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Similar to Health and Safety Impact on Employee ProductivityCorrelation: Hypothesis Testing Ho1: There is no statistically significant relationship between health and safety conditions at work and employee productivity. Ha1: There is a statistically significant relationship between health and safety conditions at work and employee productivity.Excel output table hereThe Pearson correlation coefficient of r = 0.600 indicates a moderately strong positive correlation between health and safety conditions and employee productivity. This equates to an r2 of 0.36, explaining 36% of the variance between the variables. Using an alpha of 0.05
Similar to Health and Safety Impact on Employee ProductivityCorrelation: Hypothesis Testing Ho1: There is no statistically significant relationship between health and safety conditions at work and employee productivity. Ha1: There is a statistically significant relationship between health and safety conditions at work and employee productivity.Excel output table hereThe Pearson correlation coefficient of r = 0.600 indicates a moderately strong positive correlation between health and safety conditions and employee productivity. This equates to an r2 of 0.36, explaining 36% of the variance between the variables. Using an alpha of 0.05 (20)
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Health and Safety Impact on Employee ProductivityCorrelation: Hypothesis Testing Ho1: There is no statistically significant relationship between health and safety conditions at work and employee productivity. Ha1: There is a statistically significant relationship between health and safety conditions at work and employee productivity.Excel output table hereThe Pearson correlation coefficient of r = 0.600 indicates a moderately strong positive correlation between health and safety conditions and employee productivity. This equates to an r2 of 0.36, explaining 36% of the variance between the variables. Using an alpha of 0.05
- 1. APPENDIX A Appraisal Guide Recommendations of a Clinical Practice Guideline Citation: _____________________________________________________ ____________________ _____________________________________________________ ____________________ _____________________________________________________ ____________________ Synopsis What group or groups produced the guideline? What does the guideline address? Clinical questions, conditions, interventions? What population of patients does the guideline address? Did the panel use existing SRs or did it conduct its own? What clinical outcomes was the guideline designed to achieve? What are the main recommendations? What system was used to grade the recommendations? Credibility Was the panel made up of people with the necessary Yes *Does the guideline production process include all the widely *Wer clear Yes *Is the evidence supporting each Is the guideline current? (based on
- 2. No Clinical Significance Are essential elements of any recommended action or in No *Is the magnitude of benefit associated *Is the panel’s certainty or confidence clear No Yes Was the guideline reviewed by outside experts and a member of the public or field test Are the recommendations Applicability Does the guideline address a problem, Did the research evidence involve patients similar to ours, and was the What changes, additions, training, or purchases would be needed to implement and sustain a clinical protocol based on these conclusions?Specify. _____________________________________________________ _______________________ _____________________________________________________
- 3. _______________________ *Is what we will have to do to implement the new protocol realistically achievable by us (resources, capability, c Which departments and/or providers will be affected by a change?Specify. _____________________________________________________ _______________________ _____________________________________________________ _______________________ *How will we know if our patients are benefiting from our new protocol?Specify. _____________________________________________________ _______________________ _____________________________________________________ _______________________ Are the recommendations Should we proceed to design a protocol Implement Some * = Important criteria Comments _____________________________________________________ _______________________ _____________________________________________________ _______________________ APP A-2Brown BrownAPP A-1 2
- 4. Research Objective Students Name Institution Course Code and Name Professor Date Introduction Safety is a crucial component in an organization, especially in areas where harmful substances are extracted. The government, employees, and the organization executive have a role in ensuring safety. There are a bunch of perils in today's workplaces, which, if not taken care of, will result in employees' physical injuries and bruises, affecting their ability to report to duty and the organization's overall performance. Sun Coast should implement strategies that guarantee the health and safety of employees at work; if not, they could face serious lawsuits that could lead to hefty fines or even closure. A lot can be done to reduce employee illnesses and injuries by conducting a thorough risk assessment, making policies, and implementing the proper procedures (ComplianceQuest, 2022). Health strategies are crucial in ensuring that both Sun Coast and the employees understand the potential dangers in the workplace. Training is an additional component that could be used in Sun Coast to enlighten the employees on the right procedures, practices, and ways to act to reduce the risk of getting sick,
- 5. hurt, or contaminated. Finally, reimbursing for work-related illnesses and injuries affects the company's bottom line a lot, which is why it's essential to have health and safety procedures in place. However, apart from the company's management, the government has a role in enforcing health and safety laws requiring companies to follow specific rules when making their health and safety procedures (OSHA, 2022). Suppose a company doesn't ensure its employees have a safe workplace. In that case, hefty fines should be charged, or even the organization shut down temporarily or permanently, depending on how terrible the violations are. If the company does not adhere to the stipulated rules for health and safety, it could lose money, employees, clients, vendors, productivity, and the company's brand image. Research Problem Sun Coast Remediation has lost a significant amount of money in the past due to how unsafe and dangerous its work environment is. The company's management has observed that employees are calling in sick more often, getting hurt or sick more often, and performing less work. So, it's important to research how to make and enforce a health and safety policy, as well as how it impacts the company's employees and how well they do their jobs. Research Objective · To examine the correlation between health and safety at work and also how productive employees are. · To figure out what employers can do to improve health and safety at work. · To find out what employees can do to improve health and safety at work. · To propose a safety and health policy for Sun Coast Remediation that is complete and efficient. Research Hypothesis RQ1: What is the correlation between health and safety conditions at work and how productive workers are?
