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Wunderlich MM, Krampe H, Fuest K, Leicht D, Probst MB, Runge J, Schmid S, Spies C, Weiß B, Balzer F, Poncette AS. Evaluating the Construct Validity of the Charité Alarm Fatigue Questionnaire using Confirmatory Factor Analysis. JMIR Hum Factors 2024; 11:e57658. [PMID: 39119994 DOI: 10.2196/57658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 08/10/2024] Open
Abstract
Background The Charité Alarm Fatigue Questionnaire (CAFQa) is a 9-item questionnaire that aims to standardize how alarm fatigue in nurses and physicians is measured. We previously hypothesized that it has 2 correlated scales, one on the psychosomatic effects of alarm fatigue and the other on staff's coping strategies in working with alarms. Objective We aimed to validate the hypothesized structure of the CAFQa and thus underpin the instrument's construct validity. Methods We conducted 2 independent studies with nurses and physicians from intensive care units in Germany (study 1: n=265; study 2: n=1212). Responses to the questionnaire were analyzed using confirmatory factor analysis with the unweighted least-squares algorithm based on polychoric covariances. Convergent validity was assessed by participants' estimation of their own alarm fatigue and exposure to false alarms as a percentage. Results In both studies, the χ2 test reached statistical significance (study 1: χ226=44.9; P=.01; study 2: χ226=92.4; P<.001). Other fit indices suggested a good model fit (in both studies: root mean square error of approximation <0.05, standardized root mean squared residual <0.08, relative noncentrality index >0.95, Tucker-Lewis index >0.95, and comparative fit index >0.995). Participants' mean scores correlated moderately with self-reported alarm fatigue (study 1: r=0.45; study 2: r=0.53) and weakly with self-perceived exposure to false alarms (study 1: r=0.3; study 2: r=0.33). Conclusions The questionnaire measures the construct of alarm fatigue as proposed in our previous study. Researchers and clinicians can rely on the CAFQa to measure the alarm fatigue of nurses and physicians.
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Affiliation(s)
- Maximilian Markus Wunderlich
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30 450 581018
| | - Henning Krampe
- Department of Anesthesiology and Intensive Care Medicine CVK/CCM, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kristina Fuest
- Department of Anaesthesiology & Intensive Care Medicine, Klinikum Rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany
| | - Dominik Leicht
- Department for Anaesthesiology, Intensive Care Medicine and Pain Therapy, Justus Liebig University, Giessen, Germany
| | - Moriz Benedikt Probst
- Department for Anaesthesiology, Intensive Care Medicine and Pain Therapy, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Julian Runge
- Department for Anesthesiology, Surgical Intensive Care, Pain and Palliative Medicine, Marien Hospital Herne-Universitätsklinikum der Ruhr-Universität Bochum, Herne, Germany
| | - Sebastian Schmid
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm University, Ulm, Germany
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine CVK/CCM, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Björn Weiß
- Department of Anesthesiology and Intensive Care Medicine CVK/CCM, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30 450 581018
| | - Akira-Sebastian Poncette
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30 450 581018
- Department of Anesthesiology and Intensive Care Medicine CVK/CCM, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Deschamps ML, Sanderson P, Waxenegger H, Mohamed I, Loeb RG. Auditory Sequences Presented With Spearcons Support Better Multiple Patient Monitoring Than Single-Patient Alarms: A Preclinical Simulation. HUMAN FACTORS 2024; 66:872-890. [PMID: 35934986 DOI: 10.1177/00187208221116949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE A study of auditory displays for simulated patient monitoring compared the effectiveness of two sound categories (alarm sounds indicating general risk categories from international alarm standard IEC 60601-1-8 versus event-specific sounds according to the type of nursing unit) and two configurations (single-patient alarms versus multi-patient sequences). BACKGROUND Fieldwork in speciality-focused high dependency units (HDU) indicated that auditory alarms are ambiguous and do not identify which patient has a problem. We tested whether participants perform better using auditory displays that identify the relevant patient and problem. METHOD During simulated patient monitoring of four patients in a respiratory HDU, 60 non-clinicians heard either (a) IEC risk categories as single-patient alarm sounds, (b) event-specific categories as single-patient alarm sounds, (c) IEC risk categories in multi-patient sequences or (d) event-specific categories in multi-patient sequences. Participants performed a perceptual-motor task while monitoring patients; after detecting abnormal events, they identified the patient and the event. RESULTS Participants hearing multi-patient sequences made fewer wrong patient identifications than participants hearing single-patient alarms. Advantages of event-specific categories emerged when IEC risk category sounds indicated more than one potential event. Even when IEC and event-specific sounds indicated the same unique event, spearcons supported better event identification than did auditory icon sounds. CONCLUSION Auditory displays that unambiguously convey which patient is having what problem dramatically improve monitoring performance in a preclinical HDU simulation. APPLICATION Time-compressed speech assists development of detailed risk categories needed in specific HDU contexts, and multi-patient sound sequences allow multiple patient wellbeing to be monitored.
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Affiliation(s)
| | | | | | | | - Robert G Loeb
- The University of Queensland, Brisbane, Australia
- University of Florida, Gainesville, USA
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Sowan A. Effective dealing with alarm fatigue in the intensive care unit. Intensive Crit Care Nurs 2024; 80:103559. [PMID: 37801853 DOI: 10.1016/j.iccn.2023.103559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Affiliation(s)
- Azizeh Sowan
- School of Nursing, The University of Texas Health at San Antonio, San Antonio, USA.
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Li B, Yue L, Nie H, Cao Z, Chai X, Peng B, Zhang T, Huang W. The effect of intelligent management interventions in intensive care units to reduce false alarms: An integrative review. Int J Nurs Sci 2024; 11:133-142. [PMID: 38352290 PMCID: PMC10859571 DOI: 10.1016/j.ijnss.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/03/2023] [Accepted: 12/11/2023] [Indexed: 02/16/2024] Open
Abstract
Objective In intensive care units (ICU), frequent false alarms from medical equipment can cause alarm fatigue among nurses, which might lead to delayed or missed responses and increased risk of adverse patient events. This review was conducted to evaluate the effectiveness of intelligent management interventions to reduce false alarms in ICU. Method Following the framework of Whitmore and Knafl, the reviewers systematically searched six databases: PubMed, EMBASE, CINAHL, OVID, Cochrane Library, and Scopus, and studies included intelligent management of clinical alarms published in the English or Chinese language from the inception of each database to December 2022 were retrieved. The researchers used the PICOS framework to formulate the search strategy, developed keywords, screened literature, and assessed the studies' quality using the Joanna Briggs Institute-Meta-Analysis of Statistics, Assessment, and Review Instrument (JBI-MAStARI). The review was preregistered on PROSPERO (CRD42023411552). Results Seven studies met the inclusion criteria. The results showed that different interventions for intelligent management of alarms were beneficial in reducing the number of false alarms, the duration of alarms, the response time to important alarms for nurses, and the alarm fatigue levels among nurses. Positive results were found in practice after the application of the novel alarm management approaches. Conclusion Intelligent management intervention may be an effective way to reduce false alarms. The application of systems or tools for the intelligent management of clinical alarms is urgent in hospitals. To ensure more effective patient monitoring and less distress for nurses, more alarm management approaches combined with artificial intelligence will be needed in the future to enable accurate identification of critical alarms, ensure nurses are responding accurately to alarms, and make a real difference to alarm-ridden healthcare environments.
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Affiliation(s)
- Bingyu Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Liqing Yue
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Huiyu Nie
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ziwei Cao
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaoya Chai
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Bin Peng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Tiange Zhang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Weihong Huang
- “Mobile Health” Ministry of Education - China Mobile Joint Laboratory, Xiangya Hospital of Central South University, Changsha, Hunan, China
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Movahedi A, Sadooghiasl A, Ahmadi F, Vaismoradi M. A grounded theory study of alarm fatigue among nurses in intensive care units. Aust Crit Care 2023; 36:980-988. [PMID: 36737263 DOI: 10.1016/j.aucc.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The aim of this study was to explore the process of how nurses experienced and dealt with alarm fatigue in intensive care units based on Iranian nurses' perceptions and experiences. BACKGROUND Alarm fatigue is the overstimulation of senses due to the constant ringing of alarms in intensive care units. It is associated with nurses' desensitization to critical alarms that can directly influence patient safety and quality of care. METHODS A qualitative exploratory study using the grounded theory approach by Strauss and Corbin was carried out. Participants were 20 nurses working in intensive care units. The sampling process was started purposively and continued theoretically. Data were collected using semi-structured, in-depth, and individual interviews and continued to data saturation. The constant comparative analysis approach was used consisting of the following steps: open coding, developing concepts, analysing the context, entering the process into data analysis, integrating categories. FINDINGS The participants' main concern in the exposure to alarm fatigue was 'threat to personal balance'. The core category in this research was 'trying to create a holistic balance', which reflected a set of strategies that the nurses consistently and continuously used to deal with alarm fatigue and consisted of four main categories as follows: 'smart care', 'deliberate balancing', 'conditional prioritisation', and 'negligent performance'. Threat to personal balance was strengthened by 'inappropriate circuit of individual roles', 'distortion of the organisational structure', and 'insecurity of the infrastructure'. The consequences of this process was harm to the patient, burnout among nurse, and damage to the healthcare organisation. CONCLUSIONS The research findings have practical implications for healthcare management, policymaking, nursing education, research, and clinical practice. Mitigating staff shortages, improving staff competencies, enhancing nurses' authority for responding to alarms, modifying care routines, improving the physical environment, and removing problems related to alarm equipment can prevent alarm fatigue and its unappropriated consequences.
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Affiliation(s)
- Ali Movahedi
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Afsaneh Sadooghiasl
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Fazlollah Ahmadi
- Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway; Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia.
