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Initiative Reduces Alarm Fatigue at Florida’s Mayo Clinic

Initiative Reduces Alarm Fatigue at Florida’s Mayo Clinic

A Florida hospital surgical intensive care unit (SICU) improved clinical alarm management practices and reduced nurses’ self-reported alarm fatigue, according to a study published in Critical Care Nurse (CCN ).

Implementing a Unit-Based Alarm Management Bundle for Critical Care Nurses” details how the 27-bed SICU at Mayo Clinic, Jacksonville, Florida, implemented a standardized approach to alarm management and improved nurses’ knowledge for configuring the settings to match the monitoring needs of individual patients better.

“Clinical alarms are important, but they also contribute to a noisy hospital environment for patients and clinicians,” says lead author Stephanie Bosma, DNP, APRN, FNP-BC, an advanced practice nurse practitioner at the hospital. “With high sensitivity and low specificity, monitors can generate an overwhelming number of alarms, many of which are false or nonactionable alerts.”

“Our project gave alarm management skills much-needed attention and introduced a new tool to help staff maximize the benefits of clinical alarms,” she says.

A key aspect of the initiative was an evidenced-based, nurse-driven, patient-specific bundle called the CEASE bundle. The five-step tool addresses the following:

  • Communication – focuses on working with colleagues (fellow nurses, respiratory therapists, providers, and patient care technicians) to identify patient-specific goals and determine when to suspend or silence alarms while performing care activities that induce nonactionable alarms.
  • Electrodes – targets proper skin preparation for daily ECG electrode and pulse oximeter changes.
  • Appropriateness – encompasses determining what is clinically indicated for the patient and choosing appropriate monitoring parameters with physician and interprofessional team members.
  • Setup – includes customizing alarm parameters for individual patients at the beginning of each shift.
  • Education – relates to the need for continuing education on clinical alarm monitoring systems.

To help nurses adapt, the CEASE bundle was introduced during regular staff meetings, and descriptions were placed around the unit for easy reference.

Some 82% of nurses reported via a survey administered to all SICU nurses before and after implementation that the CEASE bundle helped decrease their alarm fatigue, and 83% reported the bundle was helpful and would continue to use it.

Implementing the CEASE bundle improved nurses’ alarm management practices, perceptions, and attitudes. Several indicators improved from baseline, including nurses reporting that setting alarm parameters was less complex, staff was sensitive to alarms and responded quickly, and fewer alarms were missed.

As a result of the project, alarm management skills and monitor training is being more formally integrated into the hemodynamic education already required for nurses at the hospital.

A Day in the Life: Vascular Access Nurse

A Day in the Life: Vascular Access Nurse

Have you ever wondered what it’s like to work as a vascular access nurse and what this job offers? Here are the basics that you need to know.

Rebecca Myers , MSN, RN, VA-BC, NPD-BC, is a Vascular Access Nurse (aka PICC nurse). Her hospital experience includes critical care, education, and vascular access.

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Rebecca Myers, MSN, RN, VA-BC, NPD-BC

How did you get interested in being a vascular access nurse? What drew you to it? How long have you been doing it?

I started my nursing career in ICU and was always interested in learning new skills. In 2011, there was an opportunity to join an all-ICU RN PICC team. We trained with a seasoned team from a sister hospital. We rotated as the PICC nurse for the hospital and outpatients for a week at a time and worked in ICU the rest of the time. In addition, we placed lines for our hospital patients and outpatients needing long-term IV therapy. 

Now, I am a full-time vascular access nurse.

Explain what a vascular access nurse does. What types of patients do you serve? What do you provide for them?  

As a vascular access nurse, I consult to determine the best vascular access for a patient. I work in an inpatient setting and provide ultrasound-guided peripheral IVS, midlines, and peripherally inserted central catheters (PICCs) to patients requiring IV therapy.

