conduction from the body to the machine, which increases false alarms, says Buelow.
He explains that any barrier between the silver gel and the skin will prevent good conduction of electricity. "If necessary, use some alcohol pads or soap and water to cleanse the skin," he recommends.
Avoid large muscle masses, as the electrical activity of moving voluntary muscles can cause interference, says Buelow. "Select relatively hairless areas, and shave only if absolutely necessary," he says.
Consider removing and reapplying the patches if needed, he adds.
• Adjust settings for infants.
When you turns on most monitors, the rate alarms are usually preset at 60 and 120, notes Buelow. "A common error is to attach an infant, whose normal heart rate is 140, to a monitor that has a default tachycardia alarm at 120, and not adjust the alarm limit upward," he says.
For more information about reducing false alarms of cardiac monitors, contact:
• Michael Buelow, RN, CEN, 3018 W. Villa Theresa Drive, Phoenix, AZ 85053-1117 Telephone: (602) 439-9059. E-mail: firstname.lastname@example.org.
• Rebecca Steinmann, RN, MS, CEN, CCRN, CCNS, Emergency Department, Northwestern Memorial Hospital, 251 E. Huron St., Chicago, IL 60611-2908. Telephone: (312) 926-6320. Fax: (312) 926-6288. E-mail: Rsteinmann@aol.com.