Some observations of ICU practice in one hospital - purely anecdotal but -

[hedgehog]

when my mother was in ICU, the machines would sound frequent alarms, but the staff never responded to the alarms. Now, I'm not criticizing the staff for not responding. But I do have a couple questions:

1. If whatever caused the alarm wasn't important enough to warrant a response, why the alarm?

2. If no staff member was in the room, why disturb the patient's rest with countless random alarms?

On a related note, why does any hospital today have a PA system? Haven't these people heard of pagers and cell phones? If the random outbursts of noise startled a visitor sitting quietly by a patient, what about the patient trying to sleep?

My mother had an oxygen mask on which was quite irritating - it kept slipping out of place. The nurse commented that those masks bother all the patients, that they don't fit anyone properly. So why is this mask still in use? Does anyone in purchasing ever check with the people on the floor?

[emulatorloo]

1. Did you ever ask the nurse about it?

That would be who to ask.

[hedgehog]

2. I didn't want to bother some hard working people with things they can't control.

I may write the hospital CEO, though.

I posted here mostly to see if other people had noticed the same things elsewhere.

[emulatorloo]

3. I had noticed something similar. I did ask the nurse about it

she had a good explanation for it, but given the event was so stressful I forgot her explanation.

[Warpy]

11. Yeah, those masks are one size fits nobody

and were one of the banes of my existence. However, even ill fitting ones managed to concentrate high flow oxygen where it was supposed to be, unlike any of the alternatives like scoops.

The machinery is overly sensitive. Some alarms, like IV alarms, give a warning that a bag is almost empty, that the nurse has a set time to either procure or mix the next bag. Shutting them off doesn't work since they just start to ding again in a minute or two. Ventilator alarms will often trip when a patient changes position and there are various levels of alarm. Monitor alarms can signal things like needing new electrode patches and the monitor screens at the nursing station allow the nurse to determine the reason for the alarm remotely. If it's artifact, it can be ignored for a few minutes while s/he finishes the charting entry or whatever else s/he is working on at the moment. Alarms can only be turned off at the bedside in most places, and if the nurse is busy with a dressing change or something else, that non critical alarm can be ignored for a few minutes.

I agree that the racket in an ICU is intolerable for a healthy person. However, when I was in the last time, I was sick enough that it didn't even register for the first three days. The first thing that did register was that overhead speaker. They use that in case the nurse or doctor is up to the elbows in something and can't fish the beeper out to see what it says.

There's a method to most madness in an ICU. I've been on both sides of it and callousness or neglect has nothing to do with it. However, those oxygen masks really are shit. Thinner, more flexible plastic might help. Maybe not.

[itsrobert]

4. My mom was just in the ICU also

You have to sit there like a hawk. Any problem, the solution was more pain/knockout drugs. The more morphine, etc, the less the staff had to work. If you ask them a question, they get real defensive. I wanted a list of meds she had been on for entire stay, they got defensive on that. If me and my siblings weren't there, she would have been dead right now, instead of at a recovering center.

[TwilightGardener]

5. Alarms can mean all sorts of different things. The nurse learns pretty quickly

which ones to tune out, which ones mean something--especially once they've spent some time with the patient. You are not allowed to silence the alarms for very long, and it's unwise anyway, because obviously something serious could happen and then...no alarm. One example is pulse oximetry on the finger, one of the most obnoxious alarms I remember from my ICU days. Patient waves hand around, has poor blood flow, and the machine has trouble reading the oxygen level--alarm goes off. Or the heart monitor reads something funky in the heart rhythm that isn't serious for that particular patient.

Second question--I don't know if there's more comfortable masks out there, but they're usually one size fits all adults (plus peds/infants sizes), made by one or two companies. They can be adjusted with the elastic band, but nobody likes them and they do slip easily. Unfortunately they are necessary if the person can't use the nasal cannula (more comfortable).

[hedgehog]

6. See - someone needs to sit in the ICU with the nurses and observe these things.

If the alarm doesn't mean anything, it shouldn't be going off. There should be some way to adjust the sensitivity.

If a one size-fits-all mask doesn't, then it's time to get masks in multiple sizes!