I educate nurses about vascular access, choosing the best option for a patient, and advocating for a patient’s vein preservation and health. In addition, I educate patients about their access and what to expect before and after the procedure and answer any questions.

Did you need to get additional education for this position? Please explain.

Yes. There is an educational component required before any hands-on training. The classroom portion is an 8-hour course with successful completion needed before moving on to simulated hands-on training.

Once competence is achieved with simulated insertion techniques, we trained with a seasoned partner at a sister hospital. The requirements are to place a minimum of 10 lines successfully under supervision before moving into placing lines independently. 

My hospital system uses a uniform approach for all vascular access nurses. We use Infusion Therapy Standards of Practice to guide our practice and incorporate Michigan Appropriateness Guideline for Intravenous Catheters (MAGIC) to aid in choosing the right line for each patient.

What do you like most about working as a vascular access nurse? 

I love participating with patients, nurses, and physicians. I love being an expert in my field and having the knowledge and experience to help a patient through a procedure that has uncomfortable moments.

My master’s degree is in education, so I also love the education part of my position. There is an element of autonomy to my position that is professionally satisfying. I have been a nurse for more than 15 years and enjoy using my experience in this way.

What are your biggest challenges as a vascular access nurse? 

Challenges change with time. When I started, the challenge was consistency and gaining the staff’s trust. I have now been at my current hospital for over four years. There is always an element of education that needs to be ongoing. Nurses and physicians are changing, and keeping the information readily available is key. 

I send out a newsletter about 4x a year with summary tables for MAGIC, reminders, updates, and clickable links for more information. The more everyone knows, the better for all of our patients. The biggest challenge is to keep the communication flowing and fresh.

What are your greatest rewards as one? 

The greatest reward of being a vascular access nurse is when a patient says I did a good job. Or family tells me they can see that I am experienced and trust me.

Anytime I can do something that makes a positive difference is the best reward.

Is there anything else that is important for our readers to know?

I want readers to know it is never too late…for anything! I became a nurse after my children were adults. It is the most satisfying and enriching thing in the world. It took me a minute, but I found my tribe in nursing. So whatever your dream is, go after it!

Nursing provides so many varied opportunities! It is still a great field. If you are feeling overwhelmed at the bedside, try something else.

AACN Statement Addresses Evolving Tele-critical Care Nursing Practice

AACN Statement Addresses Evolving Tele-critical Care Nursing Practice

The American Association of Critical-Care Nurses  (AACN) updated its landmark standards for tele-critical care nursing practice, offering specific recommendations for developing and enhancing tele-critical care programs.

After issuing the first authoritative document to define practice guidelines specifically for the emerging telenursing practice in critical care in 2013, AACN’s update, “AACN Tele-critical Care Nursing Practice: An Expert Consensus Statement Supporting Acute, Progressive and Critical Care, 2022,” addresses the changes and details up-to-date findings in this fast-growing area of healthcare.

The consensus statement reflects current evidence, best practices, and the expert opinions of AACN’s nine-person Tele-critical Care Task Force. It underscores how the contributions of tele-critical care nurses continued to expand by embracing additional risk assessments, interventions, and patient safety measures.

During the pandemic, tele-critical care nurses addressed the loss of experienced nurses from the on-site team, leaving a knowledge gap. Their work includes mentoring on-site nurses, facilitating the ongoing development of newer nurses, and supporting excellent nursing care.

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The AACN updated its landmark standards for tele-critical care nursing practice, offering specific recommendations for developing and enhancing tele-critical care programs

The initiative brought together tele-critical care nursing leaders from varied backgrounds to share their expertise and dynamic front-line perspectives, resulting in a comprehensive, patient-centric update. The task force was led by Theresa Davis, Ph.D., RN, NE-BC, CHTP, FAAN, and Lisa-Mae Williams, Ph.D., RN, CCRN-K, two national leaders in tele-critical care nursing.

