The following scenario is derived from incidents reported to CHPSO:
A stable, ventilator-dependent patient (KP) was placed in a room across from the nurses’ station. The nurse caring for this patient then received a post-operative patient whose condition was deteriorating. A code was called for the post-op patient and several staff in the area responded to assist. During this emergency, KP’s ventilator tubing had become disconnected and the ventilator started alarming. However, no one responded to the alarm until a custodian passing by approached the nurses’ station and notified the unit clerk that he had noticed an alarm coming from KP’s room for several minutes and wanted to make sure someone was notified. At this point, the clinical staff realized that KP was quickly deteriorating and immediately responded. Unfortunately, they could not resuscitate KP.
Diffuse responsibility is a recognized safety concern in clinical alarm management. In order to manage the large amount of noise in busy and monitored environments, clinicians often “tune out” alarms that are not related to their own patient assignment. There is an underlying assumption that someone else is responding to an alarm associated with another clinician’s patient. Personnel in the area who are not clinicians are intimidated by alarms and assume that a clinician will respond. One approach to solving this issue is to implement the “No Pass Zone.”
Creating a No Pass Zone
The No Pass Zone concept originated as a patient experience initiative to provide quick and effective responses to patients’ needs. Employees are reminded that care of the patient is everyone’s responsibility and they are expected to respond to alarms and patient call lights when walking through the hallways. They should not continue to pass by the patient’s room or someone in need of help without stopping to assist. Mercy Gilbert Medical Center in Gilbert, Arizona created a YouTube video to demonstrate their No Pass Zone.
Developing a trusting patient‐provider relationship is an ongoing process. Patients trust that their needs and concerns will be addressed in a timely manner. When a patient is waiting on someone to meet even their basic needs, it may seem like a long time to receive a response. Once a patient pushes a call light for help, they expect that help is on the way. Imagine the patient waiting, perhaps seeing people walk by the door, talking and laughing. With the No Pass Zone, a patient’s call is quickly acknowledged, even if the initial responder is unable to take definitive action.
While this began as a patient experience initiative, there are many patient safety issues that can be addressed through creating a culture where everyone is responsible for addressing the patient’s needs. For example, patients often use their call light to ask for assistance in walking to the restroom. If they are concerned that the wait for help is too long, they may get out of bed unassisted, endangering themselves to a fall. Additionally, the No Pass Zone reduces the risk that diffuse responsibility will result in a delayed response to an alarm.
The acronym AIDET serves as a guide when stopping at the patient’s room to assist.
Acknowledge: Knock on patient’s door before entering room. Perform hand hygiene before entering room. Address the patient by name when possible. State your purpose. Introduce: State your name and occupation. Let the patient know the reason you are there. If you cannot respond to the patient’s need, let them know that you will find someone who can (see section below on response by non-clinicians). Duration: Report back to the patient to let them know how long until someone can assist, and stay until that person arrives Explanation: Explain what you are doing and why. Use language that patients and their families will understand. Ask if there are questions or concerns. Thank you: A patient may think that they have inconvenienced you when asking for help. Thank them for alerting you for the need of assistance and ask if there is anything else you can do to help. Perform hand hygiene before leaving the patient’s room.
How should a non-clinician respond to a call light or alarm?
There are situations when only a clinician can appropriately address the patient’s needs.
Here are some guidelines for activities that only a clinician should directly assist:
Physically assist a patient
Turn off alarms
Enter an isolation room (unless trained and authorized)
Offer pain relief
Explain clinical matters
Explain tests and treatments or patient scheduling
Manage an IV or IV pump
Move meal trays and/water pitchers
Assist patient with eating or give a drink
Raise or lower a patient bed
Assist a patient in or out of bed
If you are a non-clinician responding to an alarm, determine if the patient is in immediate distress and activate the emergency system (i.e., code alert). If you are responding to an alarm, do not turn off or silence the alarm. The nearest clinician should be notified. If responding to a patient call light, let the patient know that you are not trained to do what they are requesting, but you will find someone who is able to assist them.