- 6. Ho: There exists no statistically significant connection between health and safety conditions at work (independent) and how productive workers are (dependent). H1: There is a statistically significant relation between health and safety conditions at work and how much work people get done. RQ2: What do employers do to enhance the health and safety of their employees at work? Ho: Employers do not even make a big difference when it comes to enhancing health and safety at work. H1: Employers have a significant role to play in improving health and safety at work. RQ3: What do staff do to improve health and safety at work? Ho: Employees don't make a big difference when it comes to improving health and safety at work. H1: Employees have a significant role to play in making the workplace more secure and healthier. Reference ComplianceQuest. (2022, September 21). What is Employee Safety and its importance & responsibilities? ComplianceQuest QHSE
- 7. Solution s. Retrieved September 26, 2022, from https://www.compliancequest.com/employee-safety- importance-and-responsibilities/ Employer Responsibilities | Occupational Safety and Health Administration (OSHA). (2022). Retrieved September 26, 2022, from https://www.osha.gov/workers/employer-responsibilities 1 Insert Title Here Insert Your Name Here
- 8. Insert University Here Course Name Here Instructor Name Date 2 Data Analysis: Hypothesis Testing Use the Sun Coast Remediation data set to conduct a correlation analysis, simple regression analysis, and multiple regression analysis using the correlation tab, simple regression tab, and multiple regression tab respectively. The statistical
- 9. output tables should be cut and pasted from Excel directly into the final project document. For the regression hypotheses, display and discuss the predictive regression equations if the models are statistically significant. Delete instructions and examples highlighted in yellow before submitting this assignment. Correlation: Hypothesis Testing Restate the hypotheses from document uploaded (ref: 29005302WK093921NResearchObjective.docx) Example: Ho1: There is no statistically significant relationship between height and weight. Ha1: There is a statistically significant relationship between height and weight.
- 10. Enter data output results from Excel Toolpak here. Interpret and explain the correlation analysis results below the Excel output. Your explanation should include: r, r2, alpha level, p value, and rejection or acceptance of the null hypothesis and alternative hypothesis. Example: 3 The Pearson correlation coefficient of r = .600 indicates a moderately strong positive correlation. This equates to an r2 of .36, explaining 36% of the variance between the variables. Using an alpha of .05, the results indicate a p value of .023 <
- 11. .05. Therefore, the null hypothesis is rejected, and the alternative hypothesis is accepted that there is a statistically significant relationship between height and weight. Note: Excel data analysis Toolpak does not automatically calculate the p value when using the correlation function. As a workaround, the data should also be run using the regression function. The Multiple R is identical to the Pearson r in simple regression, R Square is shown, and the p value is generated. Be sure to show your results using both the correlation function and simple regression function. Simple Regression: Hypothesis Testing Restate the hypotheses from document uploaded (ref:
- 12. Ho2: Ha2: Enter data output results from Excel Toolpak here. Interpret and explain the simple regression analysis results below the Excel output. Your explanation should include: multiple R, R squared, alpha level, ANOVA F value, accept or reject the null and alternative hypotheses for the model, statistical significance of the x variable coefficient, and the regression model as an equation with explanation. Multiple Regression: Hypothesis Testing Restate the hypotheses from from document uploaded (ref: 29005302WK093921NResearchObjective.docx)
- 13. 4 Ho3: Ha3: Enter data output results from Excel Toolpak here. Interpret and explain the simple regression analysis results below the Excel output. Your explanation should include multiple R, R squared, alpha level, ANOVA F value, accept or reject the null and alternative hypotheses for the model, statistical significance of the x variable coefficients, and the regression model as an equation with explanation.
