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A critical assessment of monitoring practices, patient deterioration, and alarm fatigue on inpatient wards: a review.

Curry JP, Jungquist CR - Patient Saf Surg (2014)

Bottom Line: Leading up to this Century, it was common for most hospitalized patients and their families to believe that being surrounded by well-trained nurses and physicians assured their safety.We have designed our physiologic explanations and simplified cognitive framework to give our front line clinical nurses a thorough, easy-to-recall understanding of just how these events evolve, and how to detect them early when most amenable to treatment.Our review will also discuss currently available practices in general care floor monitoring that can both improve patient safety and significantly reduce monitor associated alarm fatigue.

View Article: PubMed Central - HTML - PubMed

Affiliation: UCLA Department of Anesthesiology, Hoag Memorial Hospital Presbyterian, One Hoag Drive, 92663 Newport Beach, CA, USA.

ABSTRACT
Approximately forty million surgeries take place annually in the United States, many of them requiring overnight or lengthier post operative stays in the over five thousand hospitals that comprise our acute healthcare system. Leading up to this Century, it was common for most hospitalized patients and their families to believe that being surrounded by well-trained nurses and physicians assured their safety. That bubble burst with the Institute of Medicine's 1999 report: To Err Is Human, followed closely by its 2001 report: Crossing the Quality Chasm. This review article discusses unexpected, potentially lethal respiratory complications known for being difficult to detect early, especially in postoperative patients recovering on hospital general care floors (GCF). We have designed our physiologic explanations and simplified cognitive framework to give our front line clinical nurses a thorough, easy-to-recall understanding of just how these events evolve, and how to detect them early when most amenable to treatment. Our review will also discuss currently available practices in general care floor monitoring that can both improve patient safety and significantly reduce monitor associated alarm fatigue.

No MeSH data available.


Related in: MedlinePlus

RECC Type III pattern of respiratory dysfunction (OSA).
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Related In: Results  -  Collection

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Figure 4: RECC Type III pattern of respiratory dysfunction (OSA).

Mentions: The potential for such catastrophic outcomes and the enormous strain ObstructiveSleep Apnea (OSA) places on society with costly co-morbid consequences, havewarranted several medical societies and foundations to recommend evidence basedperioperative detection and management strategies. The Society of Anesthesiologyand Sleep Medicine (SASM) has just released its detailed best practice consensusrecommendations for managing perioperative OSA, and has provided this reviewarticle with its direct URL link to the information [64]. It can be argued that Type III is the most catastrophic of our threepatterns because it is able to take an otherwise healthy patient’s life sosuddenly (10 or less unobserved minutes) without any visible or audiblewarnings. This further supports those experts who insist that optimal GCFsurveillance, when opioids are being utilized, must include some continuouselectronic monitoring strategy capable of detecting Type III events [20,54]. Regarding sleep, the Type III event differs from Type II, which isinduced by CO2 Narcosis, because it alone is a true sleep associatedprocess. It starts as an arousal dependent sleep breathing disorder, where weakor incomplete arousal mechanisms fail completely from severe paroxysmalhypoxemia that induces an arousal arrest, and if left undiscovered anunwitnessed respiratory arrest [59-61]. Remember, Type II deaths are directly related to opioid inducedrespiratory depression and not disordered sleep breathing, although this issuebecomes murky as our discussion on opioids in our next section will explain.TheType III pattern is not associated with elevated, upward trending sedationscores, which many clinical nurses place their absolute faith in regardingdetection of all opioid associated threats. When awake, these patients canexhibit no pathognomonic symptoms or signs that give an impending Type IIIprocess away, including any evidence of sedation. In other words, patients witharousal failure are orphaned, hidden within typical perioperative populations.As shown in Figure 4 below, the sentinel instabilitycomponents of this Type III pattern are the typical recurring cycles ofobstructive sleep apneas in the presence of one final, complete arousal failure(arousal arrest).