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Ruppel H, Dougherty M, Bonafide CP, Lasater KB. Alarm burden and the nursing care environment: a 213-hospital cross-sectional study. BMJ Open Qual 2023; 12:e002342. [PMID: 37880160 PMCID: PMC10603400 DOI: 10.1136/bmjoq-2023-002342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/23/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND High rates of medical device alarms in hospitals are a well-documented threat to patient safety. Little is known about organisational features that may be associated with nurses' experience of alarm burden. AIMS To evaluate the association between nurse-reported alarm burden, appraisals of patient safety, quality of care and hospital characteristics. METHODS Secondary analysis of cross-sectional survey data from 3986 hospital-based direct-care registered nurses in 213 acute care hospitals in New York and Illinois, USA. We evaluated associations of alarm burden with appraisals of patient safety and quality of care and hospital characteristics (work environment, staffing adequacy, size, teaching status) using χ2 tests. RESULTS The majority of respondents reported feeling overwhelmed by alarms (83%), delaying their response to alarms because they were unable to step away from another patient/task (76%), and experiencing situations where a patient needed urgent attention but no one responded to an alarm (55%). Nurses on medical-surgical units reported these experiences at higher rates than nurses working in intensive care units (p<0.001). Alarm burden items were significantly associated with poorer nurse-reported patient safety, quality of care, staffing and work environment. Findings were most pronounced for situations where a patient needed urgent attention but no one responded to the alarm, which was frequently/occasionally experienced by 72% of those who rated their hospital's safety as poor versus 38% good, p<0.001; 80% who rated overall quality of care poor/fair versus 46% good/excellent, p<0.001 and 65% from poor work environments versus 42% from good work environments, p<0.001. CONCLUSION Most nurses reported feeling overwhelmed by medical device alarms, and our findings suggest that alarm burden may be more pronounced in hospitals with unfavourable working conditions and suboptimal quality and safety. Because this was a cross-sectional study, further research is needed to explore causal relationships and the role of modifiable systems factors in reducing alarm burden.
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Affiliation(s)
- Halley Ruppel
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Clinical Futures, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maura Dougherty
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Christopher P Bonafide
- Clinical Futures, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
- Section of Hospital Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karen B Lasater
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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Albanowski K, Burdick KJ, Bonafide CP, Kleinpell R, Schlesinger JJ. Ten Years Later, Alarm Fatigue Is Still a Safety Concern. AACN Adv Crit Care 2023; 34:189-197. [PMID: 37644627 DOI: 10.4037/aacnacc2023662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Ten years after the publication of a landmark article in AACN Advanced Critical Care, alarm fatigue continues to be an issue that researchers, clinicians, and organizations aim to remediate. Alarm fatigue contributes to missed alarms and medical errors that result in patient death, increased clinical workload and burnout, and interference with patient recovery. Led by the American Association of Critical-Care Nurses, national patient safety organizations continue to prioritize efforts to battle alarm fatigue and have proposed alarm management strategies to mitigate the effects of alarm fatigue. Similarly, clinical efforts now use simulation studies, individualized alarm thresholds, and interdisciplinary teams to optimize alarm use. Finally, engineering research efforts have innovated the standard alarm to convey information more effectively for medical users. By focusing on patient and provider safety, clinical workflow, and alarm technology, efforts to reduce alarm fatigue over the past 10 years have been grounded in an evidence-based and personnel-focused approach.
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Affiliation(s)
- Kimberly Albanowski
- Kimberly Albanowski is Clinical Research Coordinator II, Section of Hospital Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kendall J Burdick
- Kendall J. Burdick is Pediatric Resident, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02215
| | - Christopher P Bonafide
- Christopher P. Bonafide is Academic Pediatric Hospitalist, Section of Hospital Medicine, Department of Pediatrics, Children's Hospital of Philadelphia; Director of Pediatric Implementation Research, Penn Implementation Science Center at the Leonard Davis Institute for Health Economics (PISCE@LDI); and Associate Professor, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ruth Kleinpell
- Ruth Kleinpell is Associate Dean for Clinical Scholarship, Independence Foundation Chair in Nursing Education, and Professor, Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Joseph J Schlesinger
- Joseph J. Schlesinger is Associate Professor, Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, and Adjunct Professor of Electrical and Computer Engineering, McGill University, Montreal, Quebec, Canada
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Wunderlich MM, Amende-Wolf S, Krampe H, Kruppa J, Spies C, Weiß B, Memmert B, Balzer F, Poncette AS. A brief questionnaire for measuring alarm fatigue in nurses and physicians in intensive care units. Sci Rep 2023; 13:13860. [PMID: 37620385 PMCID: PMC10449802 DOI: 10.1038/s41598-023-40290-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
When exposed to hundreds of medical device alarms per day, intensive care unit (ICU) staff can develop "alarm fatigue" (i.e., desensitisation to alarms). However, no standardised way of quantifying alarm fatigue exists. We aimed to develop a brief questionnaire for measuring alarm fatigue in nurses and physicians. After developing a list of initial items based on a literature review, we conducted 15 cognitive interviews with the target group (13 nurses and two physicians) to ensure that the items are face valid and comprehensible. We then asked 32 experts on alarm fatigue to judge whether the items are suited for measuring alarm fatigue. The resulting 27 items were sent to nurses and physicians from 15 ICUs of a large German hospital. We used exploratory factor analysis to further reduce the number of items and to identify scales. A total of 585 submissions from 707 participants could be analysed (of which 14% were physicians and 64% were nurses). The simple structure of a two-factor model was achieved within three rounds. The final questionnaire (called Charité Alarm Fatigue Questionnaire; CAFQa) consists of nine items along two scales (i.e., the "alarm stress scale" and the "alarm coping scale"). The CAFQa is a brief questionnaire that allows clinical alarm researchers to quantify the alarm fatigue of nurses and physicians. It should not take more than five minutes to administer.
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Affiliation(s)
- Maximilian Markus Wunderlich
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sandro Amende-Wolf
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henning Krampe
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jochen Kruppa
- Hochschule Osnabrück, University of Applied Sciences, Osnabrück, Germany
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Björn Weiß
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Belinda Memmert
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Akira-Sebastian Poncette
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
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Bosma S, Christopher R. Implementing a Unit-Based Alarm Management Bundle for Critical Care Nurses. Crit Care Nurse 2023; 43:36-45. [PMID: 37001877 DOI: 10.4037/ccn2023418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
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.
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Affiliation(s)
- Stephanie Bosma
- Stephanie Bosma is a critical care nurse, Mayo Clinic, Jacksonville, Florida
| | - Roberta Christopher
- Roberta Christopher is an advanced practice nurse and an associate professor, Keigwin School of Nursing, Jacksonville University, Jacksonville, Florida
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Gul G, Intepeler SS, Bektas M. The effect of interventions made in intensive care units to reduce alarms: A systematic review and meta-analysis study. Intensive Crit Care Nurs 2023; 75:103375. [PMID: 36529584 DOI: 10.1016/j.iccn.2022.103375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- Gulnur Gul
- Dokuz Eylül University, Institute of Health Sciences, Nursing Management PhD Student, Balcova, Izmir, Turkey; Charge-Nurse, Health Sciences University, Dr. Suat Seren Chest Diseases and Surgery Education Research Hospital, Turkey.
| | - Seyda Seren Intepeler
- Nursing Management Department, Dokuz Eylul University, Nursing Faculty, Balcova, Izmir, Turkey.
| | - Murat Bektas
- Child Health And Illness Department, Dokuz Eylul University, Nursing Faculty, Balcova, Izmir, Turkey.
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11
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Shaoru C, Hui Z, Su W, Ruxin J, Huiyi Z, Hongmei Z, Hongyan Z. Determinants of Medical Equipment Alarm Fatigue in Practicing Nurses: A Systematic Review. SAGE Open Nurs 2023; 9:23779608231207227. [PMID: 37927965 PMCID: PMC10621293 DOI: 10.1177/23779608231207227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/18/2023] [Accepted: 09/23/2023] [Indexed: 11/07/2023] Open
Abstract
Objective This study aimed to systematically evaluate the level of medical equipment alarm fatigue and its influencing factors among clinical nurses. Methods PubMed, Embase, CNKI, and Wanfang databases were systematically searched to identify articles on alarm fatigue of clinical nurses published before September 25, 2022. According to the evaluation criteria of prevalence studies recommended by JBI Evidence-Based Health Care Center, the quality of the literature meeting the inclusion criteria was evaluated, and Stata MP17 software was used for meta-analysis. Results A total of 14 cross-sectional studies were included, with a total sample of 2,848 nurses. The results showed that the alarm fatigue score of clinical nurses was 21.76 (95% CI [20.27, 23.25]). Subgroup analysis showed that the nurses who worked night shift and had lower professional title had higher alarm fatigue. Conclusion The alarm fatigue of clinical nurses was at a moderate level. To reduce the alarm fatigue level of clinical nurses, nursing managers should strengthen the alarm safety awareness of nurses, rationally arrange nurse manpower, carry out training to actively improve the alarm management ability of nurses, and optimize the alarm level and frequency of alarm equipment.
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Affiliation(s)
- Chen Shaoru
- Department of Anesthesia and Perioperative Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Henan Evidence-based Nursing Centre: A JBI Affiliated Group, The University of Adelaide, Zhengzhou, China
| | - Zhi Hui
- Department of Anesthesia and Perioperative Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Henan Evidence-based Nursing Centre: A JBI Affiliated Group, The University of Adelaide, Zhengzhou, China
| | - Wu Su
- Department of Anesthesia and Perioperative Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Henan Evidence-based Nursing Centre: A JBI Affiliated Group, The University of Adelaide, Zhengzhou, China
| | - Jiang Ruxin
- Department of Anesthesia and Perioperative Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Henan Evidence-based Nursing Centre: A JBI Affiliated Group, The University of Adelaide, Zhengzhou, China
| | - Zhang Huiyi
- Department of Anesthesia and Perioperative Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Henan Evidence-based Nursing Centre: A JBI Affiliated Group, The University of Adelaide, Zhengzhou, China
| | - Zhang Hongmei
- Henan Evidence-based Nursing Centre: A JBI Affiliated Group, The University of Adelaide, Zhengzhou, China
- Department of Nursing, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Zhang Hongyan
- Department of Anesthesia and Perioperative Medicine, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, China
- Henan Evidence-based Nursing Centre: A JBI Affiliated Group, The University of Adelaide, Zhengzhou, China
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12
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Ali Al-Quraan H, Eid A, Alloubani A. Assessment of Alarm Fatigue Risk Among Oncology Nurses in Jordan. SAGE Open Nurs 2023; 9:23779608231170730. [PMID: 37124378 PMCID: PMC10134186 DOI: 10.1177/23779608231170730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/03/2023] [Accepted: 04/02/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Using technology in the clinical setting where clinical alarms frequently occur, resulting in many false alarms, which is called alarm fatigue, alarm fatigue may increase nurses' distraction, and that might negatively affect patient safety. Objective This study aimed to assess alarm fatigue among oncology nurses in Jordan. Methods A descriptive cross-sectional design was used in a non-profit specialized cancer center. A self-reported questionnaire was answered by nurses who participated in the study. Results A total of 222 questionnaires were analyzed with a more than 95% response rate. More than half of the sample (60.4%) were females. The participants were young nurses with a mean age of 25.18 ± 3.33 years. The total mean score of alarm fatigue was 31.62 ± 7.14 on a scale ranging from zero to 52. Post-hoc analysis showed that the palliative unit (25.73 ± 7.22) and emergency room (28.73 ± 6.62) had low scores of total mean alarm fatigue than remaining area of practice, such as the ICU (33.92 ± 6.99); p-value: .004. Conclusion Alarm fatigue is a global issue affecting many practice areas. An educational program is recommended for nurses to learn how to deal with alarm fatigue. In order to effectively manage alarms, nurses' education and individual training are crucial.