- 14. 5 References Include references here using hanging indentations. Remember to remove this example. Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). SAGE.
- 15. Correlation Datajob sitemicronsmean annual sick days per employee141126.573854855410677721185.5995710410114.581 28.5413771458159.531677179.55189.571951020662185227.562 38.55249425372667277.57287.55292.773029317.563294336634 3835853618378.55380.78390.58408.544128424.5943674477455 10462.5124759484749855057513.5952865355544.910557.5956 2.57576.575886595660766149628563186428654106649677768 5.2106957706671867267736.56741.58758.56762877857810479 1058088811882768310284788576866.57877.56888.568938900. 599118929693779429958.57963.5997389876995.571007.57101 0.2121024810359 Simple Regression Datacontract #safety training expenditurelost time hours11161985.12102051500.003021461126.464016031294.104 09141445.56404371112.47505981720.816028011789.66601420 1837.52606822000.00607142271.866023361507.977022161542. 337013271544.907010251547.16709201567.55704651600.0070 1381452.698014111500.008014391500.008023881326.6090184 91351.259017401380.699016661423.579016721095.581002455 1132.881004031134.581008561163.4410020501170.921001271 1177.0510024291188.191008121323.291004051051.171101630 1054.0311023761071.751108611077.8611024361080.34110369 23.3712030957.1712076964.111201155976.641201273982.0612 01886985.69120630985.971204071000.001204881002.2712019 711035.4312062910.85130118912.351302912.3513042917.0213
- 17. 06.97240170215.37240115215.69240159215.99240125217.9924 0128218.00240105205.00245209169.58250190174.0925019917 9.06250110179.78250151192.61250219196.6525033201.362501 56202.71250161204.57250133205.00250131135.9926054145.59 26024152.6126048125.63270212128.0027091128.00270445.302 8018745.6928013450.002802451.23280656.8928013568.952801 32102.57280101102.5728034102.6428027103.5728086125.1828 0184731.362853570.9229014075.9029017397.97290131100.002 9042100.0029095100.0329017102.5629068102.5729019756.903 005956.90300268.0930011968.593001942.573202845.69320653 0.433301835.993309525.6934020126.603404026.9034019920.4 6360 Multiple Regression Datacontract #Frequency (Hz)Angle in DegreesChord LengthVelocity (Meters per Second)DisplacementDecibel142080000.180971.30.0026633712 6.201682100000.089371.30.00266337125.201714125000.03137 1.30.00266337125.9512336160000.186771.30.00266337127.591 2216200000.070571.30.00266337127.4611327250000.128171.3 0.00266337125.5711025315000.196671.30.00266337125.20192 0400000.135371.30.00266337123.061465500000.168871.30.002 66337121.301138630000.157871.30.00266337119.54114118000 00.055871.30.00266337117.15114391000000.151371.30.002663 37115.39123881250000.123871.30.00266337112.241184916000 00.127671.30.00266337108.721174050000.166655.50.00283081 126.416166663000.151555.50.00283081127.696167280000.122
- 55. 0437259133.80819040015.60.186371.30.0437259134.05819950 015.60.109971.30.0437259130.63811063015.60.178971.30.0437 259122.28815180015.60.106371.30.0437259124.188219100015. 60.175471.30.0437259124.43833125015.60.032471.30.0437259 123.178156160015.60.09871.30.0437259121.528161200015.60. 153571.30.0437259119.888133250015.60.198271.30.043725911 8.998131315015.60.128871.30.0437259116.46854400015.60.06 0871.30.0437259113.2982420015.60.175439.60.0528487123.51 44825015.60.1439.60.0528487124.64421231515.60.076339.60.0 528487122.7549140015.60.108839.60.0528487120.484450015.6 0.054339.60.0528487115.30418763015.60.154439.60.05284871 18.08413480015.60.045339.60.0528487118.96424100015.60.11 9739.60.0528487119.2246125015.60.19239.60.0528487118.214 135160015.60.159939.60.0528487114.554132200015.60.196739 .60.0528487110.894101250015.60.118739.60.0528487110.2643 4315015.60.164439.60.0528487109.25427400015.60.135439.60. 0528487106.60486500015.60.191539.60.0528487106.22418463 0015.60.1939.60.0528487104.204 Independent t Test DataGroup A Prior Training ScoresGroup B Revised Training Scores88888176809689798990618788895680748586886986508 37293657779926575758754887081718279855386807564905879 80768089509561796185748375835478719066895792838668807 79754898084628670807081828750836579768564775583618691 856891708850856491738273847282788470817684
- 56. Paired Samples t Test DataEmployeePre-Exposure μg/dLPost- Exposure μg/dL166288310104121251515616167171781818919191021211 12222122323132323142626152727162828172929182929193131 20313121333322343423343424353525353826364027364228364 42936363038383138383239393339393441413541413641413742 42384242394343404343414444424646434646444848454848464 949475050485050495656 ANOVA One-Way DataConsulting Project Return on Investment (%)A = AirB = SoilC = WaterD = Training1110458123661355811669754108861011661297587559 89591076119664975566438655854131012312910711911714812 8 1
