Editor’s Letter
Happy New Year to everyone! I always like this time of year because it is a time for renewal, a chance to do it over again and maybe get it right this time. The health club I belong to always has an overflow of members during the month of January as everyone strives for their resolution to lose weight and get fit. But each year, the membership starts to peter out around mid-February when the resolutions are harder to meet. I am hoping that I can get it right this year and I wish you all luck with your New Year’s Resolutions.
This month I am taking a look at childhood obesity which is a hot topic that is currently in the news. It is becoming a growing and concerning health problem. My other article is on a topic that was suggested to me by a friend who is a nurse. When she suggested I write about “alarm fatigue”, I was not sure what she was referring to. I am glad I followed her suggestion; it is a problem and one that should be brought to light. I would welcome your suggestions for article topics or your responses to an article I have written.
Childhood Obesity
The Center for Disease Control recently published some disturbing facts about a growing health concern. The problem of childhood obesity has considerably increased in recent years. In the past thirty years, childhood obesity has more than tripled. Between 16 and 33% of children and adolescents are considered obese. Obesity is probably the easiest medical condition to recognize and yet it is very difficult to treat. Unhealthy weight gain due to a lack of exercise and a poor diet is easily responsible for over 300,000 deaths each year. The annual cost to society for obesity is close to $100 billion.
Usually a child is not considered obese until the weight is at least 10% higher than what is recommended for their height and body type. To help differentiate, overweight is defined as having excess body weight for a particular height, from either fat, bone, muscle, water or a combination of factors. Obesity is defined as having an excess of body fat. Being overweight and/or obese is both the result of consuming more calories than the body expends. It sounds simple, however the causes of obesity are complex and they can include genetic, biological, behavioral and cultural factors.
Childhood obesity has both immediate and long-term effects on physical, emotional and mental health. Obese children are more likely to be treated for high blood pressure or high cholesterol, both of which put the youth at risk for cardiovascular disease. Obese adolescents are also more likely to have prediabetes, bone and joint problems and sleep apnea. In addition, obese kids usually experience social and psychological problems such as poor self-esteem and bullying.
Looking at long-term effects, children and teens that are obese have an 80% chance of being obese as an adult. Therefore, they would be more at risk for adult health problems such as heart disease, type 2 diabetes, stroke, osteoarthritis and several types of cancer. These health problems that obese adults face are just a few; many more illnesses and diseases are associated with obesity.
The key to combating childhood obesity is adopting healthy lifestyle habits which include eating healthy foods and engaging in physical activity. The only way to lose weight is to reduce the number of calories being eaten and to increase the level of activity. Since obesity usually effects more than one family member, lasting weight loss can be more effective if the whole family makes eating healthy and regular exercise a family activity.
Alarm Fatigue
A recent Boston Globe investigation has unearthed a dangerous trend in some hospitals that is putting some patients at risk. The Globe reports that more than 200 deaths nationwide over the past five years have been associated with problems stemming from the patients’ monitor alarms. In many of the cases, it is believed to be the result of “alarm fatigue”. Patients’ alarms are intended to alert medical personnel to any deviations from a pre-determined “normal” status for that particular patient. Alarm fatigue may occur when the number of monitor alarms overwhelms the clinicians, which could possibly lead to an alarm being silenced, ignored or disabled. Nurses have to respond to more than a dozen types of alarms that can sound hundreds of times a day, and many of these are false alarms. So, the result is that it is easy to become desensitized to a distress call and not react properly when a real emergency breaks out.
After several high profile incidents, the Boston Globe’s, Liz Kowalczyk conducted a thorough investigation of alarm fatigue in hospitals. One of the aforementioned incidents involved an 89 year old male patient at Massachusetts General Hospital who had a history of heart problems, was recovering from surgery and was awaiting a permanent pacemaker. He died in January of 2010 and just recently his family settled out of court with the hospital for $850,000. According to state and federal investigators, the 10 nurses on duty could not recall hearing the beeps at the central nurses’ station or seeing the scrolling ticker messages on three of the hallway signs that would have warned them that his heart rate fell and finally stopped after a 20 minute period. The investigators concluded that alarm fatigue experienced by the nurses working amongst constantly beeping monitors contributed to their inattention to the crisis at hand.
That case and the other Globe stories spurred the industry to closely examine the problem of alarm fatigue. Both the Joint Commission, which accredits hospitals and the US Food and Drug Administration, which regulates monitor manufacturers, recently participated in an alarm summit at Washington, D.C. Many institutions are already trying to make changes to eliminate alarm fatigue, such as cutting back on unnecessary monitors and having warnings appear on nurses’ pagers or cell phones.
To back up her research, Kowalczyk got some quotes from some frustrated nurses.
“Everyone who walks in the door gets a monitor,” said Lisa Sawtelle, a nurse at Boston Medical Center. “We have 17 types of alarms that can go off at any time. They all have different pitches and different sounds. You hear alarms all the time. It becomes…background.”
“Yes, this is real, and, yes, it’s getting worse,” said Carol Conley, chief nursing officer for Southcoast Health System, which includes Tobey Hospital. “We want to keep our patients safe and take advantage of all the technology. The unintended consequence is that we have a very over-stimulated environment.”
CBS News Medical Correspondent Dr. Jennifer Ashton feels that the alarms set up a ‘cry-wolf’ scenario where every 90 seconds an alarm is going off on just one patient. If the nurses have to constantly silence them, it takes away from giving patients quality care.