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Affiliation(s)
| | - Amjad Eid
- King Hussein Cancer Center, Amman, Jordan
| | - Aladeen Alloubani
- King Hussein Cancer Center, Amman, Jordan
- Aladeen Alloubani, King Hussein Cancer Center, Amman, Jordan.
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13
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Sinno ZC, Shay D, Kruppa J, Klopfenstein SA, Giesa N, Flint AR, Herren P, Scheibe F, Spies C, Hinrichs C, Winter A, Balzer F, Poncette AS. The influence of patient characteristics on the alarm rate in intensive care units: a retrospective cohort study. Sci Rep 2022; 12:21801. [PMID: 36526892 PMCID: PMC9758124 DOI: 10.1038/s41598-022-26261-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Intensive care units (ICU) are often overflooded with alarms from monitoring devices which constitutes a hazard to both staff and patients. To date, the suggested solutions to excessive monitoring alarms have remained on a research level. We aimed to identify patient characteristics that affect the ICU alarm rate with the goal of proposing a straightforward solution that can easily be implemented in ICUs. Alarm logs from eight adult ICUs of a tertiary care university-hospital in Berlin, Germany were retrospectively collected between September 2019 and March 2021. Adult patients admitted to the ICU with at least 24 h of continuous alarm logs were included in the study. The sum of alarms per patient per day was calculated. The median was 119. A total of 26,890 observations from 3205 patients were included. 23 variables were extracted from patients' electronic health records (EHR) and a multivariable logistic regression was performed to evaluate the association of patient characteristics and alarm rates. Invasive blood pressure monitoring (adjusted odds ratio (aOR) 4.68, 95%CI 4.15-5.29, p < 0.001), invasive mechanical ventilation (aOR 1.24, 95%CI 1.16-1.32, p < 0.001), heart failure (aOR 1.26, 95%CI 1.19-1.35, p < 0.001), chronic renal failure (aOR 1.18, 95%CI 1.10-1.27, p < 0.001), hypertension (aOR 1.19, 95%CI 1.13-1.26, p < 0.001), high RASS (aOR 1.22, 95%CI 1.18-1.25, p < 0.001) and scheduled surgical admission (aOR 1.22, 95%CI 1.13-1.32, p < 0.001) were significantly associated with a high alarm rate. Our study suggests that patient-specific alarm management should be integrated in the clinical routine of ICUs. To reduce the overall alarm load, particular attention regarding alarm management should be paid to patients with invasive blood pressure monitoring, invasive mechanical ventilation, heart failure, chronic renal failure, hypertension, high RASS or scheduled surgical admission since they are more likely to have a high contribution to noise pollution, alarm fatigue and hence compromised patient safety in ICUs.
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Affiliation(s)
- Zeena-Carola Sinno
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany
| | - Denys Shay
- grid.189504.10000 0004 1936 7558Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA USA
| | - Jochen Kruppa
- grid.434095.f0000 0001 1864 9826Hochschule Osnabrück, University of Applied Sciences, Osnabrück, Germany
| | - Sophie A.I. Klopfenstein
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany ,grid.484013.a0000 0004 6879 971XBerlin Institute of Health at Charité – Universitätsmedizin Berlin, Core Facility Digital Medicine and Interoperability, Charitéplatz 1, 10117 Berlin, Germany
| | - Niklas Giesa
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany
| | - Anne Rike Flint
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany
| | - Patrick Herren
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany
| | - Franziska Scheibe
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology, Charitéplatz 1, 10117 Berlin, Germany ,grid.517316.7NeuroCure Clinical Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Claudia Spies
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Carl Hinrichs
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Nephrology and Medical Intensive Care, Charitéplatz 1, 10117 Berlin, Germany
| | - Axel Winter
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Surgery, Charitéplatz 1, 10117 Berlin, Germany
| | - Felix Balzer
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany
| | - Akira-Sebastian Poncette
- grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany ,grid.6363.00000 0001 2218 4662Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charitéplatz 1, 10117 Berlin, Germany
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14
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Chromik J, Klopfenstein SAI, Pfitzner B, Sinno ZC, Arnrich B, Balzer F, Poncette AS. Computational approaches to alleviate alarm fatigue in intensive care medicine: A systematic literature review. Front Digit Health 2022; 4:843747. [PMID: 36052315 PMCID: PMC9424650 DOI: 10.3389/fdgth.2022.843747] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Patient monitoring technology has been used to guide therapy and alert staff when a vital sign leaves a predefined range in the intensive care unit (ICU) for decades. However, large amounts of technically false or clinically irrelevant alarms provoke alarm fatigue in staff leading to desensitisation towards critical alarms. With this systematic review, we are following the Preferred Reporting Items for Systematic Reviews (PRISMA) checklist in order to summarise scientific efforts that aimed to develop IT systems to reduce alarm fatigue in ICUs. 69 peer-reviewed publications were included. The majority of publications targeted the avoidance of technically false alarms, while the remainder focused on prediction of patient deterioration or alarm presentation. The investigated alarm types were mostly associated with heart rate or arrhythmia, followed by arterial blood pressure, oxygen saturation, and respiratory rate. Most publications focused on the development of software solutions, some on wearables, smartphones, or headmounted displays for delivering alarms to staff. The most commonly used statistical models were tree-based. In conclusion, we found strong evidence that alarm fatigue can be alleviated by IT-based solutions. However, future efforts should focus more on the avoidance of clinically non-actionable alarms which could be accelerated by improving the data availability. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021233461, identifier: CRD42021233461.
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Affiliation(s)
- Jonas Chromik
- Digital Health – Connected Healthcare, Hasso Plattner Institute, University of Potsdam, Rudolf-Breitscheid-Straße 187, Potsdam, Germany
| | - Sophie Anne Ines Klopfenstein
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, Berlin, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Core Facility Digital Medicine and Interoperability, Charitéplatz 1,Berlin, Germany
| | - Bjarne Pfitzner
- Digital Health – Connected Healthcare, Hasso Plattner Institute, University of Potsdam, Rudolf-Breitscheid-Straße 187, Potsdam, Germany
| | - Zeena-Carola Sinno
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, Berlin, Germany
| | - Bert Arnrich
- Digital Health – Connected Healthcare, Hasso Plattner Institute, University of Potsdam, Rudolf-Breitscheid-Straße 187, Potsdam, Germany
| | - Felix Balzer
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, Berlin, Germany
| | - Akira-Sebastian Poncette
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Charitéplatz 1, Berlin, Germany
- Correspondence: Akira-Sebastian Poncette
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15
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Nyarko BA, Nie H, Yin Z, Chai X, Yue L. The effect of educational interventions in managing nurses' alarm fatigue: An integrative review. J Clin Nurs 2022. [PMID: 35968774 DOI: 10.1111/jocn.16479] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 06/30/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alarm fatigue is becoming more widely acknowledged as a serious safety concern in modern clinical practice. Nurses are not always proficient in the alarms' functions and capabilities, and they do not undertake training regularly. Educating nurses on alarms maintains their knowledge and abilities in complex clinical settings. Some education has been undertaken to improve clinical alarm response, but the evidence for evaluating the effectiveness of nurse education interventions is limited. OBJECTIVE To evaluate the effects of educational interventions for reducing alarm fatigue in nurses, including the reduction of excessive, false and non-actionable alarms, which are major factors causing alarm fatigue in nurses. DATA SOURCES PUBMED, EMBASE, CINAHL, SCOPUS and OVID databases were systematically searched from 2016 to 2021. DESIGN Integrative Review. REVIEW METHODS An integrative review of literature was performed using the PRISMA checklist. Critical appraisal was done using Joanna Briggs Institute level of evidence. RESULTS Thirteen studies met the inclusion criteria. The results of most studies showed that educational intervention was beneficial for reducing the total number of alarms and false alarms. Furthermore, nurses' perceptions and knowledge improved, but the reduction in nurses' alarm fatigue is uncertain. A positive effect in alarm management practices was identified after the educational intervention. CONCLUSION Educational intervention may be the way to manage nurses' alarm fatigue. The use of medical devices in hospitals is increasing exponentially, and for this reason, alarms are inevitable. The introduction of effective and continuous education and training programs for nurses concerning clinical alarm management as well as raising nurses' awareness of the occurrence of alarm fatigue is vital.
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Affiliation(s)
- Brenda Abena Nyarko
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
| | - Huiyu Nie
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
| | - Zengzhen Yin
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoya Chai
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Liqing Yue
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
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16
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Nurses’ clinical alarm-related behaviors and influencing factors in China †. FRONTIERS OF NURSING 2022. [DOI: 10.2478/fon-2022-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Objective
To explore the nurses’ behaviors regarding clinical alarms, analyze the related influencing factors, and provide rationales for alarm management.
Methods
A cross-sectional survey was conducted in China. The self-made questionnaire of nurses’ clinical alarm-related knowledge, attitude, and behavior (NCAKAB) was used.
Results
The valid response rate was 98.66% (n = 2368). The average nurses’ clinical alarm-related behaviors (NCAB) score was 65.14 ± 7.95 (out of 85). The dimension scores of NCAB from high to low were alarm learning (4.02 ± 0.85, out of 5), alarm response (27.99 ± 3.64, out of 35), alarm setting (19.24 ± 3.88, out of 25), alarm recognition (7.63 ± 1.68, out of 10) and alarm notification (6.25 ± 1.84, out of 10). There were significant differences in alarm behavior scores between nurses of different ages (F = 4.619, P = 0.000), nursing stints (F = 9.564, P = 0.000), professional titles (F = 4.425, P = 0.004), departments (F = 9.166, P = 0.000), and hospital levels (t = 2.705, P = 0.007). The study showed that nurses’ total alarm behavior scores were positively correlated with the total alarm knowledge score (r = 0.267; P < 0.001) and the total alarm attitude score (r = 438; P < 0.001).