- 57. Insert Title Here Insert Your Name Here Insert University Here 2 Sun Coast Remediation Course Project Guidance Background To help make a connection between business research and its use in the real world, this course will use an iterative course project. Throughout the term, you
- 58. will serve as the health and safety director for Sun Coast Remediation (Sun Coast). Sun Coast provides remediation services to business and governmental organizations. Most of their contracts involve working within contamination sites where they remove toxic substances from soil and water. In addition to the toxicity of the air, water, and soil their employees come into contact with, the work environment is physically demanding and potentially contributory to injuries involving musculoskeletal systems, vision, and hearing. Sun Coast genuinely cares about the health, safety, and well-being of their 5,500 employees, but they are also concerned about worker compensation costs and potential long-term litigation from injuries and illness related to
- 59. employment. Health and Safety Director Task Sun Coast hired you last month to replace the previous health and safety director, who left to pursue other opportunities. This is a critical position within the company because there are many health and safety-related issues due to the nature of the work. The former health and safety director was in the midst of analyzing these issues through the implementation of a research project when she left the organization.
- 60. 3 Sun Coast Remediation Course Project Introduction Senior leadership at Sun Coast has identified several areas for concern that they believe could be solved using business research methods. The previous director was tasked with conducting research to help provide information to make decisions about these issues. Although data were collected, the project was never completed. Senior leadership is interested in seeing the project through to fruition. The following is the completion of that project and includes the
- 61. statement of the problems, literature review, research objectives, research questions and hypotheses, research methodology, design, and methods, data analysis, findings, and recommendations. Statement of the Problems Six business problems were identified: Particulate Matter (PM) There is a concern that job-site particle pollution is adversely impacting employee health. Although respirators are required in certain environments, PM varies in size depending on the project and job site. PM that is between 10 and 2.5 microns can float in the air for minutes to hours (e.g., asbestos, mold spores, pollen, cement dust, fly ash),
- 62. while PM that is less than 2.5 microns can float in the air for hours to weeks (e.g. bacteria, viruses, oil smoke, smog, soot). Due to the smaller size of PM that is less than 2.5 microns, it is potentially more harmful than PM that is between 10 and 2.5 since the conditions are more suitable for inhalation. PM that is less than 2.5 is also able to be inhaled into the deeper regions of the lungs, potentially causing more deleterious health effects. It would be helpful to understand if there is a relationship between PM size and employee health. PM air quality data have been collected from 103 job sites, which is 4
- 63. recorded in microns. Data are also available for average annual sick days per employee per job- site. Safety Training Effectiveness Health and safety training is conducted for each new contract that is awarded to Sun Coast. Data for training expenditures and lost-time hours were collected from 223 contracts. It would be valuable to know if training has been successful in reducing lost-time hours and, if so, how to predict lost-time hours from training expenditures. Sound-Level Exposure Sun Coast’s contracts generally involve work in noisy environments due to a variety of heavy equipment being used for both remediation and the clients’ ongoing operations on the job
- 64. sites. Standard ear-plugs are adequate to protect employee hearing if the decibel levels are less than 120 decibels (dB). For environments with noise levels exceeding 120 dB, more advanced and expensive hearing protection is required, such as earmuffs. Historical data have been collected from 1,503 contracts for several variables that are believed to contribute to excessive dB levels. It would be important if these data could be used to predict the dB levels of work environments before placing employees on-site for future contracts. This would help the safety department plan for procurement of appropriate ear protection for employees. New Employee Training All new Sun Coast employees participate in general health and
