Team-Based Intervention to Reduce the Impact of Nonactionable Alarms in an Adult Intensive Care Unit

Alarm Management in Provisional COVID-19 Intensive Care Units: Retrospective Analysis and Recommendations for Future Pandemics

BACKGROUND

In response to the high patient admission rates during the COVID-19 pandemic, provisional intensive care units (ICUs) were set up, equipped with temporary monitoring and alarm systems. We sought to find out whether the provisional ICU setting led to a higher alarm burden and more staff with alarm fatigue.

OBJECTIVE

We aimed to compare alarm situations between provisional COVID-19 ICUs and non-COVID-19 ICUs during the second COVID-19 wave in Berlin, Germany. The study focused on measuring alarms per bed per day, identifying medical devices with higher alarm frequencies in COVID-19 settings, evaluating the median duration of alarms in both types of ICUs, and assessing the level of alarm fatigue experienced by health care staff.

METHODS

Our approach involved a comparative analysis of alarm data from 2 provisional COVID-19 ICUs and 2 standard non-COVID-19 ICUs. Through interviews with medical experts, we formulated hypotheses about potential differences in alarm load, alarm duration, alarm types, and staff alarm fatigue between the 2 ICU types. We analyzed alarm log data from the patient monitoring systems of all 4 ICUs to inferentially assess the differences. In addition, we assessed staff alarm fatigue with a questionnaire, aiming to comprehensively understand the impact of the alarm situation on health care personnel.

RESULTS

COVID-19 ICUs had significantly more alarms per bed per day than non-COVID-19 ICUs (P<.001), and the majority of the staff lacked experience with the alarm system. The overall median alarm duration was similar in both ICU types. We found no COVID-19-specific alarm patterns. The alarm fatigue questionnaire results suggest that staff in both types of ICUs experienced alarm fatigue. However, physicians and nurses who were working in COVID-19 ICUs reported a significantly higher level of alarm fatigue (P=.04).

CONCLUSIONS

Staff in COVID-19 ICUs were exposed to a higher alarm load, and the majority lacked experience with alarm management and the alarm system. We recommend training and educating ICU staff in alarm management, emphasizing the importance of alarm management training as part of the preparations for future pandemics. However, the limitations of our study design and the specific pandemic conditions warrant further studies to confirm these findings and to explore effective alarm management strategies in different ICU settings.

Critical Care Alarm Fatigue and Monitor Customization: Alarm Frequencies and Context Factors

BACKGROUND

Alarm fatigue among nurses working in the intensive care unit has garnered considerable attention as a national patient safety priority. A viable solution for reducing the frequency of alarms and unnecessary noise is intensive care unit alarm monitor customization.

LOCAL PROBLEM

A 24-bed cardiovascular and thoracic surgery intensive care unit in a large academic medical center identified a high rate of alarms and associated noise as a problem contributing to nurse alarm fatigue.

METHODS

An alarm monitor quality improvement project used both alarm frequency and nurse surveys before and after implementation to determine the effectiveness of interventions. Multimodal interventions included nurse training sessions, informational flyers, organizational policies, and an alarm monitor training video. Unexpected results inspired an extensive investigation and secondary analysis, which included examining the data-capturing capabilities of the alarm monitors and the impact of context factors.

RESULTS

Alarm frequencies unexpectedly increased after the intervention. The software data-capturing features of the alarm monitors for determining frequency did not accurately measure nurse interactions with monitors. Measured increases in patient census, nurse staffing, and data input from medical devices from before to after the intervention substantially affected project results.

CONCLUSIONS

Alarm frequencies proved an unreliable measure of nurse skills and practices in alarm customization. Documented changes in context factors provided strong anecdotal evidence of changed circumstances that clarified project results and underscored the critical importance of contemporaneous collection of context data. Designs and methods used in quality improvement projects must include reliable outcome measures to achieve meaningful results.

The relationship between alarm fatigue and burnout among critical care nurses: A cross-sectional study

BACKGROUND

Alarm fatigue has significant negative impacts on nurses and patient safety. However, the relationship between alarm fatigue and burnout is still unclear.

AIMS

This study aimed to explore the relationship between alarm fatigue and burnout among critical care nurses.

STUDY DESIGN

A descriptive-analytical cross-sectional study design was used. Data were collected from five hospitals in mainland China between January 2022 and March 2022. A general information questionnaire, the Chinese version of the Intensive Care Unit Nurse Alarm Fatigue Questionnaire, and the Chinese version of the Maslach Burnout Inventory were used.

RESULTS

A total of 236 critical care nurses were enrolled in this study. The mean score of alarm fatigue among critical care nurses was 21.11 ± 6.83. The results showed that critical care nurses experienced moderate alarm fatigue levels, and most nurses had moderate to high levels of burnout. The multiple linear regression analyses showed that alarm fatigue was independently associated with emotional exhaustion, depersonalization dimensions, and reduced personal accomplishment dimension.

CONCLUSIONS

Alarm fatigue was associated with burnout among critical care nurses. Reducing critical care nurses' alarm fatigue may help to alleviate burnout.

RELEVANCE TO CLINICAL PRACTICE

Managers should provide comprehensive training for nurses and promote the application of artificial intelligence technology in alarm management to reduce alarm fatigue and improve burnout among critical care nurses.

