{"id":31,"date":"2016-05-16T19:56:39","date_gmt":"2016-05-16T19:56:39","guid":{"rendered":"http:\/\/[vc_row][vc_column][vc_column_text][caption%20id=attachment_143%20align=alignnone%20width=960]"},"modified":"2026-01-20T17:08:05","modified_gmt":"2026-01-20T17:08:05","slug":"breaking-the-sound-barrier","status":"publish","type":"post","link":"https:\/\/magazines.uthscsa.edu\/schools\/2016\/05\/16\/breaking-the-sound-barrier\/","title":{"rendered":"Nurses connect research, resources to ensure patient safety"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column][vc_column_text]The whir of the ventilators.\u00a0 The web of wires and tubes that wind across the walls.\u00a0 The flashing of lights and the constant buzzing and beeping of monitors by the patient\u2019s bedside.\u00a0 These sights and sounds are standard in any hospital Intensive Care Unit (ICU). Every mechanism is essential to monitoring a critically ill patient\u2019s vital signs and can mean the difference between life and death for the patient.\u00a0 This scenario may sound intimidating, even distracting. Now imagine you are a nurse in an ICU surrounded by dozens of critically ill patients at all hours of the day and night, responsible for these devices and the patients\u2019 well-being.\u00a0 Although hospital technologies are designed to improve patient safety, they can create new hazards if not carefully implemented and managed.\u00a0 The U.S. Joint Commission on Patient Safety reported that between January 2009 and June 2012, nearly 100 documented hospital device alarm-related hazards occurred in hospital ICUs and telemetry units across the country. Of those, 80 resulted in a patient\u2019s death. The remaining caused a patient permanent loss of function and unanticipated additional needed care.\u00a0 Unfortunately, perils like these transpire every day in hospitals nationwide and are a result of system and staff failures to respond in a timely and appropriate manner to alarm signals.\u00a0 The Commission found that in these cases the major contributing factors were: absent or inadequate alarm systems, improper alarm settings, alarm signals not audible in all areas, or alarm signals turned off. In 2013, the Commission made addressing and improving clinical alarm system safety a national goal.<\/p>\n<p><strong><em>Tackling an alarming trend<\/em><\/strong><br \/>\nOne researcher in the School of Nursing at The University of Texas Health Science Center at San Antonio is on a mission to improve safety outcomes for patients in the ICU through her study \u201cUsability Testing of ICU Cardiac Monitors: Guiding Quality Initiatives on Improving Clinical Alarm Systems Safety.\u201d\u00a0 Azizeh Sowan, Ph.D., RN, assistant professor in the Department of Health Restoration and Care Systems Management, is leading this unique study that analyzes both the alarm system technology and staff performance involved in safely and effectively caring for critically ill patients in the hospital.\u00a0 \u201cHospital staff has the ultimate responsibility of ensuring patients are safe throughout their hospital stay,\u201d Dr. Sowan said. \u201cNurses in particular must be alert, experienced with protocols and tailored care plans for every patient, and up-to-date with hospital equipment at all times.\u201d<\/p>\n<p>With technology advancing at such a high rate, Dr. Sowan said hospital devices are becoming more sophisticated and complex in design and function.\u00a0 \u201cEvery day in a single hospital, hundreds of alarms are triggered by patients\u2019 bedside monitors that are programmed to sense when patients are in distress. Those can translate into several thousand alarms sounding during a single shift depending on the unit,\u201d Dr. Sowan said. \u201cNurses are the primary responders to these monitors and the patients\u2019 needs,\u201d she said.\u00a0 Not all of the alarms require immediate intervention, however. The U.S. Joint Commission on Patient Safety estimated that between 85 percent and 99 percent of alarm signals do not require clinical intervention, such as when alarm parameters are set too rigidly causing alarms to sound precipitously and often; default settings are not adjusted for the individual patient; electrocardiography (ECG) electrodes have dried out; or sensors are not placed correctly on a patient\u2019s body.\u00a0 \u201cOftentimes, health care workers become desensitized or immune to the multiple alarms sounding and can become overwhelmed by information. This phenomenon is called \u2018alarm fatigue,\u2019\u201d Dr. Sowan said. \u201cIn some cases, health care workers respond by simply turning an alarm volume down, turning it off, or adjusting the alarm settings outside the limits that are safe and appropriate for the patient\u2014all of which can have serious or fatal consequences,\u201d she said. Some common patient injuries or deaths the Commission traced back to alarms included those caused by falls, delays in treatment, improper ventilator settings and medication errors.