- 65. safety training. The training program was revamped and implemented six months ago. Upon completion of the training programs, the employees are tested on their knowledge. Test data are available for two groups: Group A employees who participated in the prior training program and Group B 5 employees who participated in the revised training program. It is necessary to know if the revised training program is more effective than the prior training program. Lead Exposure Employees working on job sites to remediate lead must be
- 66. monitored. Lead levels in blood are measured as micrograms of lead per deciliter of blood (μg/dL). A baseline blood test is taken pre-exposure and postexposure at the conclusion of the remediation. Data are available for 49 employees who recently concluded a 2-year lead remediation project. It is necessary to determine if blood lead levels have increased. Return on Investment Sun Coast offers four lines of service to their customers, including air monitoring, soil remediation, water reclamation, and health and safety training. Sun Coast would like to know if each line of service offers the same return on investment. Return on investment data are available for air monitoring, soil remediation, water reclamation, and
- 67. health and safety training projects. If return on investment is not the same for all lines of service, it would be helpful to know where differences exist. soap and water, wipe the electrode area with a washcloth or gauze to roughen a small area of the skin when appropriate. Do not use alcohol for skin preparation; it dries out the skin. [level B] b. Consider daily ECG electrode changes. [level E] c. Do not use Spo2 finger clip sensor on the ear. [level C] d. Place Spo2 probe on warm extremities. [level C] 2. Assess alarm parameter settings and customize
- 68. according to individual patient’s condition and age to reduce clinically insignificant alarms. Check alarm settings at the start of every shift, with any AACN Practice Alert Scope and Impact of the Problem Alarm fatigue is a patient safety risk, occurring when clinicians are exposed to excessive numbers of alarms, particularly false and clinically insignificant alarms. This overexposure results in sensory overload and desensiti- zation to alarms. Consequently, response to alarms may be delayed or alarms may be missed altogether. Patients’ deaths have been attributed to alarm fatigue when a seri - ous clinical event was missed because the alarm was not heard or was assumed to be false.1 In recent studies,2,3 from 89% to 99% of electrocardiographic (ECG) monitor alarms were found to be false or clinically insignificant. To date, clinical strategies to reduce alarms and alarm fatigue have been focused on ECG and oxygen saturation (Spo2) alarms. However, evidence for these strategies is limited. Interventions presented here are primarily sup- ported by expert opinion and/or have demonstrated success in quality improvement projects. To reduce false
- 69. and clinically insignificant alarms and alarm fatigue, clinical units should assess their alarm burden and select interventions that address unit-specific needs. Expected Nursing Practice Bedside Care Providers 1. Use technology correctly and according to manu- facturer’s recommendations to minimize false and technical alarms: a. Provide proper skin preparation for ECG electrodes. Wash the electrode area with ©2018 American Association of Critical-Care Nurses doi: https://doi.org/10.4037/ccn2018468 Managing Alarms in Acute Care Across the Life Span: Electrocardiography and Pulse Oximetry AACN Levels of Evidence Level A Meta-analysis of quantitative studies or metasyn- thesis of qualita tive studies with results that consis tently support a specific action, intervention, or treatment
- 70. (including systematic review of randomized controlled trials) Level B Well-designed, controlled studies with results that consistently support a specific action, intervention, or treatment Level C Evidence from qualitative, systematic reviews of qualitative, descriptive, or correlational studies, or randomized controlled trials with inconsistent results Level D Peer-reviewed professional organizational standards with clinical studies to support recommen- dations Level E Multiple case reports, theory-based evidence from expert opinions, or peer-reviewed professional organiza- tional standards without clinical studies to support recommendations Level M Manufacturer’s recommendations only e16 CriticalCareNurse Vol 38, No. 2, APRIL 2018 www.ccnonline.org
