Improving patient monitoring and alert management strategies in the burn intensive care unit

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The combination of injured skin, professional medical care, and continuous monitoring of the needs of critically ill burn patients can make alarm management a major challenge for burn units.
As part of a corporate plan to reduce excessive alerts and reduce the risk of alert fatigue, the Burns Intensive Care Unit (BICU) of North Carolina successfully resolved its unit-specific issues.
These efforts have resulted in a continuous decrease in unoperable alarms and improved alarm management strategies for the 21-bed BICU at the Jaycee Burn Center in North Carolina at Chapel Hill Medical Center at the University of North Carolina. In each of the five data collection periods over the two-year period, the average number of alarms per patient day remained below the initial baseline.
The “Evidence-Based Program to Reduce Alarm Fatigue in Burn Intensive Care Units” details the alarm safety improvement plan, including changes in skin preparation practices and nursing staff education strategies. The research was published in the August issue of Critical Care Nurses (CCN).
Co-author Rayna Gorisek, MSN, RN, CCRN, CNL, is mainly responsible for the education of all BICU nurses, nursing assistants and respiratory therapists. During the study, she was a clinical IV nurse in the burn center. She is currently the head clinical nurse in the surgical ICU of the VA Medical Center in Durham, North Carolina.
We can build on our organization-wide efforts to make changes to improve patient monitoring and alert management strategies specific to the BICU environment. Even in a highly specialized BICU, through the use of current evidence-based practice recommendations, the goal of reducing injuries related to clinical alert systems is achievable and sustainable. ”
The medical center established a multidisciplinary alert safety working group in 2015 to achieve the joint committee’s national patient safety goals, which require hospitals to make alert management a priority for patient safety and use clear processes to identify and manage the most important Alert. The working group carried out a continuous improvement process, tested small changes in individual units, and applied the knowledge learned to a wider range of tests.
BICU benefits from this collective learning, but faces unique challenges associated with monitoring critically ill patients with damaged skin.
During the 4-week baseline data collection period in January 2016, an average of 110 alarms occurred per bed per day. The vast majority of alarms fit the definition of an alarm alarm, indicating that the parameter is moving toward a threshold that requires an immediate response or a critical alarm.
In addition, analysis shows that almost all invalid alarms are caused by the removal of electrocardiogram (ECG) monitoring leads or loss of contact with the patient.
A literature review showed the lack of best practices to improve ECG lead compliance with burn tissue in the ICU environment, and led the BICU to develop a new skin preparation process specifically for chest burns, sweating, or Stevens-Johnson syndrome /Patients with toxic epidermal necrolysis.
The staff aligned their alert management strategy and education with the American Association of Intensive Care Nurses (AACN) practice alert “Managing acute care alerts throughout the life cycle: ECG and pulse oximetry”. The AACN Practice Alert is an instruction based on published evidence and guidelines to guide the practice of evidence-based nursing in a healthy work environment.
After the initial educational intervention, the number of alerts at the collection point dropped by more than 50% in the first 4 weeks after the initial education intervention, but it rose at the second collection point. The re-emphasis of education in staff meetings, safety meetings, new nurse positioning, and other changes led to a drop in the number of alerts at the next collection point.
Working groups across the organization also recommended changing the default alarm settings to narrow the range of alarm parameters to reduce inoperable alarms while still ensuring patient safety. All ICUs including BICU have implemented new default alarm values, which may help to further improve the number of alarms in BICU.
“The fluctuation in the number of alerts during the two-year period underscores the importance of understanding other factors that may affect employees, including unit-level culture, work pressure, and leadership changes,” Gorisek said.
As AACN’s bimonthly clinical practice journal for emergency and intensive care nurses, CCN is a trusted source of information related to bedside care for critically ill and critically ill patients.
Tags: burns, intensive care, education, fatigue, healthcare, intensive care, nursing, breathing, skin, stress, syndrome
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Post time: Aug-30-2021