<\/p>\n<p><em><strong>Partnering to protect patients<\/strong><\/em><br \/>\nFunded by a grant from the UT Health Science Center\u2019s Nursing Advisory Council in 2015, Dr. Sowan reached out to School of Nursing alumnus Charles Reed, Ph.D., RN, CNRN, to partner with her in assembling a team at University Hospital, the UT Health Science Center\u2019s teaching hospital.\u00a0 Dr. Reed earned his B.S.N. in 1996, his M.S.N. in 2006 and his Ph.D. in 2014 all from the School of Nursing and now serves as executive director of the Center for Nursing Excellence at University Hospital.\u00a0 With University Hospital in close proximity to the university and with Dr. Reed at the helm of the hospital\u2019s patient care program, Dr. Sowan said \u201cwe had the trifecta of resources\u2014leadership, facilities and equipment, and availability of participants\u201d\u2014for their study.\u00a0 Dr. Reed added, \u201cThe collaboration between the School of Nursing faculty and University Hospital is first rate. It creates a pipeline for innovation and provides an excellent training ground for students who rotate through the program.\u201d Dr. Reed said more than 100 UT Health Science Center nursing students rotate through University Hospital each year to train and shadow their nurses.\u00a0 Drs. Sowan and Reed assembled a team to conduct the study in University Hospital\u2019s cardiac\/transplant ICU.\u00a0 \u201cNational research tells us that triggered alarm rates are the highest in ICUs across the nation and that cardiac monitors are associated with the highest number of alarms and patient deaths,\u201d Dr. Sowan said.<\/p>\n<p><em><strong>Team technique<\/strong><\/em><br \/>\nNurse team leaders Ileana Fonseca, M.S.N., RN, and Ana Vera, M.S.N., RN, collaborated with Albert Tarriela, RN, CCRN, to advance the studies. All work at University Hospital.\u00a0 Fonseca and Vera collected data from a survey of 30 ICU nurses at University Hospital, observed and monitored how the nurses used and interacted with the monitors, and performed usability tests of the monitors.\u00a0 Fonseca, who earned her M.S.N. in 2013 from the School of Nursing, said the study is uncovering a surplus of valuable information.\u00a0 \u201cWhat we\u2019re finding is that although all monitors are basically built and operate in a similar way, nurses navigate them in different ways,\u201d Fonseca said. \u201cThe newer models, like the ones University Hospital uses, are highly complicated,\u201d she said. \u201cWith the responsibility of caring for multiple critically ill patients, nurses need proper training and troubleshooting skills and practice on this technology.\u201d<\/p>\n<p><em><strong>Pioneering process<\/strong><\/em><br \/>\nDr. Sowan said the study is one-of-a-kind because it builds on two previous alarm fatigue studies embarked on in 2013.\u00a0 Albert Tarriela, RN, CCRN, who was among the 2013 study leaders, delved deeper into the details of the technology by working with a representative of the company that manufactures the monitors and a University Hospital biomedical engineer. They were able to retrieve and analyze data from the devices that shed light on how the devices work, how they are programmed, how the various settings operate and how nurses navigate them.\u00a0 \u201cThis previous knowledge coupled with the results from our current nurse surveys is allowing us to devise a training plan for nurses so they can learn how to adjust the parameters of the monitors to function safely and appropriately for each individual patient in their care,\u201d Dr. Sowan said. \u201cOne size does not fit all. Customizing care in all aspects and comprehensive training for all nurses are crucial to patient safety.\u201d<\/p>\n<p>As a result of Dr. Sowan\u2019s research, Dr. Reed and his nursing team have achieved a 25 percent reduction of the total number of false alarms triggered in the cardiac\/transplant ICU at University Hospital. Training and simulation sessions are being developed that will guide nurses in all hospital units and floors to efficiently and effectively program and operate monitors to prevent errors.\u00a0 \u201cIt\u2019s an exciting time to be a nurse with these new advancements in professional training,\u201d said Ileana Fonseca, M.S.N., RN. \u201cIt also makes me proud to be a part of this important research that is coming from my alma mater\u2014our very own School of Nursing. Ultimately, it\u2019s going to improve the work environment for nurses nationwide and most importantly, create a safer environment for our patients.