- 71. change in patient condition and with any change in caregiver. Customize alarms according to unit or hospital policy. [level E] Nursing Leaders 1. Establish interprofessional teams to gather alarm- related data and address issues related to alarms, such as the development of policies and proce- dures. Consider developing a culture of suspend- ing alarms when staff are at the bedside performing patient care that may produce false alarms. Stan- dardize monitoring practices across clinical envi- ronments. Develop policies and procedures for nurses to customize bedside monitor alarms. [level E] 2. Ensure that the unit’s default alarm settings are appropriate for the patient population. Collaborate with an interprofessional team, including biomedi- cal engineering, to determine the appropriate default alarm settings for the unit’s patient population. Adjustments may include changes to alarm param- eter limits, on/off status, delay status, and priority
- 72. level of alarm. [level E] 3. Provide initial and ongoing education for end users of devices with alarms. Provide education on moni- toring systems and alarms, as well as operational effectiveness, to new nurses and all staff members on a periodic basis. Budget for ongoing education when purchasing monitoring systems. [level E] 4. Consider use of an alarm notification system (eg, mid- dleware, monitor watchers/technicians). [level E] 5. Monitor only those patients with clinical indications for monitoring. Collaborate with an interprofessional team to determine which patients in a population or care unit should be monitored and what param- eters to use. When appropriate, use the American Heart Association’s Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings.4 [level C] Supporting Evidence Bedside Care Providers 1. Use technology correctly and according to manu-
- 73. facturer’s recommendations. a. Provide proper skin preparation for ECG electrodes. Research,5 quality improvement reports,6-8 and expert opinion9-11 support proper skin preparation to decrease the number of false and technical alarms. Proper skin preparation before ECG electrodes are placed decreases skin impedance and signal noise, thereby enhancing conductivity.11 Washing the electrode area with soap and water, wiping with a washcloth or gauze, or when appropriate using the sandpaper on the electrode to roughen the skin (which helps remove part of the stratum corneum [outer layer of the epidermis] to reduce impedance) is the recommended skin preparation.4,5,10 Excessive hair at the electrode site should be clipped.10 Proper skin preparation has been included in quality improvement projects on alarm management as one component of bundled interventions that demonstrated reductions in alarms of 44% to 89%.6-8
- 74. b. Consider daily ECG electrode changes. Expert opinion10 and results of quality improvement projects6-8,12,13 suggest that changing ECG electrodes daily may decrease the number of false and technical alarms. In 3 quality improvement projects, daily electrode changes with proper skin prepara- tion resulted in a 19% to 46% reduction in alarms.6,8,12 In another quality improve- ment project, daily electrode changes were included in a bundled intervention, and alarms were reduced overall by 89%.7 A pediatric quality improvement project that included daily electrode changes in an alarm management bundle resulted in 55% reduc- tion in alarms.13 The effect of daily elec- trode changes as an intervention to reduce alarms has not been confirmed through research. Daily electrode changes may not be appropriate in patients with fragile skin such as older adults or premature infants. Soaking electrodes with water during the patient’s bath may reduce pain during electrode removal.13
- 75. c. Do not use Spo2 finger clip sensor on the ear. In a study of 30 adult patients under- going pulmonary function tests, Haynes14 www.ccnonline.org CriticalCareNurse Vol 38, No. 2, APRIL 2018 e17 e18 CriticalCareNurse Vol 38, No. 2, APRIL 2018 www.ccnonline.org demonstrated that a pulse oximeter finger clip placed on an ear did not provide clinically reliable Spo2 readings when compared with arterial blood gas analysis. d. Place Spo2 probe on warm extremities. Temperature was found to have an impact on the degree of pulse oximetry error in the operating room.15 2. Assess alarm parameter settings and customize according to the individual patient’s condition.