“Tele-critical care programs have become more pervasive with advances in technologies and expansions in modalities, and the number of patients served,” Davis says. We’ve seen significant growth in tele-critical care services, including expanding beyond traditional critical care areas, medical-surgical units and even home-care settings. This document offers a broader definition of the term ‘teleICU’ to reflect how these nurses contribute to care beyond intensive care units.”

“In addition to caring for patients, tele-critical care nurses are helping to address the experience gap by providing an extra layer of support and expertise to the on-site team,” Williams says. “Knowledge and expertise are precious commodities, especially when caring for critically ill patients. Mentoring a novice nurse, a float nurse, or traveling nurse can instill a greater sense of confidence, while peer-to-peer collaboration can help on-site colleagues feel more supported.”

The consensus statement’s practice recommendations include essential elements for tele-critical care nurses, nurse leaders, and their healthcare organizations.

The document includes clinical scenarios with real-world examples of how clinicians implemented each key recommendation in various environments, including natural disasters and the COVID-19 pandemic. An increased focus on the importance of equity, diversity, and inclusion has been integrated throughout the document, beginning with its first recommendation and continuing through the practice model and clinical vignettes.

The statement includes the AACN Tele-critical Care Nursing Practice Model, which provides the conceptual framework for implementing and evaluating tele-critical care nursing practice.

Download the 41-page consensus statement here.

AACN Taps 188 Hospital Units for 2021 Beacon Awards

AACN Taps 188 Hospital Units for 2021 Beacon Awards

ALISO VIEJO, Calif. — Feb. 16, 2022 — The American Association of Critical-Care Nurses (AACN ) recognized 188 units from 126 hospitals that earned the Beacon Award for Excellence between Jan. 1, 2021, and Dec. 31, 2021. (View recipient list.)

The Beacon Award for Excellence lauds hospital units that employ evidence-based practices to improve patient and family outcomes. The award provides gold, silver and bronze levels of recognition to hospital units that exemplify excellence in professional practice, patient care and outcomes. Recognition is for a three-year term.

AACN President Beth Wathen, MSN, RN, CCRN-K, praises the exemplary efforts of the unit teams who achieved the Beacon Award for Excellence.

“Meaningful recognition takes on even greater relevance and importance as we continue to meet the challenges of the COVID-19 pandemic,” she said. “Being recognized as a Beacon unit underscores these teams’ ongoing commitment to providing safe, patient-centered and evidence-based care to patients and families. This achievement is a tremendous honor to those who have worked so hard to achieve excellence in patient care and positive patient outcomes.”

Beacon-designated units meet the criteria in five categories, all of which are consistent with other national awards, including the ANCC Magnet Recognition Program®, the Malcolm Baldridge National Quality Award and National Quality Forum’s Eisenberg Patient Safety and Quality awards. Units that receive the Beacon Award demonstrate practices that align with AACN’s Healthy Work Environment standards.

Recipients of a gold-level Beacon Award demonstrate staff-driven excellence in sustained unit performance and improved patient outcomes that exceed national benchmarks. Silver-level recipients demonstrate continual learning and effective systems to achieve optimal patient care. Bronze-level awardees demonstrate success in developing, deploying and integrating unit-based performance criteria for optimal outcomes.

In all, 58 units received gold-level Beacon awards, the program’s highest distinction. Among the 2021 recipients, University of California Davis Health System in Sacramento and University of North Carolina (UNC) Medical Center each had four units recognized with gold-level awards, with a fifth unit at UNC earning a silver-level award. St. Elizabeth Healthcare in Edgewood, Kentucky, had three units earn gold-level awards.

Children’s Hospital Los Angeles had four units recognized with Beacon awards in 2021, with two gold-level awards and two silver-level awards. VCU Health System in Virginia, Rush University Medical Center in Chicago and MetroHealth Medical Center in Cleveland, each had two units receive gold-level awards and a third unit was recognized with a silver-level award.