Conclusions
Nurses scored highest in alarm learning, followed by alarm response, alarm setting, alarm recognition, and alarm notification behavior. The factors that influenced alarm behavior included age, title, department, nursing stint, hospital level, professional title, alarm-related training, willingness to participate in alarm-related training, whether or not departments have improved alarm management over the last 3 years, and whether or not departments have formulated norms for alarm management. Nurses with higher scores for clinical alarm knowledge had higher correlating scores for alarm behavior; similarly, nurses with higher scores for clinical alarm attitude had higher scores for alarm-related behavior.
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Sowan AK, Staggers N, Reed CC, Austin T, Chen Q, Xu S, Lopez E. State of Science in Alarm System Safety: Implications for Researchers, Vendors, and Clinical Leaders. Biomed Instrum Technol 2022; 56:19-28. [PMID: 35213681 PMCID: PMC8979078 DOI: 10.2345/0899-8205-56.1.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
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.
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Affiliation(s)
- Azizeh K. Sowan
- Azizeh K. Sowan, PhD, RN, MSN, MSDA, MBA, FAAN is an associate professor in the School of Nursing at the University of Texas Health at San Antonio.
| | - Nancy Staggers
- Nancy Staggers, PhD, RN, FAAN is a professor in the School of Nursing and Department of Biomedical Informatics at the University of Utah in Salt Lake City.
| | - Charles C. Reed
- Charles C. Reed, PhD, RN, CNRN, is a vice president and associate chief nursing officer at the University Health System in San Antonio, TX.
| | - Tommye Austin
- Tommye Austin, PhD, MBA, RN, NEA-BC, is a senior vice president and chief nurse executive at the University Health System in San Antonio.
| | - Qian Chen
- Qian Chen, PhD, is an assistant professor in the Department of Computer Science at the University of Texas at San Antonio.
| | - Shouhuai Xu
- Shouhuai Xu, PhD, was affiliated with The University of Texas at San Antonio at the time this work was conducted; he currently is a professor in the Department of Computer Science at the University of Colorado Colorado Springs.
| | - Emme Lopez
- Emme Lopez is a librarian in the School of Nursing at the University of Texas Health at San Antonio.
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Deschamps MLFA, Sanderson P. Nurses' use of auditory alarms and alerts in high dependency units: A field study. APPLIED ERGONOMICS 2021; 96:103475. [PMID: 34107432 DOI: 10.1016/j.apergo.2021.103475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 04/09/2021] [Accepted: 05/23/2021] [Indexed: 06/12/2023]
Abstract
A fieldwork study conducted in six units of a major metropolitan Australian hospital revealed that nurses' attitudes towards alarms are influenced by each unit's physical layout and caseload. Additionally, nurses relied heavily on both non-actionable and actionable alarms to maintain their awareness of the status of their patients' wellbeing, and used auditory alarms beyond the scope of their intended design. Results suggest that before reducing or removing auditory alarms from the clinical environment to improve patient safety, it is important to understand how nurses in different clinical contexts use current alarm systems to extract meaningful information. Such an understanding could guide appropriate alarm reduction strategies and guide alternative design solutions to support nurses' situation awareness during monitoring.
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Affiliation(s)
| | - Penelope Sanderson
- School of Psychology, The University of Queensland, Brisbane, Queensland, 4072, Australia.
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Seifert M, Tola DH, Thompson J, McGugan L, Smallheer B. Effect of bundle set interventions on physiologic alarms and alarm fatigue in an intensive care unit: A quality improvement project. Intensive Crit Care Nurs 2021; 67:103098. [PMID: 34393010 DOI: 10.1016/j.iccn.2021.103098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 04/15/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine if the implementation of an evidence-based bundle designed to reduce the number of physiologic monitor alarms reduces alarm fatigue in intensive care nurses. DESIGN This quality improvement project retrospectively reviewed alarm data rates, types, and frequency to identify the top three problematic physiologic alarms in an intensive care unit. An alarm management bundle was implemented to reduce the number of alarms. The Nurses' Alarm Fatigue Questionnaire was used to measure nurses' alarms fatigue pre- and post-implementation of the bundle. SETTING A combined medical surgical intensive care unit at an accredited hospital in the United States. RESULTS The top three problematic alarms identified during the pre-implementation phase were arrhythmia, invasive blood pressure, and respiration alarms. All three identified problematic physiologic alarms had a reduction in frequency with arrhythmia alarms demonstrating the largest decrease in frequency (46.82%). When measuring alarm fatigue, the overall total scores increased from pre- (M = 30.59, SD = 5.56) to post-implementation (M = 32.60, SD = 4.84) indicating no significant difference between the two periods. CONCLUSION After implementing an alarm management bundle, all three identified problematic physiologic alarms decreased in frequency. Despite the reduction in these alarms, there was not a reduction in nurses' alarm fatigue.
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Affiliation(s)
- Micah Seifert
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710, United States.
| | - Denise H Tola
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710, United States.
| | - Julie Thompson
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710, United States.
| | - Lynn McGugan
- Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, United States.
| | - Benjamin Smallheer
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710, United States.
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20
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Watanakeeree K, Suba S, Mackin LA, Badilini F, Pelter MM. ECG alarms during left ventricular assist device (LVAD) therapy in the ICU. Heart Lung 2021; 50:763-769. [PMID: 34225087 DOI: 10.1016/j.hrtlng.2021.03.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/22/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In hospitalized patients with left ventricular assist device (LVAD), electrical interference and low amplitude QRS complexes are common, which could impact the accuracy of electrocardiographic (ECG) arrhythmia detection and create technical alarms. This could contribute to provider alarm fatigue and threaten patient safety. OBJECTIVES We examined three LVAD patients in the cardiac intensive care unit (ICU) to determine: 1) the frequency and accuracy of audible arrhythmia alarms; 2) occurrence rates of technical alarms; and 3) alarm burden (# alarms/hour of monitoring) METHODS: Secondary analysis. RESULTS During 593 h, there were 549 audible arrhythmia alarms and 98% were false. There were 25,232 technical alarms and 93% were for artifact, which was configured as an inaudible text alert. CONCLUSION False-arrhythmia and technical alarms are frequent in LVAD patients. Future studies are needed to identify both clinical and algorithm-based strategies to improve arrhythmia detection and reduce technical alarms in LVAD patients.
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Affiliation(s)
- Kevin Watanakeeree
- Assistant Unit Director, Emergency Department, UCSF Medical Center, United States
| | - Sukardi Suba
- PhD Graduate, ECG Monitoring Research Lab, Department of Physiological Nursing, United States.
| | - Lynda A Mackin
- Clinical Professor, Department of Physiological Nursing, United States
| | - Fabio Badilini
- Director, Center for Physiologic Research, Department of Physiological Nursing, United States
| | - Michele M Pelter
- Associate Professor, Director, ECG Monitoring Research Lab, and Associate Translational Scientist, Center for Physiologic Research, Department of Physiological Nursing, United States.
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Claudio D, Deb S, Diegel E. A Framework to Assess Alarm Fatigue Indicators in Critical Care Staff. Crit Care Explor 2021; 3:e0464. [PMID: 34151285 PMCID: PMC8205220 DOI: 10.1097/cce.0000000000000464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This article examines work-related and Personality personality factors that could influence health providers in experiencing alarm fatigue. The purpose of this study is to provide a basis to determine factors that may predict the potential of alarm fatigue in critical care staff. DESIGN A questionnaire-based survey and an observational study were conducted to assess factors that could contribute to indicators of alarm fatigue. INTERVENTIONS Factors included patient-to-staff ratio, criticality of the alarm, priority of different tasks, and personality traits. SETTING The study was conducted at an eight-bed ICU in a mid-size hospital in Montana. SUBJECTS Data were collected for six day shifts and six night shifts involving 24 critical care professionals. Within each 12-hour shift, six 15-minute intervals were randomly generated through work sampling for 6 days; a total of 1,080 observations were collected. MEASUREMENTS Alarm fatigue was assessed with the subjective workload assessment technique and Boredom, Apathy, and Distrust Affects, which were measured through validated questionnaires. The Big Five Personality model was used to assess personality traits. MAIN RESULTS Work factors including task prioritization, nurse-to-patient ratio, and length of shifts were associated with indicators of alarm fatigue. Personality traits of openness, conscientiousness, and neuroticism were also associated. CONCLUSIONS We recommend assessing personality traits for critical care staff to be aware of how their individualities can affect their behavior towards alarm fatigue. We also recommend an examination of alternative strategies to reduce alarm fatigue, including examining the use of breaks, work rotation, or shift reduction.
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Affiliation(s)
- David Claudio
- Department of Mechanical and Industrial Engineering, Montana State University
| | - Shuchisnigdha Deb
- Department of Industrial, Manufacturing, and Systems Engineering, University of Texas
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Lee SJ, Lee YM, Seo EJ, Son YJ. Impact of Hospital Nurses' Perception on Clinical Alarms and Patient Safety Culture on Alarm Management Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4018. [PMID: 33921203 PMCID: PMC8069512 DOI: 10.3390/ijerph18084018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/17/2021] [Accepted: 04/09/2021] [Indexed: 01/02/2023]
Abstract
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.