- 76. Customizing alarm settings on the bedside moni- tor to reflect a patient’s condition-specific factors and age may reduce clinically insignificant alarms. For example, turning off the atrial fibrillation alarm for a patient with known atrial fibrillation that will not be treated would eliminate alarms that are not actionable for that patient. Education on alarm customization has been provided as part of several quality improvement projects that have demonstrated reductions in total alarms.7,16-18 Nurses should check alarm settings to ensure that the settings are appropriate for the patient’s condi- tion at the start of each shift, with any change in the patient’s condition, and with any change in caregiver, and nurses should customize alarm settings in accordance with unit or hospital policy. Nursing Leaders 1. Establish interprofessional teams to gather alarm- related data and address improvement opportuni- ties related to alarms. Using an interprofessional team approach with stakeholders from the clinical, technical, and information technology communi- ties to gather alarm data and develop policies and
- 77. response algorithms helps to reduce alarms.13,17,19-22 The interprofessional team should include staff nurses. Gathering alarm data will assist in deter- mining the alarms that are most problematic for the specific unit (eg, false alarms, clinically insignif- icant alarms, technical alarms, duplicate alarms). The interprofessional team can establish policies to provide direction on which patients to monitor and on appropriate alarm parameters to optimize alarm systems and reduce alarms. For example, the policy should include appropriate suspension of alarms during patient care, which can decrease the number of audible alarms by 20%.23 Incorpo- rating this practice into nursing standards of care and unit orientation fosters a culture of appropri- ate alarm use, leading to safer environments for patients.21,22 2. Ensure default alarm settings are appropriate for the patient population. Changing the unit’s alarm default settings has decreased alarm rates,17,24 most likely by reducing the number of clinically insignificant alarms. In a medical-surgical unit with telemetry monitoring, changing the alarm
- 78. default for high heart rate from 120 to 130 beats per minute resulted in a 50% decrease in the num- ber of alarms.25 In a small pilot randomized trial,26 researchers investigated changes in default alarm settings as a method for reducing alarms. Several quality improvement projects have included changes to unit default settings as part of bundled interven- tions that resulted in reduction in the overall num- ber of alarms. These changes included changing the priority level of an alarm parameter, such as changing the alarm for ventricular tachycardia for >2 beats from high to low priority/nonaudible,16,26 eliminating duplicate alarms,7,12,18 changing alarm parameter default settings from on to off (eg, alarms for premature ventricular contractions),7,27-29 and widening alarm parameter limits (eg, increasing high heart rate limit and decreasing low heart rate limit).16,18,30 Widening alarm parameter limits was also supported by a recent systematic review.24 In a simulation study, increasing Spo2 alarm delays from 5 to 15 seconds decreased alarms by 70%, and decreasing the alarm limits from 90% to 88% decreased alarms by 45%.22 By combining these 2 approaches, alarms were reduced by 85%. In a pediatric quality improvement project, the Spo2
- 79. alarm delay was increased from 5 to 10 seconds and the high respiratory rate limit was increased, which resulted in an additional 25% reduction in alarms on the unit.13 However, changing default alarm parameter set- tings must be undertaken with caution because of the potential patient safety risk if actionable alarms are inadvertently eliminated by default alarm set- tings that are too wide or are inappropriate for the patient population.24,31 An interprofessional team www.ccnonline.org CriticalCareNurse Vol 38, No. 2, APRIL 2018 e19 should determine the appropriate default alarm settings for the unit’s patient population. In addition to changing the unit’s default alarm settings, consider development of alarm limit profiles for specialty patient groups (eg, based on age or diagnosis). 3. Provide initial and ongoing education on devices
- 80. with alarms. Education increases understanding of how monitoring systems and their alarms should be managed.17,32 Quality improvement projects to reduce alarms have included education of nursing staff.18,28 One project demonstrated that after receiving education and retraining, nurses indi- vidualized alarm settings at the outset, instead of adjusting settings in response to continual activa- tion of an alarm.18 Education must be robust, given the complexity of monitoring systems.28 The cost for educating end users of technology should be included in budgets. 4. Consider use of an alarm notification system. Alarm notification systems (eg, middleware, monitor watchers/technicians) are an additional safety measure to help nurses manage alarms. Notifying nurses of alarms via pagers or phones may be useful on units where alarm audibility is difficult because of the unit’s layout.33 Escalation rules and delays can be programmed into some systems to route an alarm to another caregiver if no response is received and to decrease the number of alarms to which the nurse is exposed.16,33 Reduction of alarms was demonstrated in a quality improve-
- 81. ment project using a paging system with an alarm escalation strategy and programmed delay times.33 Successful implementation requires unit-specific decisions about the type of device used, which alarms are forwarded to the device, and what rules are in place for delays, acknowledgment, and esca- lation.34 One study has demonstrated the potential for monitor watchers to reduce nurses’ exposure to alarms by intercepting false and clinically insignifi - cant alarms.35 Insufficient evidence exists to support the use of monitor watchers to improve patients’ outcomes,36 although other potential benefits have been suggested, such as reducing nurses’ time man- aging technical issues.4,37 One study demonstrated faster communication between monitor watchers and nurses using a 2-way communication badge, compared with a 1-way pager system.38 Imple- menting alarm notification systems requires cau- tion to ensure that alarm fatigue is not exacerbated by increasing the number of notifications to which nurses are exposed. 5. Monitor only those patients with clinical indica- tions for monitoring. Expert opinion and research
- 82. recommend monitoring only those patients with clinical indications for monitoring and for only as long as necessary, which can significantly decrease the number of clinically insignificant alarms.39-41 An interprofessional team should determine which patients in a population or care unit should be mon- itored and for what parameters. In 2017, the Amer- ican Heart Association published an update of their 2004 standards for ECG monitoring in hospitalized patients, specifying who should be monitored and for how long.4 Implementation/Organizational Support for Practice Bedside Care Providers Provide proper skin preparation for and placement of ECG electrodes. Use proper Spo2 probe and placement. Check alarm settings at the start of each shift, with any change in the patient’s condition, and with any change in caregiver.