[TwilightGardener]

10. Well, to use my above example of pulse oximetry--on some patients, it just

doesn't work well, has trouble reading the oxygen level through the finger because the patient's circulation is bad, or is very "positional" (can only read well in certain positions). But there's no way to make it less sensitive, it's meant to be sensitive and accurate. So it's up to the nurse to go in and decide if the alarm shows a real problem with the patient's oxygenation, or if he/she needs to check and adjust the sensor or switch fingers. Some alarms don't need to be checked at all, like the slow "ding...ding..." of the heart monitor when someone occasionally throws a single funky beat--but the machine still needs to let you know that your patient has this occasional blip, because you have to figure that in when analyzing the patient's usual rhythm. Alarms you always pay attention to: IV alarms, vent alarms, rapid dings of the heart monitor--all meant to alert us that something has changed. And to tie it all up--when your mom's mask slipped, her oxygen levels drop, and the alarm goes off, and that's how the nurse knows to come in and fix it! Hope your mom does better, BTW.

[MannyGoldstein]

7. I work in the medical device field so I know a little bit...

One of the fundamental issues around medical devices is that they have to err on the side of caution, particularly when it comes to the types of things that happen in ICUs. It's generally considered better to be extra sensitive and generate false alarms rather than less sensitive and potentially miss a problem. It's up to medical professionals to sift through the alarms and other info and figure out what's important. "Patient is annoyed by false alarm" is a lesser problem than "patient dies because problem was missed".

This ultra-cautious approach is not without drawbacks - as you experienced.

As devices get smarter and designed better, things will improve.

PA systems seem like a bad idea to me. So do poorly-fitting oxygen masks.

Most hospitals have an ombudsman or some other position that advocates for patients. I'd recommend that you send a letter to that person at your mom's hospital, and let them know what you experienced. At the hospitals I'm familiar with, ombudsmen are very powerful.

[MuseRider]

8. I find all this information

about the Intensive Care Units in hospitals these days frightening.

I know I sound like one of those old people with the, "Well we walked to school 10 miles away and 20 miles back with a hot potato to keep us warm" stories but how in the hell can any of this be considered Critical Care?

We sat in our patients rooms, we ate in their rooms. We traded off for bathroom breaks only when our patient was stable enough to do so. You had to look for a nurse? Really? God I hope I just drop over dead one day rather than be treated in the manner that I hear from people now.

[madrchsod]

9. icu`s have monitors at the nurses station and....

they can tell immediately what is and how severe the problem is. my heart monitor was wifi`d the next floor.

those alarms are a pain in the ass at 3 in the morning...

[hedgehog]

12. That's what I was thinking - that the alarm should be with the nurse, not the patient!

[Warpy]

16. It's one of those fail safe things the manufacturers do

to make sure the patient gets looked at while an alarm is being silenced.

That's why we can't shut them off at the desk.

[Celebration]

13. Trust me on this

There are some huge lawsuits about this very thing--ignoring alarms. They do it because a great percentage of them are false alarms. But then along comes one that isn't! You have other good questions I can't answer.

My mom was in the hospital once and she needed help getting up and going to the bathroom. I wasn't sure what to do but we punched the nurse's button. Nobody came, nobody came, nobody came. Finally I just guessed at the procedure and helped her. The next morning I asked the nurses' station what happened?? She checked, and said "oh my goodness we forgot to put the switch on." She put the switch on, and every single room lit up. None of the nurses had answered patients" calls all night long.

Oh, yeah, don't leave relatives alone in the hospital unless they can get up and get around.

[grasswire]

14. when I worked in an ICU - CCU...

...some years ago as an EKG tech and unit secretary, part of my job was to monitor the monitors at the desk, which beeped with each individual patient's rhythm as the image of the heartbeat was diplayed on the screens. If someone's beeps changed rhythm, even without an alarm being triggered, I would hear it and look at the screen to see what was going on. Usually nothing was amiss. I suspect this kind of monitoring is all technological now.

[auntsue]

15. In our family we try to not leave people all alone in

the hospital. Nurse often have more patients than they can safely handle. We are polite and supportive and call tattention to beeping machines. Nurses have told me thay are glad to have family present they feel like we are assisting not criticizing. Too much can go wrong so we just take turns hanging out with our family members.

[Celebration]

17. as EVERYONE should

Good for you.