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Affiliation(s)
- Soo-Joung Lee
- Division of Nursing, Inje University Haeundae Paik-Hospital, Busan 48108, Korea;
| | - Yun-Mi Lee
- Institute of Health Science, College of Nursing, Inje University, Busan 47392, Korea;
| | - Eun Ji Seo
- Research Institute of Nursing Science, College of Nursing, Ajou University, Suwon 16499, Korea;
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea
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Sowan AK, Staggers N, Berndt A, Austin T, Reed CC, Malshe A, Kilger M, Fonseca E, Vera A, Chen Q. Improving the Safety, Effectiveness, and Efficiency of Clinical Alarm Systems: Simulation-Based Usability Testing of Physiologic Monitors. JMIR Nurs 2021; 4:e20584. [PMID: 34345793 PMCID: PMC8328265 DOI: 10.2196/20584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/18/2020] [Accepted: 01/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Clinical alarm system safety is a national patient safety goal in the United States. Physiologic monitors are associated with the highest number of device alarms and alarm-related deaths. However, research involving nurses' use of physiologic monitors is rare. Hence, the identification of critical usability issues for monitors, especially those related to patient safety, is a nursing imperative. OBJECTIVE This study examined nurses' usability of physiologic monitors in intensive care units with respect to the effectiveness and efficiency of monitor use. METHODS In total, 30 nurses from 4 adult intensive care units completed 40 tasks in a simulation environment. The tasks were common monitoring tasks that were crucial for appropriate monitoring and safe alarm management across four categories of competencies: admitting, transferring, and discharging patients using the monitors (7 tasks); managing measurements and monitor settings (23 tasks); performing electrocardiogram (ECG) analysis (7 tasks); and troubleshooting alarm conditions (3 tasks). The nurse-monitor interaction was video-recorded. The principal investigator and two expert intensive care units nurse educators identified, classified, and validated task success (effectiveness) and the time of task completion (efficiency). RESULTS Among the 40 tasks, only 2 (5%) were successfully completed by all the nurses. At least 1-27 (3%-90%) nurses abandoned or did not correctly perform 38 tasks. The task with the shortest completion time was "take monitor out of standby" (mean 0:02, SD 0:01 min:s), whereas the task "record a 25 mm/s ECG strip of any of the ECG leads" had the longest completion time (mean 1:14, SD 0:32 min:s). The total time to complete 37 navigation-related tasks ranged from a minimum of 3 min 57 s to a maximum of 32 min 42 s. Regression analysis showed that it took 6 s per click or step to successfully complete a task. To understand the nurses' thought processes during monitor navigation, the authors analyzed the paths of the 2 tasks with the lowest successful completion rates, where only 13% (4/30) of the nurses correctly completed these 2 tasks. Although 30% (9/30) of the nurses accessed the correct screen first for task 1 and task 2, they could not find their way easily from there to successfully complete the 2 tasks. CONCLUSIONS Usability testing of physiologic monitors revealed major ineffectiveness and inefficiencies in the current nurse-monitor interactions. The results indicate the potential for safety and productivity issues in completing routine tasks. Training on monitor use should include critical monitoring functions that are necessary for safe, effective, efficient, and appropriate monitoring to include knowledge of the shortest navigation path. It is imperative that vendors' future monitor designs mimic clinicians' thought processes for successful, safe, and efficient monitor navigation.
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Affiliation(s)
- Azizeh K Sowan
- School of Nursing University of Texas Health at San Antonio San Antonio, TX United States
| | - Nancy Staggers
- School of Nursing and Department of Biomedical Informatics University of Utah Salt Lake City, UT United States
| | - Andrea Berndt
- School of Nursing University of Texas Health at San Antonio San Antonio, TX United States
| | | | | | - Ashwin Malshe
- College of Business University of Texas at San Antonio San Antonio, TX United States
| | - Max Kilger
- College of Business University of Texas at San Antonio San Antonio, TX United States
| | | | - Ana Vera
- University Health San Antonio, TX United States
| | - Qian Chen
- College of Electrical and Computer Engineering University of Texas at San Antonio San Antonio, TX United States
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Lewandowska K, Weisbrot M, Cieloszyk A, Mędrzycka-Dąbrowska W, Krupa S, Ozga D. Impact of Alarm Fatigue on the Work of Nurses in an Intensive Care Environment-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228409. [PMID: 33202907 PMCID: PMC7697990 DOI: 10.3390/ijerph17228409] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022]
Abstract
Background: In conditions of intensive therapy, where the patients treated are in a critical condition, alarms are omnipresent. Nurses, as they spend most of their time with patients, monitoring their condition 24 h, are particularly exposed to so-called alarm fatigue. The purpose of this study is to review the literature available on the perception of clinical alarms by nursing personnel and its impact on work in the ICU environment. Methods: A systematic review of the literature was carried out according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol. The content of electronic databases was searched through, i.e., PubMed, OVID, EBSCO, ProQuest Nursery, and Cochrane Library. The keywords used in the search included: “intensive care unit,” “nurse,” “alarm fatigue,” “workload,” and “clinical alarm.” The review also covered studies carried out among nurses employed at an adult intensive care unit. Finally, seven publications were taken into consideration. Data were analyzed both descriptively and quantitatively, calculating a weighted average for specific synthetized data. Results: In the analyzed studies, 389 nurses were tested, working in different intensive care units. Two studies were based on a quality model, while the other five described the problem of alarms in terms of quantity, based on the HTF (Healthcare Technology Foundation) questionnaire. Intensive care nurses think that alarms are burdensome and too frequent, interfering with caring for patients and causing reduced trust in alarm systems. They feel overburdened with an excessive amount of duties and a continuous wave of alarms. Having to operate modern equipment, which is becoming more and more advanced, takes time that nurses would prefer to dedicate to their patients. There is no clear system for managing the alarms of monitoring devices. Conclusion: Alarm fatigue may have serious consequences, both for patients and for nursing personnel. It is necessary to introduce a strategy of alarm management and for measuring the alarm fatigue level.
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Affiliation(s)
- Katarzyna Lewandowska
- Department of Anaesthesiology Nursing & Intensive Care, Medical University in Gdansk, 80211 Gdansk, Poland;
| | - Magdalena Weisbrot
- Intensive Care Unit, University Clinical Centre in Gdansk, 80211 Gdansk, Poland;
| | - Aleksandra Cieloszyk
- Independent Team of Physiotherapists, University Clinical Centre in Gdansk, 80211 Gdansk, Poland;
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology Nursing & Intensive Care, Medical University in Gdansk, 80211 Gdansk, Poland;
- Correspondence:
| | - Sabina Krupa
- Departament of Emergency, Institute of Health Sciences Medical College of Rzeszow University, 35310 Rzeszow, Poland; (S.K.); (D.O.)
| | - Dorota Ozga
- Departament of Emergency, Institute of Health Sciences Medical College of Rzeszow University, 35310 Rzeszow, Poland; (S.K.); (D.O.)
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Hagan R, Gillan CJ, Spence I, McAuley D, Shyamsundar M. Comparing regression and neural network techniques for personalized predictive analytics to promote lung protective ventilation in Intensive Care Units. Comput Biol Med 2020; 126:104030. [PMID: 33068808 PMCID: PMC7543875 DOI: 10.1016/j.compbiomed.2020.104030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 12/11/2022]
Abstract
Mechanical ventilation is a lifesaving tool and provides organ support for patients with respiratory failure. However, injurious ventilation due to inappropriate delivery of high tidal volume can initiate or potentiate lung injury. This could lead to acute respiratory distress syndrome, longer duration of mechanical ventilation, ventilator associated conditions and finally increased mortality. In this study, we explore the viability and compare machine learning methods to generate personalized predictive alerts indicating violation of the safe tidal volume per ideal body weight (IBW) threshold that is accepted as the upper limit for lung protective ventilation (LPV), prior to application to patients. We process streams of patient respiratory data recorded per minute from ventilators in an intensive care unit and apply several state-of-the-art time series prediction methods to forecast the behavior of the tidal volume metric per patient, 1 hour ahead. Our results show that boosted regression delivers better predictive accuracy than other methods that we investigated and requires relatively short execution times. Long short-term memory neural networks can deliver similar levels of accuracy but only after much longer periods of data acquisition, further extended by several hours computing time to train the algorithm. Utilizing Artificial Intelligence, we have developed a personalized clinical decision support tool that can predict tidal volume behavior within 10% accuracy and compare alerts recorded from a real world system to highlight that our models would have predicted violations 1 hour ahead and can therefore conclude that the algorithms can provide clinical decision support.
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Affiliation(s)
- Rachael Hagan
- School of Electrical and Electronic Engineering and Computer Science, Queen's University Belfast, Queen's Road, Queen's Island, Belfast, Northern Ireland, BT9 3DT, United Kingdom.
| | - Charles J Gillan
- School of Electrical and Electronic Engineering and Computer Science, Queen's University Belfast, Queen's Road, Queen's Island, Belfast, Northern Ireland, BT9 3DT, United Kingdom
| | - Ivor Spence
- School of Electrical and Electronic Engineering and Computer Science, Queen's University Belfast, Queen's Road, Queen's Island, Belfast, Northern Ireland, BT9 3DT, United Kingdom
| | - Danny McAuley
- The Centre for Experimental Medicine, School of Medicine, Dentistry and Biological Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, United Kingdom
| | - Murali Shyamsundar
- The Centre for Experimental Medicine, School of Medicine, Dentistry and Biological Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, United Kingdom
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Milhomme D, Pomerleau E. [Factors influencing the nurse’s decision to set and modulate alarm parameters of bedside monitoring in intensive care : an integrative review of literature]. Rech Soins Infirm 2020; 140:57-68. [PMID: 32524802 DOI: 10.3917/rsi.140.0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction : In critical care units, improper alarm settings for bedside monitoring systems promotes numerous alarms and may lead to nurse fatigue.
Purpose : Achieve an integrative review of the literature to identify the factors that influence the nurse in her decision to set and modulate the alarm parameters of bedside monitoring systems in the intensive care unit. Method : An integrative review of the literature according to the five steps of the Whittemore and Knafl method was carried out from the literature related to the field of critical care.
Results : The factors related to the nurse’s decision to set or modulate the alarm parameters of the monitoring systems are divided into two themes : personal factors and contextual factors.
Discussion : Certain factors identified in this integrative review were also identified as elements that contribute to the clinical surveillance process carried out by expert nurses in a critical care context.
Conclusion : The results of this study suggest the need to focus empirically on the factors influencing the nurse’s decision to adjust and modulate alarm parameters in critical care monitoring systems.
