It’s safe to say that you and your staff hear a lot of alarms – in fact, one study suggests that health care professionals can hear up to 700 alarms per patient day.1 Did you estimate that many? This is the real danger of alarm fatigue. It doesn’t necessarily mean you’re tired of hearing alarms. It means you may have stopped hearing them altogether.2
It’s no wonder that the ECRI Institute has identified monitoring alarms as a top technology health hazard3 and dedicated a great deal of time and resources to reduce ECG monitoring alarms. In fact, the danger of false and clinically insignificant alarms (or more accurately, the likelihood that the ones that are significant will go unnoticed) has been among its top 10 health technology hazards every year since 2008.4
The good news: there are measures you can take. The AACN recently published a Practice Alert containing seven items that can reduce the frequency of false monitoring alarms. At the top of the list with the highest level of evidence: “Provide proper skin preparation for ECG electrodes (Level B).”2
If this is surprising, consider the role of a typical electrode. The electrode must effectively read the signal from within a patient’s body through the skin – which itself can vary greatly from patient to patient. Multiple factors such as the presence of hair, diaphoresis and the patient’s use of lotions directly affect the contact, and therefore the effectiveness, of the electrode.5 The price of inefficient ECG signal conduction is poor ECG trace quality and frequent false alarms.6
Multiple studies have shown the dramatic difference that proper skin preparation makes in reducing skin impedance, or the barrier of the skin to passing ECG signal from inside the body to the electrode on the skin’s surface.6 One, conducted in 2007, showed nearly a 97% reduction in skin impedance when a mildly abrasive skin prep product was used at electrode application sites.7 Others were very comparable.
The above mentioned studies involved abrading the skin before electrode application, a fast and efficient method. Along with a selection of electrodes for a range of conditions and environments, 3M provides lightly abrasive 3M™ Red Dot™ Trace Prep specifically for reducing skin impedance and gaining a better trace.5
Another concern: in 1998 a survey conducted at the AAMI Annual Meeting and an AACN National Teaching Institute™ & Critical Care Exposition showed that most nursing professionals were not aware of skin impedance, and only 17% had a protocol in place requiring pre-electrode skin prep.5 This has almost certainly improved over time. But this is also certain: the alarms continue.
Our white paper, Proper Skin Preparation Improves Trace Quality and Reduces ECG Monitoring Alarms, can tell you more about the number one thing you can do to counteract alarm fatigue. It covers the history, factors, concerns and solutions for better alarm management through proper skin preparation. It also provides information on electrode application, troubleshooting ECG artifacts and signing up for our Alarm Fatigue Reduction Program.
1. Cvach M, Monitor Alarm Fatigue: An Integrative Review, Biomedical Instrumentation & Technology, July/August 2012, pgs 268-277.
2. AACN Practice Alert, Alarm Management, April 2013 http://www.aacn.org/wd/practice/docs/practicealerts/alarm-management-practicealert.pdf.
3. ECRI Institute. Top 10 Health Technology Hazards for 2016. Health Devices. November 2015
4. ECRI Institute. Top 10 Health Technology Hazards 2008-20016. https://www.ecri.org/Pages/default.aspx
5. Oster C, Improving ECG Trace Quality: Biomedical Instrumentation & Technology 34(3):219-22·December 1999
6. Melendez, Luis A., and Richard M. Pino. “Electrocardiogram interference: a thing of the past?.” Biomedical Instrumentation & Technology 46.6 (2012): 470-477.
7. Jonasson, Linda. A prospective study on the relevance of skin preparation for noise, impedance and ECG intervals among healthy males. http:// www.essays.se/about/ Skin+preparation