- 83. Customize alarm parameter settings for individual patients in accordance with unit or hospital policy. Nurse Leaders Organize an interprofessional alarm management team. Develop unit-specific default parameters and alarm management policies. Provide ongoing education on monitoring systems and alarm management for unit staff. Develop policies/procedures for monitoring only those patients with clinical indications for monitoring. Need More Information or Help? 1. Contact a clinical practice specialist for additional information: Go to www.aacn.org, click Clinical e20 CriticalCareNurse Vol 38, No. 2, APRIL 2018
- 84. www.ccnonline.org Resources, and scroll down to select AACN Practice Resource Network. 2. AAMI Foundation alarm resources: http://www .aami.org/thefoundation/content.aspx? ItemNumber=1730 3. ECRI Institute alarm resources: https://www.ecri .org/resource-center/Pages/Alarms.aspx 4. National Association of Clinical Nurse Specialists Alarm Fatigue Toolkit: http://nacns.org/professional -resources/toolkits-and-reports/alarm-fatigue -toolkit/ 5. The Joint Commission National Patient Safety Goal on clinical alarm safety (NPSG.06.01.01): https:// www.jointcommission.org/assets/1/6/NPSG _Chapter_HAP_Jan2017.pdf Original Authors: Stacy Jepsen, MS, APRN, ACNS-BC, CCRN, and Susan Sendelbach, RN, PhD, CCNS, FAHA
- 85. Contributing Authors: Halley Ruppel, RN, MSN, CCRN, Marjorie Funk, RN, PhD, FAHA, FAAN, and Sharon Wahl, MSN, APRN- CCNS, CCRN Approved by the Clinical Resources Task Force, August 2017. Financial Disclosures None reported. References 1. Joint Commission. Medical device alarm safety in hospitals. Sentinel Event Alert. 2013;(50):1-3. 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.
- 86. 3. Bonafide CP, Localio AR, Holmes JH, et al. Video analysis of factors associated with response time to physiologic monitor alarms in a chil- dren’s hospital. JAMA Pediatr. 2017;171(6):524-531. 4. Sandau KE, Funk M, Auerbach A, et al. Update to practice standards for electrocardiographic monitoring in hospital settings: a Scientific Statement from the American Heart Association. Circulation. 2017;136(19):e273. 5. Clochesy JM, Cifani L, Howe K. Electrode site preparation techniques: a follow-up study. Heart Lung. 1991;20(1):27-30. 6. 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. 7. Sendelbach S, Wahl S, Anthony A, Shotts P. Stop the noise: a quality
- 87. improvement project to decrease electrocardiographic nuisance alarms. Crit Care Nurse. 2015;35(4):15-22. 8. 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. 9. Adams-Hamoda MG, Caldwell MA, Stotts NA, Drew BJ. Factors to con- sider when analyzing 12-lead electrocardiograms for evidence of acute myocardial ischemia. Am J Crit Care. 2003;12(1):9-16. 10. Block FE 3rd, Block FE Jr. Decreasing false alarms by obtaining the best signal and minimizing artifact from physiological sensors. Biomed Instrum Technol. 2015;49(6):423-431. 11. Patel SI, Souter MJ. Equipme nt-related electrocardiographic artifacts: causes, characteristics, consequences, and correction.
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