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Pelter MM, Suba S, Sandoval C, Zègre-Hemsey JK, Berger S, Larsen A, Badilini F, Hu X. Actionable Ventricular Tachycardia During In-Hospital ECG Monitoring and Its Impact on Alarm Fatigue. Crit Pathw Cardiol 2020; 19:79-86. [PMID: 32102049 PMCID: PMC7413570 DOI: 10.1097/hpc.0000000000000216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ventricular tachycardia (V-tach) is the most common lethal arrhythmia, yet 90% of alarms are false and contribute to alarm fatigue. We hypothesize that some true V-tach also causes alarm fatigue because current criteria are too sensitive (i.e., ≥6 beats ≥100 beats/min [bpm]). PURPOSE This study was designed to determine (1) the proportion of clinically actionable true V-tach events; (2) whether true actionable versus nonactionable V-tach differs in terms of heart rate and/or duration (seconds); and (3) if actionable V-tach is associated with adverse outcomes. METHODS This was a secondary analysis in 460 intensive care unit (ICU) patients. Electronic health records were examined to determine if a V-tach event was actionable or nonactionable. Actionable V-tach was defined if a clinical action(s) was taken within 15 minutes of its occurrence (i.e., new and/or change of medication, defibrillation, and/or laboratory test). Maximal heart rate and duration for each V-tach event were measured from bedside monitor electrocardiography. Adverse patient outcomes included a code blue event and/or death. RESULTS In 460 ICU patients, 50 (11%) had 151 true V-tach events (range 1-20). Of the 50 patients, 40 (80%) had only nonactionable V-tach (97 events); 3 (6%) had both actionable and nonactionable V-tach (32 events); and 7 patients (14%) had only actionable V-tach (23 events). There were differences in duration comparing actionable versus nonactionable V-tach (mean 56.19 ± 116.87 seconds vs. 4.28 ± 4.09 seconds; P = 0.001) and maximal heart rate (188.81 ± 116.83 bpm vs. 150.79 ± 28.26 bpm; P = 0.001). Of the 50 patients, 3 (6%) had a code blue, 2 died, and all were in the actionable V-tach group. CONCLUSIONS In our sample, <1% experienced a code blue following true V-tach. Heart rate and duration for actionable V-tach were much faster and longer than that for nonactionable V-tach. Current default settings typically used for electrocardiographic monitoring (i.e., ≥6 beats ≥100 bpm) appear to be too conservative and can lead to crisis/red level nuisance alarms that contribute to alarm fatigue. A prospective study designed to test whether adjusting default settings to these higher levels is safe for patients is needed.
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Affiliation(s)
- Michele M Pelter
- From the University of California, San Francisco, School of Nursing
| | - Sukardi Suba
- From the University of California, San Francisco, School of Nursing
| | - Cass Sandoval
- University of California, San Francisco, Medical Center
| | | | - Sarah Berger
- University of California, San Francisco, Medical Center
| | - Amy Larsen
- University of California, San Francisco, Medical Center
| | - Fabio Badilini
- From the University of California, San Francisco, School of Nursing
| | - Xiao Hu
- Duke University School of Nursing
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28
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Kaur D, Panos RJ, Badawi O, Bapat SS, Wang L, Gupta A. Evaluation of clinician interaction with alerts to enhance performance of the tele-critical care medical environment. Int J Med Inform 2020; 139:104165. [PMID: 32402986 DOI: 10.1016/j.ijmedinf.2020.104165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Identify opportunities to improve the interaction between clinicians and Tele-Critical Care (Tele-CC) programs through an analysis of alert occurrence and reactivation in a specific Tele-CC application. MATERIALS AND METHODS Data were collected automatically through the Philips eCaremanager® software system used at multiple hospitals in the Avera health system. We evaluated the distribution of alerts per patient, frequency of alert types, time between consecutive alerts, and Tele-CC clinician choice of alert reactivation times. RESULTS Each patient generated an average of 79.8 alerts during their ICU stay (median 31.0; 25th - 75th percentile 10.0-89.0) with 46.4 for blood pressure and 38.4 for oxygenation. The most frequent alerts for continuous physiological parameters were: MAP limit (28.9 %), O2/RR (26.4 %), MAP trend (16.5 %), HR trend (12.1 %), and HR limit (11.3 %). The median time between consecutive alerts for one parameter was less than 10 min for 86 % of patients. Tele-CC providers responded to all alert types with immediate reactivation 47-88 % of the time. Limit alerts had longer reactivation times than their trend alert counterparts (p-value < .001). CONCLUSIONS The alert type specific differences in frequency, time occurrence and provider choice of reactivation time provide insight into how clinicians interact with the Tele-CC system. Systems engineering enhancements to Tele-CC software algorithms may reduce alert burden and thereby decrease clinicians' cognitive workload for alert assessment. Further study of Tele-CC alert generation, alert presentation to clinicians, and the clinicians' options to respond to these alerts may reduce provider workload, minimize alert desensitization, and optimize the ability of Tele-CC clinicians to provide efficient and timely critical care management.
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Affiliation(s)
- Dhamanpreet Kaur
- Massachusetts Institute of Technology, 32 Vassar Street, Cambridge, MA 02139, United States.
| | - Ralph J Panos
- Cincinnati VA Medical Center, 3100 Vine Street, Cincinnati, OH 45220, United States.
| | - Omar Badawi
- Philips, 217 E Redwood St, Baltimore, MD 21202, United States.
| | - Sanika S Bapat
- Wellesley College, 106 Central St, Wellesley, MA 02481, United States.
| | - Li Wang
- Massachusetts Institute of Technology, 32 Vassar Street, Cambridge, MA 02139, United States.
| | - Amar Gupta
- Massachusetts Institute of Technology, 32 Vassar Street, Cambridge, MA 02139, United States.
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Fernandes CO, Miles S, Lucena CJPD, Cowan D. Artificial Intelligence Technologies for Coping with Alarm Fatigue in Hospital Environments Because of Sensory Overload: Algorithm Development and Validation. J Med Internet Res 2019; 21:e15406. [PMID: 31769762 PMCID: PMC6904899 DOI: 10.2196/15406] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/14/2019] [Accepted: 10/17/2019] [Indexed: 12/02/2022] Open
Abstract
Background Informed estimates claim that 80% to 99% of alarms set off in hospital units are false or clinically insignificant, representing a cacophony of sounds that do not present a real danger to patients. These false alarms can lead to an alert overload that causes a health care provider to miss important events that could be harmful or even life-threatening. As health care units become more dependent on monitoring devices for patient care purposes, the alarm fatigue issue has to be addressed as a major concern for the health care team as well as to enhance patient safety. Objective The main goal of this paper was to propose a feasible solution for the alarm fatigue problem by using an automatic reasoning mechanism to decide how to notify members of the health care team. The aim was to reduce the number of notifications sent by determining whether or not to group a set of alarms that occur over a short period of time to deliver them together, without compromising patient safety. Methods This paper describes: (1) a model for supporting reasoning algorithms that decide how to notify caregivers to avoid alarm fatigue; (2) an architecture for health systems that support patient monitoring and notification capabilities; and (3) a reasoning algorithm that specifies how to notify caregivers by deciding whether to aggregate a group of alarms to avoid alarm fatigue. Results Experiments were used to demonstrate that providing a reasoning system can reduce the notifications received by the caregivers by up to 99.3% (582/586) of the total alarms generated. Our experiments were evaluated through the use of a dataset comprising patient monitoring data and vital signs recorded during 32 surgical cases where patients underwent anesthesia at the Royal Adelaide Hospital. We present the results of our algorithm by using graphs we generated using the R language, where we show whether the algorithm decided to deliver an alarm immediately or after a delay. Conclusions The experimental results strongly suggest that this reasoning algorithm is a useful strategy for avoiding alarm fatigue. Although we evaluated our algorithm in an experimental environment, we tried to reproduce the context of a clinical environment by using real-world patient data. Our future work is to reproduce the evaluation study based on more realistic clinical conditions by increasing the number of patients, monitoring parameters, and types of alarm.
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Affiliation(s)
| | - Simon Miles
- Kings College London, London, United Kingdom
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30
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Case Study: More Patient Safety by Design - System-based Approaches for Hospitals. Adv Health Care Manag 2019. [PMID: 32077657 DOI: 10.1108/s1474-823120190000018001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Since the publication of the report "To Err Is Human: Building a Safer Health System" by the US Institute of Medicine in 2000, much has changed with regard to patient safety. Many of the more recent initiatives to improve patient safety target the behavior of health care staff (e.g., training, double-checking procedures, and standard operating procedures). System-based interventions have so far received less attention, even though they produce more substantial improvements, being less dependent on individuals' behavior. One type of system-based intervention that can benefit patient safety involves improvements to hospital design. Given that people's working environments affect their behavior, good design at a systemic level not only enables staff to work more efficiently; it can also prevent errors and mishaps, which can have serious consequences for patients. While an increasing number of studies have demonstrated the effect of hospital design on patient safety, this knowledge is not easily accessible to clinicians, practitioners, risk managers, and other decision-makers, such as designers and architects of health care facilities. This is why the Swiss Patient Safety Foundation launched its project, "More Patient Safety by Design: Systemic Approaches for Hospitals," which is presented in this chapter.
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Waterson J, Bedner A. Types and Frequency of Infusion Pump Alarms and Infusion-Interruption to Infusion-Recovery Times for Critical Short Half-Life Infusions: Retrospective Data Analysis. JMIR Hum Factors 2019; 6:e14123. [PMID: 31407667 PMCID: PMC6709565 DOI: 10.2196/14123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/22/2019] [Accepted: 06/19/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Alarm fatigue commonly leads to a reduced response to alarms. Appropriate and timely response to intravenous pump alarms is crucial to infusion continuity. The difficulty of filtering out critical short half-life infusion alarms from nonurgent alarms is a key challenge for risk management for clinicians. Critical care areas provide ample opportunities for intravenous medication error with the frequent administration of high-alert, critical short half-life infusions that require rigorous maintenance for continuity of delivery. Most serious medication errors in critical care occur during the execution of treatment, with performance-level failures outweighing rule-based or knowledge-based mistakes. OBJECTIVE One objective of this study was to establish baseline data for the types and frequency of alarms that critical care clinicians are exposed to from a variety of infusion devices, including both large volume pumps and syringe drivers. Another objective was to identify the volume of these alarms that specifically relate to critical short half-life infusions and to evaluate user response times to alarms from infusion devices delivering these particular infusions. METHODS The event logs of 1183 infusion pumps used in critical care environments and in general care areas within the European region were mined for a range of alarm states. The study then focused on a selection of infusion alarms from devices delivering critical short half-life infusions that would warrant rapid attention from clinicians in order to avoid potentially harmful prolonged infusion interruption. The reaction time of clinicians to infusion-interruption states and alarms for the selected critical short half-life infusions was then calculated. RESULTS Initial analysis showed a mean average of 4.50 alarms per infusion in the general critical care pump population as opposed to the whole hospital rate of 1.39. In the pediatric intensive care unit (PICU) group, the alarms per infusion value was significantly above the mean average for all critical care areas, with 8.61 alarms per infusion. Infusion-interruption of critical short half-life infusions was found to be a significant problem in all areas of the general critical care pump population, with a significant number of downstream (ie, vein and access) occlusion events noted. While the mean and median response times to critical short half-life infusion interruptions were generally within the half-lives of the selected medications, there was a high prevalence of outliers in terms of reaction times for all the critical short half-life infusions studied. CONCLUSIONS This study gives an indication of what might be expected in critical care environments in terms of the volume of general infusion alarms and critical short half-life infusion alarms, as well as for clinician reaction times to critical short half-life infusion-interruption events. This study also identifies potentially problematic areas of the hospital for alarm fatigue and for particular issues of infusion and infusion-line management. Application of the proposed protocols can help create benchmarks for pump alarm management and clinician reaction times. These protocols can be applied to studies on the impact of alarm fatigue and for the evaluation of protocols, infusion-monitoring strategies, and infusion pump-based medication safety software aimed at reducing alarm fatigue and ensuring the maintenance of critical short half-life infusions. Given the frequency of infusion alarms seen in this study, the risk of alarm fatigue due to the white noise of pump alarms present in critical care, to which clinicians are constantly exposed, is very high. Furthermore, the added difficulties of maintaining critical short half-life infusions, and other infusions in specialist areas, are made clear by the high ratio of downstream occlusion to infusion starts in the neonatal intensive care unit (NICU). The ability to quantitatively track the volume of alarms and clinician reaction times contributes to a greater understanding of the issues of alarm fatigue in intensive care units. This can be applied to clinical audit, can allow for targeted training to reduce nuisance alarms, and can aid in planning for improvement in the key area of maintenance of steady-state plasma levels of critical short half-life infusions. One clear conclusion is that the medication administration rights should be extended to include right maintenance and ensured delivery continuity of critical short half-life infusions.
