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BACKGROUND: The prevalence of nuisance (technical) alarms is the leading cause of alarm fatigue resulting in decreased awareness and a reduction in effective care. The Joint Commission identified in their National Patient Safety goals alarm fatigue as a major safety issue. The introduction of noninvasive respiratory volume monitoring (RVM) has implications for effective perioperative respiratory status management. We evaluated this within the Kaiser Permanente health system. METHODS: This observational study was conducted at 4 hospitals in the Kaiser Permanente system. Standard data from RVM, pulse oximetry, and capnography were collected postoperatively in the post-anesthesia care unit (PACU) and/or on the general hospital floor. Devicespecific alarm types, rates, and respective actions were recorded and analyzed by non-study staff. RESULTS: RVM was applied to 247 subjects (143 females, body mass index 32.3 = 8.7 kg/m², age 60.9 = 13.9 y) providing 2,321 h. RVM alarms occurred 605 times (0.25 alarms/h); 64% were actionable and addressed, 17% were not addressed, 13% were self-resolved, and only 6% were nuisance. In a subgroup, RVM completed all 127 h of monitoring, whereas oximetry with capnography only completed 51 h with 12.9 alarms/h (73% nuisance). The overall RVM alarm rate was significantly lower than with either pulse oximeters or capnography monitors. We saw a nearly 1,000-fold reduction in nuisance alarms compared to capnography and a 20--50-fold reduction in nuisance alarms compared to pulse oximetry. CONCLUSIONS: Our study indicates that alarm fatigue due to nuisance alarms continues to be a clinical challenge in perioperative settings. Among the 3 common technologies for respiratory function monitoring, RVM had the lowest rate of overall technical alarms and the highest rate of compliance. Furthermore, with early interventions, none of the subjects monitored with RVM suffered any negative outcomes. [ABSTRACT FROM AUTHOR]

The VA health care system is the largest source of public mental health care in the country, providing specialty mental health care services to more than 550,000 veterans annually. This chapter reviews the nature and scope of VA psychiatric emergency services.

Previous studies have shown that bone mass is significantly decreased in chronic alcoholic white patients, especially those with evidence of liver involvement. However, liver disease is an independent risk factor for bone loss. In vitro studies have shown that alcohol has a direct effect on osteoblasts. The effects of chronic alcohol consumption on bone mass in the absence of liver disease are not known. In addition, the effect of alcohol on bone in black alcoholic subjects has not been examined previously. In the present study, we evaluated the effects of prolonged heavy alcohol intake on bone mass in both black (n = 21) and white (n = 19) male subjects without significant liver disease. Bone mineral density (BMD) of the lumbar spine and hip and various markers of bone metabolism in alcoholic subjects were compared with those in respective age-matched controls (n = 16 blacks and 14 whites). Mean values for BMD of the lumbar spine, total hip, and femoral neck were not significantly different between alcoholic subjects and their respective controls among either blacks or whites. In white subjects, age and duration of alcohol were noted to have significant independent effects on BMD, whereas in blacks, age was the only factor that significantly affected bone mass independently. In the absence of liver disease, prolonged heavy alcohol intake results in bone loss in white subjects. The skeleton of black subjects may be less affected by alcohol.