Technological Intervention to Improve Alarm Management in Acute Care Telemetry Units

Background: Telemetry monitoring is intended to improve patient safety and reduce harm. However, excessive monitor alarms may have the undesired effect of staff ignoring, silencing, or delaying a response due to alarm fatigue. Outlier patients, or those patients who are responsible for generating the most monitor alarms, contribute to excessive monitor alarms. Methods: Daily alarm data reports at a large academic medical center indicated that one or two patient outliers generated the most alarms daily. A technological intervention aimed at reminding registered nurses (RNs) to adjust alarm thresholds for patients who triggered excessive alarms was implemented. The notification was sent to the assigned RN's mobile phone when a patient exceeded the unit's seven-day average of alarms per day by greater than 400%. Results: A reduction in average alarm duration was observed across the four acute care telemetry units (P < 0.001), with an overall decrease of 8.07 seconds in the postintervention versus preintervention period. However, alarm frequency increased significantly (χ23 = 34.83, P < 0.001). Conclusion: Implementing a technological intervention to notify RNs to adjust alarm parameters may reduce alarm duration. Reducing alarm duration may improve RN telemetry management, alarm fatigue, and awareness. More research is needed to support this conclusion, as well as to determine the cause of the observed increase in alarm frequency.

The effect of interventions made in intensive care units to reduce alarms: A systematic review and meta-analysis study

OBJECTIVES

This study examines the effects of the interventions in alarm management in intensive care units on reducing alarms on the basis of current evidence.

METHODOLOGY

This systematic review and meta-analysis study was conducted between January 1, 2010 and October 31, 2021 by searching 16 databases through an independent search by three researchers. The acronym of PICOS was used and the keywords as well as inclusion/exclusion criteria were determined. The Joanna Briggs Institute meta-Analysis of Statistics Assessment and Review Instruments (JBI-MAStARI) were used to assess methodological quality. Professional meta-analysis Software (ProMeta 3) statistical software package was used for data analysis. The study is preregistered on PROSPERO (CRD42021286770).

SETTING

Intensive care units.

RESULTS

The systematic review included 25 studies, whereas the meta-analysis included 15. According to the heterogeneity test in the study, alarm-reducing interventions yielded a heterogeneous distribution. The overall effect size value of all studies, which was found using the random-effects model, was determined to be -0.03 [95 % confidence interval (CI)], a value between -0.16 and 0.10 CI. Based on the results, individual studies showed that the strategies suggesting to ensure alarm safety were effective in reducing the number of alarms; the combined results of the studies in this meta-analysis showed that the interventions made to reduce alarms had too little effect.

CONCLUSION

This study showed that the interventions have a very weak effect size on reducing the number of alarms.

Premature ventricular complexes during continuous electrocardiographic monitoring in the intensive care unit: Occurrence rates and associated patient characteristics

AIMS AND OBJECTIVES

This study examined the occurrence rate of specific types of premature ventricular complex (PVC) alarms and whether patient demographic and/or clinical characteristics were associated with PVC occurrences.

BACKGROUND

Because PVCs can signal myocardial irritability, in-hospital electrocardiographic (ECG) monitors are typically configured to alert nurses when they occur. However, PVC alarms are common and can contribute to alarm fatigue. A better understanding of occurrences of PVCs could help guide alarm management strategies.

DESIGN

A secondary quantitative analysis from an alarm study.

METHODS

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was followed. Seven PVC alarm types (vendor-specific) were described, and included isolated, couplet, bigeminy, trigeminy, run PVC (i.e. VT >2), R-on-T and PVCs/min. Negative binomial and hurdle regression analyses were computed to examine the association of patient demographic and clinical characteristics with each PVC type.

RESULTS

A total of 797,072 PVC alarms (45,271 monitoring hours) occurred in 446 patients, including six who had disproportionately high PVC alarm counts (40% of the total alarms). Isolated PVCs were the most frequent type (81.13%) while R-on-T were the least common (0.29%). Significant predictors associated with higher alarms rates: older age (isolated PVCs, bigeminy and couplets); male sex and presence of PVCs on the 12-lead ECG (isolated PVCs). Hyperkalaemia at ICU admission was associated with a lower R-on-T type PVCs.

CONCLUSIONS

Only a few distinct demographic and clinical characteristics were associated with the occurrence rate of PVC alarms. Further research is warranted to examine whether PVCs were associated with adverse outcomes, which could guide alarm management strategies to reduce unnecessary PVC alarms.

RELEVANCE TO CLINICAL PRACTICE

Targeted alarm strategies, such as turning off certain PVC-type alarms and evaluating alarm trends in the first 24 h of admission in select patients, might add to the current practice of alarm management.

An Evidence-Based Initiative to Reduce Alarm Fatigue in a Burn Intensive Care Unit

BACKGROUND

Alarm fatigue occurs when nurses are exposed to multiple alarms of mixed significance and become desensitized to alarms to the point that a critical alarm may receive no response or a delayed response. In burn intensive care units, reducing the risk of alarm fatigue is uniquely challenging because of the critically ill patient population and the nature of burn skin injuries. Nurses and the interdisciplinary team can become fatigued and desensitized to alarms, decreasing response rates for necessary interventions.

OBJECTIVE

To decrease the risk of alarm fatigue by using an initiative designed to reduce nonactionable and false alarms in a burn intensive care unit.

METHODS

Baseline data (alarm count per patient-day by alarm type) were collected for 1 month before education and implementation of evidence-based interventions. Data were collected every 6 months for 2 years.

INTERVENTIONS

A series of interventions included raising awareness of the risks associated with alarm fatigue, customizing alarm parameters and default settings, providing education on electrode placement and daily electrode changes, using physical reminders, and consistently sharing alarm data. The education, delivered in modules, aligned with the evidence-based interventions.

RESULTS

Preintervention baseline data were compared to postintervention data at 6, 12, 18, and 24 months. The results showed a significantly sustained reduction (P < .001) in total alarm rate over time.

CONCLUSION

A quality improvement initiative based on evidence-based practice can contribute to a sustainable reduction in nonactionable and false alarms, ultimately improving patient safety.