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Affiliation(s)
- James Waterson
- Medication Management Solutions, Becton Dickinson Limited, Eysins, Switzerland
| | - Arkadiusz Bedner
- Medication Management Solutions, Becton Dickinson Limited, Eysins, Switzerland
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Assis APD, Oliveira FTD, Camerini FG, Silva RCLD, Moraes CMD. Individualized parameterization of multiparametric monitors alarms in infarcted patients. Rev Bras Enferm 2019; 72:609-616. [PMID: 31269123 DOI: 10.1590/0034-7167-2018-0485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 02/01/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To measure the magnitude of the effect of an individualized parameterization protocol for hemodynamic alarms in patients with acute myocardial infarction. METHOD Pragmatic clinical trial, open label and single arm, whose intervention was performed through a protocol validated and tested in 32 patients using multiparametric monitors. The heart rate, blood pressure, respiratory rate, oxygen saturation and ST segment-monitoring were measured and classified for clinical consistency one hour before and after the intervention, for 64 hours. RESULTS The protocol obtained Content Validity Index of 0.92. Of the 460 registered alarms, 261 were considered inconsistent before the intervention and 47 after it. The Relative Risk of inconsistent alarms after the protocol was 0.32 (95% CI 0.23-0.43, p <0.0001). CONCLUSION The protocol proved to be a protective factor to the appearance of inconsistent clinical alarms of multiparametric monitors.
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Affiliation(s)
| | | | - Flávia Giron Camerini
- Universidade do Estado do Rio de Janeiro, Faculdade de Enfermagem. Rio de Janeiro, Rio de Janeiro, Brasil
| | - Roberto Carlos Lyra da Silva
- Universidade Federal do Estado do Rio de Janeiro, Escola de Enfermagem Alfredo Pinto. Rio de Janeiro, Rio de Janeiro, Brasil
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Poncette AS, Spies C, Mosch L, Schieler M, Weber-Carstens S, Krampe H, Balzer F. Clinical Requirements of Future Patient Monitoring in the Intensive Care Unit: Qualitative Study. JMIR Med Inform 2019; 7:e13064. [PMID: 31038467 PMCID: PMC6658223 DOI: 10.2196/13064] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/05/2019] [Accepted: 03/30/2019] [Indexed: 01/25/2023] Open
Abstract
Background In the intensive care unit (ICU), continuous patient monitoring is essential to detect critical changes in patients’ health statuses and to guide therapy. The implementation of digital health technologies for patient monitoring may further improve patient safety. However, most monitoring devices today are still based on technologies from the 1970s. Objective The aim of this study was to evaluate statements by ICU staff on the current patient monitoring systems and their expectations for future technological developments in order to investigate clinical requirements and barriers to the implementation of future patient monitoring. Methods This prospective study was conducted at three intensive care units of a German university hospital. Guideline-based interviews with ICU staff—5 physicians, 6 nurses, and 4 respiratory therapists—were recorded, transcribed, and analyzed using the grounded theory approach. Results Evaluating the current monitoring system, ICU staff put high emphasis on usability factors such as intuitiveness and visualization. Trend analysis was rarely used; inadequate alarm management as well as the entanglement of monitoring cables were rated as potential patient safety issues. For a future system, the importance of high usability was again emphasized; wireless, noninvasive, and interoperable monitoring sensors were desired; mobile phones for remote patient monitoring and alarm management optimization were needed; and clinical decision support systems based on artificial intelligence were considered useful. Among perceived barriers to implementation of novel technology were lack of trust, fear of losing clinical skills, fear of increasing workload, and lack of awareness of available digital technologies. Conclusions This qualitative study on patient monitoring involves core statements from ICU staff. To promote a rapid and sustainable implementation of digital health solutions in the ICU, all health care stakeholders must focus more on user-derived findings. Results on alarm management or mobile devices may be used to prepare ICU staff to use novel technology, to reduce alarm fatigue, to improve medical device usability, and to advance interoperability standards in intensive care medicine. For digital transformation in health care, increasing the trust and awareness of ICU staff in digital health technology may be an essential prerequisite. Trial Registration ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 (Archived by WebCite at http://www.webcitation.org/77T1HwOzk)
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Affiliation(s)
- Akira-Sebastian Poncette
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany.,Einstein Center Digital Future, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Lina Mosch
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Monique Schieler
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Henning Krampe
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Felix Balzer
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany.,Einstein Center Digital Future, Berlin, Germany
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Vitoux RR, Schuster C, Glover KR, Dekker M. Frequency and Duration of Infusion Pump Alarms: Establishing National Benchmarks. Biomed Instrum Technol 2019; 52:433-441. [PMID: 30479151 DOI: 10.2345/0899-8205-52.6.433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Reduction of clinical alarms is a priority due to alarm fatigue and the high incidence of nonactionable alarms, especially those generated from physiological monitors. However, research on infusion pump alarm types and frequencies is limited. The purpose of this study was to establish a baseline for infusion pump alarm frequencies and duration in the hospital setting. Frequency and duration of alarms across 29 hospitals using 11,410 infusion pumps revealed 987,240 alarms associated with 568,164 infusions during a consecutive 60-day period. Pump alarms accounted for only 0.8% of infusion time, with an average of 1.74 alarms per delivery and 0.18 alarms per hour. Average alarm duration was 0:02:38 (h:min:s), with 60% of alarms being addressed within 0:01:08. The most frequent alarms were keep vein open (33.77%), hold expired (27.18%), and downstream occlusion (22.94%). The medical/surgical and intensive care unit (ICU) care areas had the highest number of alarms (41.66% and 39.70% of total alarms, respectively), but pediatrics/neonatal ICU had the highest frequency of alarms per delivery (4.91). Intravenous fluids accounted for 47.16% of total alarms, with an average of 3.03 alarms per delivery, whereas parenteral nutrition and propofol had 6.77 and 6.74 average alarms per delivery, respectively. A higher average number of alarms per delivery occurred on Saturdays (1.74) and Sundays (1.73) compared with weekdays. Infusion pump alarm data collected and analyzed were sufficient to establish a reasonable baseline of infusion pump alarm types and relative frequencies for the device.
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Vitoux RR, Schuster C, Glover KR. Perceptions of Infusion Pump Alarms: Insights Gained From Critical Care Nurses. JOURNAL OF INFUSION NURSING 2018; 41:309-318. [PMID: 30188453 PMCID: PMC6125754 DOI: 10.1097/nan.0000000000000295] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Between 1983 and 2011, equipment-related alarms in critical care have increased from 6 to 40 different alarm types. As nurses become overwhelmed, distracted, or desensitized by alarm noise, they may miss critical alarms that could result in patient harm. The findings of an infusion pump alarm survey indicated that nurses overwhelmingly agree that infusion pump nuisance alarms occur frequently and disrupt patient care. But nurses' perceptions of pump alarms are different from those previously reported for clinical alarms in general. It may not be appropriate to broadly apply general alarm management recommendations to infusion pump alarms at this time.