\u201d[\/vc_column_text][\/vc_column][\/vc_row][vc_row opn_row_id=&#8221;top&#8221; opn_hide_navigation=&#8221;on&#8221;][vc_column][vc_column_text][\/vc_column_text][\/vc_column][\/vc_row][vc_row opn_row_id=&#8221;azizeh&#8221; opn_hide_navigation=&#8221;on&#8221; css=&#8221;.vc_custom_1768928881362{padding-top: 10px !important;padding-right: 10px !important;padding-bottom: 10px !important;padding-left: 15px !important;background-color: #f7f5f0 !important;}&#8221;][vc_column width=&#8221;1\/2&#8243;][vc_custom_heading text=&#8221;Azizeh Sowan, Ph.D., RN&#8221; font_container=&#8221;tag:h3|text_align:left&#8221; google_fonts=&#8221;font_family:Lato%3A100%2C100italic%2C300%2C300italic%2Cregular%2Citalic%2C700%2C700italic%2C900%2C900italic|font_style:400%20regular%3A400%3Anormal&#8221;][vc_column_text]Dr. Azizeh Sowan\u2019s\u00a0successful track record in\u00a0creating evidence-based\u00a0practice resources for\u00a0nurses and her expertise\u00a0in informatics has given\u00a0her team a leading edge in\u00a0research. Prior to joining\u00a0the UT Health Science\u00a0Center faculty, Dr. Sowan\u00a0was a nurse researcher\u00a0in her home country of\u00a0Jordan where she created\u00a0an interactive evidencebased\u00a0practice course that was placed online for health\u00a0care professionals in 15 Jordanian hospitals. The course\u00a0served as a resource to help clinicians learn how to find\u00a0answers to research questions involving patient care.\u00a0The success of the project earned Dr. Sowan the \u201cBest\u00a0Nursing Project in the Arab World Award\u201d from the\u00a0League of Arab States just three years ago.<br \/>\n\u201cI\u2019ve always had an interest in mathematics, physics\u00a0and incorporating logic and statistics into nursing\u00a0research,\u201d she said.\u00a0 For more information about Dr. Sowan, visit\u00a0<a href=\"https:\/\/www.uthscsa.edu\/stories\">UTHSCSA.edu\/stories\u00a0<\/a>and search for Dr. Azizeh Sowan.[\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_single_image image=&#8221;139&#8243; img_size=&#8221;large&#8221; onclick=&#8221;img_link_large&#8221;][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1768927909595{margin-top: 20px !important;padding-top: 10px !important;padding-right: 10px !important;padding-bottom: 10px !important;padding-left: 15px !important;background-color: #f7f5f0 !important;}&#8221;][vc_column width=&#8221;1\/2&#8243;][vc_custom_heading text=&#8221;Charles Reed, Ph.D., RN, CNRN&#8221; font_container=&#8221;tag:h3|text_align:left&#8221; google_fonts=&#8221;font_family:Lato%3A100%2C100italic%2C300%2C300italic%2Cregular%2Citalic%2C700%2C700italic%2C900%2C900italic|font_style:400%20regular%3A400%3Anormal&#8221;][vc_column_text]Mentoring nurses\u00a0and nursing students is\u00a0something Dr. Charles\u00a0Reed enjoys most about his\u00a0career. That\u2019s because he\u00a0remembers being mentored\u00a0by nurses he admired,\u00a0including his own mother,\u00a0Suellen Reed, Ph.D., RN,\u00a0who was among the School\u00a0of Nursing\u2019s first cohort of\u00a0faculty members when the\u00a0school opened in 1969. She\u00a0served as an associate dean and retired in 2000.\u00a0 \u201cWhen I was a kid, my mom would sometimes take me with her to the office in the School of Nursing,&#8221; Dr. Reed said. &#8220;I felt really comfortable there because it was an environment where learning and caring about people were encouraged. I wanted to be a part of that when I grew up.&#8221;\u00a0Today, Dr. Reed is fulfilling his dream. Armed with\u00a0three degrees in nursing from the UT Health Science Center, Dr. Reed leads in multiple roles: as executive\u00a0director of the Center for Nursing Excellence at University\u00a0Hospital, as a nationally published researcher, and as\u00a0a mentor to hundreds of nursing students who rotate\u00a0through University Hospital as part of their curriculum.\u00a0 \u201cIt is a privilege to be where I am today,\u201d he said.\u00a0\u201cI have the School of Nursing, my mom and my mentors\u00a0to thank for putting me on this remarkable path.\u201d[\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_single_image image=&#8221;393&#8243; img_size=&#8221;large&#8221; alignment=&#8221;right&#8221; onclick=&#8221;img_link_large&#8221;][\/vc_column][\/vc_row][vc_row][vc_column][vc_custom_heading text=&#8221;Article by Natalie A. Gutierrez&#8221; font_container=&#8221;tag:h6|text_align:left&#8221; google_fonts=&#8221;font_family:Lato%3A100%2C100italic%2C300%2C300italic%2Cregular%2Citalic%2C700%2C700italic%2C900%2C900italic|font_style:700%20bold%20italic%3A700%3Aitalic&#8221;][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>The whir of the ventilators.<br \/>\nThe web of wires and tubes that wind across the walls.<br \/>\nThe flashing of lights and the constant buzzing and beeping of monitors by the patient\u2019s bedside.<br \/>\nThese sights and sounds are standard in any hospital Intensive Care Unit (ICU).<\/p>\n","protected":false},"author":42,"featured_media":143,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"magazine":[24],"issue-year":[19],"featured-story":[],"class_list":["post-31","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-alumni","magazine-tribute","issue-year-19"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Nurses connect research, resources to ensure patient safety - Magazines of the Schools at UT Health San Antonio<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/magazines.uthscsa.edu\/schools\/2016\/05\/16\/breaking-the-sound-barrier\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Nurses connect research, resources to ensure patient safety - Magazines of the Schools at UT Health San Antonio\" \/>\n<meta property=\"og:description\" content=\"The whir of the ventilators. 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