Educational Program for Physiologic Monitor Use and Alarm Systems Safety: A Toolkit

Implementing a Unit-Based Alarm Management Bundle for Critical Care Nurses

Background

Clinical alarms are designed to signal an unsatisfactory patient physiological state and alert staff members to malfunctioning medical equipment. Alarm desensitization and fatigue can occur when clinicians are exposed to an overwhelming number of clinical alarms, particularly nonactionable alarms.

Local Problem

Alarm fatigue and alarm management competency related to use of Philips monitoring systems were noted to be problematic among nurses working in the 27-bed surgical intensive care unit of a teaching hospital in northeastern Florida.

Methods

A quality improvement project was conducted to reduce alarm fatigue and improve nursing competency in managing alarms. The CEASE (Communication, Electrodes, Appropriateness, Setup, and Education) evidence-based alarm management bundle was implemented on the unit, and a representative from the alarm manufacturer conducted in-service training sessions. A clinical alarms survey developed by the Healthcare Technology Foundation was distributed both before and after the intervention to 115 nurses working in the unit. Descriptive and inferential statistics were used to assess for differences between the preintervention and postintervention periods.

Results

Nurse participants demonstrated improved alarm management competency, resulting in significant improvements in their perceptions of alarm functionality, settings, response time, and policy adherence. There was a statistically significant decrease in self-reported alarm fatigue, and the CEASE bundle was found to influence nursing practice.

Conclusions

The Joint Commission’s 2022 goal of improving clinical alarm safety remains a top priority nationwide. Implementation of the CEASE alarm management bundle was effective in reducing surgical intensive care unit nurses’ alarm fatigue and improving their alarm management practices.

State of Science in Alarm System Safety: Implications for Researchers, Vendors, and Clinical Leaders

Alarm fatigue is a complex phenomenon that needs to be assessed within the context of the clinical setting. Considering that complexity, the available information on how to address alarm fatigue and improve alarm system safety is relatively scarce. This article summarizes the state of science in alarm system safety based on the eight dimensions of a sociotechnical model for studying health information technology in complex adaptive healthcare systems. The summary and recommendations were guided by available systematic reviews on the topic, interventional studies published between January 2019 and February 2022, and recommendations and evidence-based practice interventions published by professional organizations. The current article suggests implications to help researchers respond to the gap in science related to alarm safety, help vendors design safe monitoring systems, and help clinical leaders apply evidence-based strategies to improve alarm safety in their settings. Physiologic monitors in intensive care units-the devices most commonly used in complex care environments and associated with the highest number of alarms and deaths-are the focus of the current work.

Does alarm fatigue start in nursing school?

PURPOSE

Alarm fatigue among working nurses is a well-documented, high-priority safety issue. This article describes a study to learn whether alarm fatigue develops in undergraduate nursing student populations.

METHODS

This longitudinal quantitative study employed survey data from a single cohort of nursing students in the Southeastern US over a period of 18 months to assess nursing students' level of sensitivity to alarms, including the call bell, bathroom, fall and safety, I.V. infusion pumps, and telemetry alarms.

RESULTS

These data were significant for I.V. infusion pump alarms and indicated a general decrease in sensitivity over an 18-month period. Nursing students with previous healthcare experience also noted decreased sensitivity to bathroom call bells and fall and safety alarms.

CONCLUSION

Alarm fatigue was recognized among the surveyed nursing students. Nurse educators also identified a performance-based strategy to increase student awareness of alarm fatigue and evidence-based strategies to minimize desensitization to alarms in both education and practice.

Impact of Hospital Nurses' Perception on Clinical Alarms and Patient Safety Culture on Alarm Management Practice

This study aimed to identify the impact of nurses' perception of clinical alarms and patient safety culture on alarm management. Additionally, we aimed to describe the importance of clinical alarm issues. The data were collected from 21 August to 10 September 2020. The study participants were 116 nurses working in a tertiary acute care hospital in Korea. The self-report questionnaire included general characteristics, clinical alarm issues, nurses' alarm perception, patient safety culture, and alarm management practice. The mean age of nurses was 28.04 ± 4.06 years, with 5.71 ± 4.35 years of total clinical experience. For the importance of alarm issues, frequent false alarms leading to reduced attention or response was the most important issue. Hierarchical linear regression analysis revealed that a higher level of nurses' perceived patient safety culture was the strongest predictor of better alarm management practice (p < 0.001), followed by their perception of clinical alarms (p = 0.034). In addition, female nurses (p = 0.004), charge nurses (p = 0.013), and nurses who work less than 40 h per week (p = 0.008) were more likely to work better in alarm management practice. Future studies are needed to develop standardized alarm management guidelines by improving nurses' positive perceptions of clinical alarms and patient safety culture.