A critical assessment of monitoring practices, patient deterioration, and alarm fatigue on inpatient wards: a review.

Curry JP, Jungquist CR - Patient Saf Surg (2014)

RECC Type III pattern of respiratory dysfunction (OSA).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4109792&req=5

Figure 4: RECC Type III pattern of respiratory dysfunction (OSA).
Mentions: The potential for such catastrophic outcomes and the enormous strain ObstructiveSleep Apnea (OSA) places on society with costly co-morbid consequences, havewarranted several medical societies and foundations to recommend evidence basedperioperative detection and management strategies. The Society of Anesthesiologyand Sleep Medicine (SASM) has just released its detailed best practice consensusrecommendations for managing perioperative OSA, and has provided this reviewarticle with its direct URL link to the information [64]. It can be argued that Type III is the most catastrophic of our threepatterns because it is able to take an otherwise healthy patient’s life sosuddenly (10 or less unobserved minutes) without any visible or audiblewarnings. This further supports those experts who insist that optimal GCFsurveillance, when opioids are being utilized, must include some continuouselectronic monitoring strategy capable of detecting Type III events [20,54]. Regarding sleep, the Type III event differs from Type II, which isinduced by CO2 Narcosis, because it alone is a true sleep associatedprocess. It starts as an arousal dependent sleep breathing disorder, where weakor incomplete arousal mechanisms fail completely from severe paroxysmalhypoxemia that induces an arousal arrest, and if left undiscovered anunwitnessed respiratory arrest [59-61]. Remember, Type II deaths are directly related to opioid inducedrespiratory depression and not disordered sleep breathing, although this issuebecomes murky as our discussion on opioids in our next section will explain.TheType III pattern is not associated with elevated, upward trending sedationscores, which many clinical nurses place their absolute faith in regardingdetection of all opioid associated threats. When awake, these patients canexhibit no pathognomonic symptoms or signs that give an impending Type IIIprocess away, including any evidence of sedation. In other words, patients witharousal failure are orphaned, hidden within typical perioperative populations.As shown in Figure 4 below, the sentinel instabilitycomponents of this Type III pattern are the typical recurring cycles ofobstructive sleep apneas in the presence of one final, complete arousal failure(arousal arrest).

Bottom Line: Leading up to this Century, it was common for most hospitalized patients and their families to believe that being surrounded by well-trained nurses and physicians assured their safety.We have designed our physiologic explanations and simplified cognitive framework to give our front line clinical nurses a thorough, easy-to-recall understanding of just how these events evolve, and how to detect them early when most amenable to treatment.Our review will also discuss currently available practices in general care floor monitoring that can both improve patient safety and significantly reduce monitor associated alarm fatigue.

View Article: PubMed Central - HTML - PubMed

Affiliation: UCLA Department of Anesthesiology, Hoag Memorial Hospital Presbyterian, One Hoag Drive, 92663 Newport Beach, CA, USA.

ABSTRACT
Approximately forty million surgeries take place annually in the United States, many of them requiring overnight or lengthier post operative stays in the over five thousand hospitals that comprise our acute healthcare system. Leading up to this Century, it was common for most hospitalized patients and their families to believe that being surrounded by well-trained nurses and physicians assured their safety. That bubble burst with the Institute of Medicine's 1999 report: To Err Is Human, followed closely by its 2001 report: Crossing the Quality Chasm. This review article discusses unexpected, potentially lethal respiratory complications known for being difficult to detect early, especially in postoperative patients recovering on hospital general care floors (GCF). We have designed our physiologic explanations and simplified cognitive framework to give our front line clinical nurses a thorough, easy-to-recall understanding of just how these events evolve, and how to detect them early when most amenable to treatment. Our review will also discuss currently available practices in general care floor monitoring that can both improve patient safety and significantly reduce monitor associated alarm fatigue.

No MeSH data available.


Related in: MedlinePlus