In a time when clinicians are being asked to do much more with far less, multifaceted strategies to protect and allocate vital resources are more important than ever.
Each day a nurse can be prompted by as many as 700 alarms1, many of which are related to ECG monitoring. A significant proportion of ECG alarms are false or triggered by clinically insignificant events.2,3 These alarms often require unnecessary response and intervention consuming valuable nursing time and infection prevention supplies such as PPE. These false alarms can also result in added stress to healthcare workers and patients in an already stressful environment.
Adoption of a standardized approach to patient skin preparation and electrode application can significantly improve overall trace quality and reduce the burden of insignificant alarms1, 4-5 so that essential – and often strained – resources can be allocated to more critical activities and priorities.
Below are some tips and tricks that can help reduce the amount of time spent responding to and troubleshooting ECG alarms:
- Clip excess hair: Hair prevents the electrodes from sticking to the skin and prevents the electrode gel from reaching the skin.
- Clean and dry the skin: Cleanse the skin with soap and water. Recognizing that this may not be ideal or sometimes even possible in the critical care setting, ensure that the skin is dry by wiping with a gauze pad or washcloth. In general, alcohol should be avoided or limited to situations in which electrode adhesion is an issue and be allowed to dry completely prior to skin abrasion.
- Abrade the skin (for adult patients only) to reduce skin impedance and improve trace quality: AACN recommends wiping the skin with a washcloth or gauze when appropriate.6 Some electrodes also have abraders built into the liner of the electrode that can be used.
- When applying the electrode, activate the pressure sensitive adhesive: Press your finger around the outside edge of the electrode to activate the pressure sensitive adhesive.
- Evaluate alarm parameter settings and modify according to individual patient condition in accordance with hospital policy.
Taking these few, simple steps when applying electrodes can minimize the need for electrode replacement and help reduce unnecessary alarms1, 4-5 to help save nursing time that can be dedicated to more immediate patient care needs in the critical care setting.
Resources:
1 Cvach MM, Biggs M, Rothwell KJ, Charles-Hudson C. Daily electrode change and effect on cardiac monitor alarms: an evidence-based practice approach. J Nurs Care Qual. 2013;28:265-271.
2 Drew BJ, Harris P, Zegre-Hemsey JK, et al. Insights into the problem of alarm fatigue with physiologic monitor devices: a comprehensive observational study of consecutive intensive care unit patients. PloS One. 2014; 9(10): e110274.
3 Bonafide CP, Localio AR, Holmes JH, et al. Video analysis of factors associated with response time to physiologic monitor alarms in a children’s hospital. JAMA Pediatr. 2017; 171(6): 524-531.
4 Sendelbach S, Wahl S, Anthony A, Shotts P. Stop the noise: a quality improvement project to decrease electrocardiographic nuisance alarms. Crit Care Nurse. 2015; 35(4): 15-22.
5 Walsh-Irwin C, Jurgens CY. Proper skin preparation and electrode placement decreases alarms on a telemetry unit. Dimens Crit Care Nurs. 2015; 34(3): 134-139.
6 Jepsen S, Sendelbach S, Ruppel H, Funk M, Wahl S. AACN Practice Alert. Managing alarms in acute care across the life span: Electrocardiography and pulse oximetry. Crit Care Nurse. 2018; 38(2): e16-e20.
