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CRNA Career Pro
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The leading resource for CRNA School applicants!
The leading resource for CRNA School applicants!

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ATTENTION: CRNA school applicants! Are you preparing for a CRNA school interview? This video is the only resource you will need to ACE your Nurse Anesthesia interview.🏅 👉 Please leave any questions in the comment section under the video on our Youtube channel! We would be more than happy to answer any questions that you will have such as, will there be a written test, are the questions clinically based or more of a meet and greet, and much more. We have a summary of every programs interview style and question types. 👉 So please leave you comments under the video located on our Youtube channel, so we can help you to prepare for your big day. 👍#BeComeACRNA #AceTheIntervie #CrnaCareerPro
https://youtu.be/yqbOxzQU-qI

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Here is a great resource for CRNAs and Anesthesiologist to use when evaluating the job market. Find job openings easily! #BecomeaCRNA #SleepJobs #CrnaCareerPro
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Attention NURSES (Pop Quiz)!!! #Nursing #CrnaCareerPro
More questions: http://www.crna-school-admissions.com
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This EKG represents which of the following? #BeaCRNA   #nurses  
a. 2nd degree AV block (Mobitz Type 2)
b. 1st degree AV block
c. 3rd degree AV block (complete heart block)
d. 2nd degree AV block (Mobitz Type 1)

More questions at: www.crna-school-admissions.com
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What bigger reward is there than taking care of such a sweet patient, and them doing so well! (Please Share) ‪#‎LoveMyJob‬ ‪#‎BeaCRNA‬ #nursing  
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Which of the following would you want to avoid the most with mitral regurgitation (insufficiency)?
a. tachycardia
b. bradycardia
c. decreased afterload
d. normal preload

More practice questions at: www.crna-school-admissions.com
#BecomeaCRNA #CRNASchool
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Learn how you can afford CRNA school. #CRNASchool   #BecomeaCRNA   #Nursing  

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Attention Nurses: Turn your nursing Degree into an Advanced Practice Nursing degree in 28 months! #BecomeaCRNA   #CRNASchool  

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Anesthesia Professionals and Alarm Fatigue

Failing to notice or ignoring an alarm is often the result of a clinician’s “alarm” or “alert fatigue.” The widespread safety issue has been a widespread concern for years. As electronic devices in hospitals multiply, staff are subjected to 1,000 or more alerts per day—and only a small minority of these require any action. Anesthesiologists should consider leading the effort to develop customized alarm management policies in their institutions.

The ASA adopted its Statement on Principles for Alarm Management for Anesthesia Professionals at its annual meeting in October 2013. The introduction to the Statement provides as follows:

As Anesthesia Professionals, we interact with many different types of monitors, machines, infusion pumps and other equipment; many of these devices have audible and/or visual alarms. We rely on alarms to signal us when set parameters/ thresholds are violated and/or when a potentially abnormal situation has occurred. A given alarm’s clinical usefulness depends on numerous factors including attributes of the patient (e.g., baseline clinical status and vital signs), the clinical situation at the time (e.g., anesthetic and procedural factors), the intended recipient(s) (e.g., experience, hearing acuity), unintended recipients (who may be distracted or worried), and the physical environment (e.g., noise and light levels). Management of these alarms becomes challenging, especially in that we must rapidly discern when a trigger is trivial, meaningful or life threatening.

After five years of heading ECRI’s list of Top 10 Health Technology Hazards, missed alarms are now in the number two position. “Missed alarms” include those occurring “when the condition is communicated to clinical staff, but not appropriately addressed—whether because staff fail to notice the alarm, choose to ignore an alarm that warrants a response, or otherwise respond incorrectly.” Failing to notice or ignoring an alarm is often the result of the clinicians’ “alarm” or “alert fatigue.”

Case Report 14-4 from the Anesthesia Quality Institute’s Anesthesia Incident Reporting System AQI-AIRS) defines alarm fatigue as “the process in which providers, exposed to excessive or irrelevant alarms and alerts, modify their responsiveness to alarms—from ignoring alarms to silencing them altogether.”

Anesthesiologists and nurse anesthetists rely on a panoply of monitors to care for their patients on the operating table and in the critical care unit. One among many examples of the importance of these monitors in triggering life-saving actions comes from a 2014 Ohio malpractice case. In Burk v. Fairfield Ambulatory Surgery Center, the premature release of a tourniquet placed for a Bier block caused a bolus of lidocaine to be introduced into the plaintiff’s system, which in turn caused her to suffer an arrhythmia and to stop breathing. Although the blood pressure monitor, pulse oximeter and EKG all had alarms, none sounded, and the patient quickly coded. She was resuscitated, intubated and transferred to the hospital, where she stayed for 23 days. The patient sued the surgery center and the anesthesiologist and his group, citing numerous injuries, including cardiac arrest, anoxic brain injury, and memory and speech deficits. The Ohio appellate court reversed the trial court’s denial of the defendants’ motion for summary judgment and sent the case back to the trial court.

The AQI-AIRS report cited above notes that “The problem of alarm fatigue results from clinical alarms systems functioning as screening rather than diagnostic studies, favoring sensitivity and negative predictive value over specificity and positive predictive value. The zeal to detect and alarm for every potentially dangerous situation has ironically decreased patient safety by creating an epidemic of false-positive alarms leading to alarm fatigue.” and lists five scenarios showing alarm fatigue that will probably be familiar to many anesthesia professionals. Some of these scenarios are:

1. Transferred patient from O.R. (kidney/pancreas transplant) to the ICU ... Nurses were busy attaching ECG leads while I packed up portable monitor. SpO2 is 88 percent, no alarms sounding. O2 Sat number blinking red, but nobody is paying attention to it. Placed mask back on patient and encouraged him to breathe. SpO2 back to 100 percent.

2. Default alarm volumes on multiple anesthesia machines are found to have been set to the lowest (inaudible volume) value.

3. Attending is insisting that all alarms be disabled prior to giving an anesthetic on all cardiac patients. Anesthesia technicians have been instructed to accomplish this. I don’t feel this is safe.

In all of these cases, useful alarms were turned off or muted, presumably in response to the distraction or annoyance of false alarms. Anesthesia clinicians may sometimes set alarm conditions too high, turn alarm volumes down or off, or neglect to adjust alarm default settings for specific patients or populations. In some instances, the anesthesiologist or CRNA may not hear an alarm, or they may be distracted and might hear the alarms only after a significant amount of precious minutes have lapsed. In other instances, a series of cascading minor alarm failures is the culprit.

While most clinicians recognize the critical role alarms play, they often become desensitized to alarms and overwhelmed by all the noise. According to the Joint Commission, one single hospital patient can set off several hundred alarms each day, depending on the severity of their condition, while as few as one percent of all alarm signals even require clinical intervention. Keith Ruskin, MD and Dirk Hueske-Kraus, MD noted in their article Alarm Fatigue: Impacts on Patient Safety in the December 2015 issue of Current Opinions in Anesthesiology that “Electronic medical devices are an integral part of patient care. As new devices are introduced, the number of alarms to which a healthcare professional may be exposed may be as high as 1000 alarms per shift. The US Food and Drug Administration has reported over 500 alarm-related patient deaths in five years.” Shefali Luthra, in Screen Flashes and Pop-Up Reminders: ‘Alert Fatigue’ Spreads Through Medicine(Kaiser Health News, June 15, 2016), quoted an assistant professor of medicine at Harvard Medical School as saying that “Clinicians ignore safety notifications [from electronic health records] between 49 percent and 96 percent of the time.”

Read the rest of our article here: http://ow.ly/Jb2y302ajor

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