Response to nursing DB

Response to nursing discussion board (peer). 150 words 1 reference-within 5 years NURSING JOURNALS ONLY.

Cleveland Clinic Florida also implemented a computer-based sepsis-screening tool when I worked in the intensive care unit (ICU). While the nurse was documenting the patient’s shift assessment in the electronic chart, a “Best Practice” alert would pop-up notifying the user that the patient had met certain sepsis criteria. However, the program would alert several times a shift for vital signs and laboratory values that were not really alert worthy.  This became a significant obstacle to overcome because alarm fatigue lead everyone to start ignoring the repeated false alerts.  Many nurses and physicians started closing down the pop-up boxes without really paying much attention to the values listed.  Constant pop-up alerts during a very busy shift became a distraction from the charting and a nuance, instead of a helpful aid.

After a shared governance meeting, our unit was able to discuss the matter with Information Technology (IT) representatives. We were able to customize the alerts so that different criteria was required in order to trigger alerts in the ICU. Meaning, if the patient was admitted to a regular floor, any value that was suspicious of sepsis would trigger an alert so that the medical-surgical or telemetry nurse would contact the physician. But if the patient was admitted to either the Medical or Surgical Intensive Care Units, then more specific criteria was required in order to trigger an alert. Chronic low blood pressures or persistently high heart rates no longer set off numerous “Best Practice” alert boxes in ICU.  After all, we were aware that most of the Medical ICU was already septic. Interdisciplinary rounds for every single post-op surgical patient in the ICU was a standard practice, which meant the patient’s labs were reviewed several times a shift by several professionals.

Also, in certain instances where specific values were extremely abnormal, in order to close down the alert, the nurse would have to enter a password. This meant that the nurse was accepting responsibility of addressing the abnormal value in some way or another. This accountability was very persuasive in making sure that all nurses and doctors carefully monitored their patient’s results. In conclusion, the obstacle to change was overcome in the ICU by adjusting the electronic charting alerts to meet the needs of the unit.

Our sepsis alerts did not set off a pager to the rapid response team like you described. This system made every nurse caring for the patient with abnormal values responsible for those values. I enjoyed learning of how your hospital implemented the system. I feel that would never had happened at my hospital because we were always short staffed with patients that were too high of an acuity level to even think about leaving the unit to check on another patient.