The medical intensive care unit (MICU) at ChristianaCare, Newark, Delaware, becomes the first unit in the United States to renew its Beacon Award for the fifth consecutive three-year cycle, earning gold-level recognition in 2021. In addition, two other units at ChristianaCare were recognized with silver-level awards.

“Through their relentless and uncompromising pursuit to deliver care that is nonpareil, the nurses of ChristianaCare’s MICU have become the paragon of what our profession can accomplish,” said Ric Cuming, EdD, MSN, RN, NEA-BC, FAAN, ChristianaCare’s chief nurse executive and ChristianaCare HomeHealth’s president. “The success that our ChristianaCare MICU has trailblazed, even in the face of this pandemic and continuously elevating benchmarks, also has catalyzed our health system’s other intensive care units to achieve unprecedented gains in safety and quality that have been recognized with the AACN’s Beacon award, the touchstone by which all critical care nursing excellence and quality are measured.”

A total of 34 hospitals had multiple units honored with an award in 2021, demonstrating excellence in caring for acutely and critically ill patients and their families. Memorial Hermann Hospital in Houston had the most units earn Beacon awards, with six units recognized with silver-level awards.

In all, 25 units at 13 New York hospitals attained Beacon status in 2021, the most for any state. Northwell Health had three units at North Shore University Hospital in Manhasset, New York, and two at its nearby Syosset Hospital receive Beacon awards. In Rochester, Highland Hospital, Rochester General Hospital an Unity Hospital Rochester Regional Health earned six Beacon awards, bringing the total for these area hospitals to 34 units currently recognized through the Beacon award program. Last year, University of Rochester Medical Center described its journey toward multiple Beacon awards in “The Beacon Collaborative: A Journey to Excellence,” published in the peer-reviewed journal Critical Care Nurse.

Learn more about the Beacon Award for Excellence, and read about one unit’s Beacon journey in Your Stories on the AACN website.

About the Beacon Award for Excellence: Established in 2003, AACN’s award recognizes top hospital units that meet standards of excellence in recruitment and retention; education, training and mentoring; research and evidence-based practice; patient outcomes; leadership and organizational ethics; and creation of a healthy work environment. Award criteria — which measure systems, outcomes and environments against evidence-based national criteria for excellence — provide a mechanism to initiate patient safety efforts. To learn more about the award, visit www.aacn.org/beacon or call 800-899-2226.

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 130,000 members and over 200 chapters in the United States.

Nurse of the Week: Critical Care Nurse Kayla Miller Performs CPR on Victims of Dayton, Ohio Shooting

Nurse of the Week: Critical Care Nurse Kayla Miller Performs CPR on Victims of Dayton, Ohio Shooting

Our Nurse of the Week is Kayla Miller, a critical care nurse from Dayton, Ohio who performed CPR on victims of the shooting that occurred early on the morning of August 4. Miller was fleeing the Ned Peppers Bar after hearing gunfire ringing out when she spotted victims who had been shot. Putting her own life in danger, Miller stopped to perform CPR on the wounded victims on the sidewalk.

Miller was at the Ned Peppers Bar celebrating a friend’s 25th birthday. As she was attempting to flee the scene for her own safety, she felt compelled to stop and help in any way she could. According to Miller, chaos ensued after hundreds of people in the area heard the shots.

Miller tells NBC’s TODAY, “I look down the sidewalk and see just a row of bodies. People shot, some alive, some not. I’m grateful to be able to be alive and talk to my family and friends and tell them I’m OK, but my heart breaks for these families.”

Nine people were killed in the shooting and 27 were injured after a 24-year-old opened fire outside the Ned Peppers Bar in the city’s popular Oregon district just after one o’clock in the morning. It was the second mass shooting in the United States in less than 24 hours, following a shooting at a Walmart in El Paso, Texas the day before that left 20 people dead.

To learn more about Kayla Miller, a critical care nurse who performed CPR on victims of the Dayton, Ohio shooting on August 4, visit here.