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Affiliation(s)
- Rachel R. Vitoux
- Corresponding Author: Rachel R. Vitoux, MBA, MSN, RN, CPHIMS, B. Braun Medical Inc, 824 Twelfth Avenue, Bethlehem, PA 18018-3524 ()
| | - Catherine Schuster
- B. Braun Medical, Bethlehem, Pennsylvania
- Rachel R. Vitoux, MBA, MSN, RN, CPHIMS, director of clinical consulting and services at B. Braun Medical, delivers data analytics and research to improve infusion safety and advance clinical practice. She earned an MBA in sustainable business from Marylhurst University in Marylhurst, Oregon, and an MSN as a clinical nurse specialist and a BSN from Indiana University
- Catherine Schuster, PhD, MA, BSN, RN, is the manager of nursing research at B. Braun Medical. She earned a PhD and an MA in public health promotion and research from The Ohio State University, a BS in applied behavioral sciences from the University of California, Davis, and a BSN from the University of Oklahoma
- Kevin R. Glover, MS, MEd, corporate vice president, clinical education program development, research, and innovation at B. Braun Medical, directs collaborative initiatives between industry, clinical service providers, relevant professional associations, and academia to develop and test educational solutions collectively to improve the quality, safety, and effectiveness of patient care
| | - Kevin R. Glover
- B. Braun Medical, Bethlehem, Pennsylvania
- Rachel R. Vitoux, MBA, MSN, RN, CPHIMS, director of clinical consulting and services at B. Braun Medical, delivers data analytics and research to improve infusion safety and advance clinical practice. She earned an MBA in sustainable business from Marylhurst University in Marylhurst, Oregon, and an MSN as a clinical nurse specialist and a BSN from Indiana University
- Catherine Schuster, PhD, MA, BSN, RN, is the manager of nursing research at B. Braun Medical. She earned a PhD and an MA in public health promotion and research from The Ohio State University, a BS in applied behavioral sciences from the University of California, Davis, and a BSN from the University of Oklahoma
- Kevin R. Glover, MS, MEd, corporate vice president, clinical education program development, research, and innovation at B. Braun Medical, directs collaborative initiatives between industry, clinical service providers, relevant professional associations, and academia to develop and test educational solutions collectively to improve the quality, safety, and effectiveness of patient care
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Freysdóttir GR, Björnsdóttir K, Svavarsdóttir MH. Nurses' use of monitors in patient surveillance: an ethnographic study on a coronary care unit. Eur J Cardiovasc Nurs 2018; 18:272-279. [PMID: 30497283 DOI: 10.1177/1474515118816930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Physiological monitors are increasingly used for patient surveillance. Although nurses play a vital role in the observation, analysis and use of information obtained from these devices, difficulties in their use, coupled with the high frequency of false and nuisance monitor alarms, can lead to negative working conditions and threaten patient safety. AIM With the purpose of promoting effective monitor use and ensuring patient safety, the aim was to explore both how cardiovascular nurses use monitors in patient surveillance and the effect that the monitors have on the nurses' work. METHODS A qualitative ethnographic design with semi-structured interviews and a field observation conducted at a 35-bed coronary care unit. A purposive sample was used in selecting participants. Data were analysed using systematic text condensation. RESULTS Eight registered nurses, all women, aged 27-49 years, were participants. The themes helping device, competence development and distractions and strain reflected both the knowledge on which the nurses drew in working with monitors and their influence on the nurses' work. False security and collaboration and teamwork discussed how the nurses trust and depend on each other during monitor surveillance and how poor work conditions and unclear responsibility undermine surveillance. CONCLUSIONS Monitors enable nurses to observe critically ill cardiac patients closely and respond quickly to life-threatening changes in their condition. Current work arrangements and limited training diminish the reliability of monitor surveillance. It is imperative to revise the structure of the surveillance and improve education in monitor surveillance to enhance nurses' clinical competence and patients' safety.
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Affiliation(s)
| | | | - Margrét Hrönn Svavarsdóttir
- 3 School of Health Sciences, University of Akureyri, Iceland.,4 Department of Health Sciences, Norwegian University of Sciences and Technology, Norway
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Shanmugham M, Strawderman L, Babski-Reeves K, Bian L. Alarm-Related Workload in Default and Modified Alarm Settings and the Relationship Between Alarm Workload, Alarm Response Rate, and Care Provider Experience: Quantification and Comparison Study. JMIR Hum Factors 2018; 5:e11704. [PMID: 30355550 PMCID: PMC6231885 DOI: 10.2196/11704] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/10/2018] [Accepted: 09/23/2018] [Indexed: 11/13/2022] Open
Abstract
Background Delayed or no response to impending patient safety–related calls, poor care provider experience, low job satisfaction, and adverse events are all unwanted outcomes of alarm fatigue. Nurses often cite increases in alarm-related workload as a reason for alarm fatigue, which is a major contributor to the aforementioned unwanted outcomes. Increased workload affects both the care provider and the patient. No studies to date have evaluated the workload while caring for patients and managing alarms simultaneously and related it to the primary measures of alarm fatigue—alarm response rate and care provider experience. Many studies have assessed the effect of modifying the default alarm setting; however, studies on the perceived workload under different alarm settings are limited. Objective This study aimed to assess nurses’ or assistants’ perceived workload index of providing care under different clinical alarm settings and establish the relationship between perceived workload, alarm response rate, and care provider experience. Methods In a clinical simulator, 30 participants responded to alarms that occurred on a physiological monitor under 2 conditions (default and modified) for a given clinical condition. Participants completed a National Aeronautics and Space Administration-Task Load Index questionnaire and rated the demand experienced on a 20-point visual analog scale with low and high ratings. A correlational analysis was performed to assess the relationships between the perceived workload score, alarm response rate, and care provider experience. Results Participants experienced lower workloads when the clinical alarm threshold limits were modified according to patients’ clinical conditions. The workload index was higher for the default alarm setting (57.60 [SD 2.59]) than for the modified alarm setting (52.39 [SD 2.29]), with a statistically significant difference of 5.21 (95% CI 3.38-7.04), t28=5.838, P<.05. Significant correlations were found between the workload index and alarm response rate. There was a strong negative correlation between alarm response rate and perceived workload, ρ28=−.54, P<.001 with workload explaining 29% of the variation in alarm response rate. There was a moderate negative correlation between the experience reported during patient care and the perceived workload, ρ28=−.49, P<.05. Conclusions The perceived workload index was comparatively lower with alarm settings modified for individual patient care than in an unmodified default clinical alarm setting. These findings demonstrate that the modification of clinical alarm limits positively affects the number of alarms accurately addressed, care providers’ experience, and overall satisfaction. The findings support the removal of nonessential alarms based on patient conditions, which can help care providers address the remaining alarms accurately and provide better patient care.
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Affiliation(s)
- Manikantan Shanmugham
- Department of Industrial and Systems Engineering, Mississippi State University, Mississippi State, MS, United States
| | - Lesley Strawderman
- Department of Industrial and Systems Engineering, Mississippi State University, Mississippi State, MS, United States
| | - Kari Babski-Reeves
- Department of Industrial and Systems Engineering, Mississippi State University, Mississippi State, MS, United States
| | - Linkan Bian
- Department of Industrial and Systems Engineering, Mississippi State University, Mississippi State, MS, United States
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Managing Alarms in Acute Care Across the Life Span: Electrocardiography and Pulse Oximetry. Crit Care Nurse 2018; 38:e16-e20. [PMID: 29606686 DOI: 10.4037/ccn2018468] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Bach TA, Berglund LM, Turk E. Managing alarm systems for quality and safety in the hospital setting. BMJ Open Qual 2018; 7:e000202. [PMID: 30094341 PMCID: PMC6069923 DOI: 10.1136/bmjoq-2017-000202] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/19/2018] [Accepted: 05/25/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To provide an overview of documented studies and initiatives that demonstrate efforts to manage and improve alarm systems for quality in healthcare by human, organisational and technical factors. METHODS A literature review, a grey literature review, interviews and a review of alarm-related standards (IEC 60601-1-8, IEC 62366-1:2015 and ANSI/Advancement of Medical Instrumentation HE 75:2009/2013) were conducted. Qualitative analysis was conducted to identify common themes of improvement elements in the literature and grey literature reviews, interviews and the review of alarm-related standards. RESULTS 21 articles and 7 publications on alarm quality improvement work were included in the literature and grey literature reviews, in which 10 themes of improvement elements were identified. The 10 themes were categorised into human factors (alarm training and education, multidisciplinary teamwork, alarm safety culture), organisational factors (alarm protocols and standard procedures, alarm assessment and evaluation, alarm inventory and prioritisation, and sharing and learning) and technical factors (machine learning, alarm configuration and alarm design). 26 clinicians were interviewed. 9 of the 10 themes were identified from the interview responses. The review of the standards identified 3 of the 10 themes. The study findings are also presented in a step-by-step guide to optimise implementation of the improvement elements for healthcare organisations. CONCLUSIONS Improving alarm safety can be achieved by incorporating human, organisational and technical factors in an integrated approach. There is still a gap between alarm-related standards and how the standards are translated into practice, especially in a clinical environment that uses multiple alarming medical devices from different manufacturers. Standardisation across devices and manufacturers and the use of machine learning in improving alarm safety should be discussed in future collaboration between alarm manufacturers, end users and regulators.
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Affiliation(s)
- Tita Alissa Bach
- Group Technology and Research, Life Sciences program, DNV GL AS, Hovik, Norway
| | | | - Eva Turk
- Group Technology and Research, Life Sciences program, DNV GL AS, Hovik, Norway
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Glover KR, Vitoux RR, Schuster C, Curtin CR. Types and Frequency of Infusion Pump Alarms: Protocol for a Retrospective Data Analysis. JMIR Res Protoc 2018; 7:e10446. [PMID: 29903696 PMCID: PMC6024101 DOI: 10.2196/10446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/26/2018] [Accepted: 04/26/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The variety of alarms from all types of medical devices has increased from 6 to 40 in the last three decades, with today's most critically ill patients experiencing as many as 45 alarms per hour. Alarm fatigue has been identified as a critical safety issue for clinical staff that can lead to potentially dangerous delays or nonresponse to actionable alarms, resulting in serious patient injury and death. To date, most research on medical device alarms has focused on the nonactionable alarms of physiological monitoring devices. While there have been some reports in the literature related to drug library alerts during the infusion pump programing sequence, research related to the types and frequencies of actionable infusion pump alarms remains largely unexplored. OBJECTIVE The objectives of this study protocol are to establish baseline data related to the types and frequency of infusion pump alarms from the B. Braun Outlook 400ES Safety Infusion System with the accompanying DoseTrac Infusion Management Software. METHODS The most recent consecutive 60-day period of backup hospital data received between April 2014 and February 2017 from 32 United States-based hospitals will be selected for analysis. Microsoft SQL Server (2012 - 11.0.5343.0 X64) will be used to manage the data with unique code written to sort data and perform descriptive analyses. A validated data management methodology will be utilized to clean and analyze the data. Data management procedures will include blinding, cleaning, and review of existing infusion data within the DoseTrac Infusion Management Software databases at each hospital. Patient-identifying data will be removed prior to merging into a dedicated and secure data repository. This pooled data will then be analyzed. RESULTS This exploratory study will analyze the aggregate alarm data for each hospital by care area, drug infused, time of day, and day of week, including: overall infusion pump alarm frequency (number of alarms per active infusion), duration of alarms (average, range, median), and type and frequency of alarms distributed by care area. CONCLUSIONS Infusion pump alarm data collected and analyzed in this study will be used to help establish a baseline of infusion pump alarm types and relative frequencies. Understanding the incidences and characteristics of infusion pump alarms will result in more informed quality improvement recommendations to decrease and/or modify infusion pump alarms, and potentially reduce clinical staff alarm fatigue and improve patient safety. . REGISTERED REPORT IDENTIFIER RR1-10.2196/10446.
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Affiliation(s)
- Kevin R Glover
- Scientific Affairs, B. Braun Medical Inc, Allentown, PA, United States
| | - Rachel R Vitoux
- Clinical Consulting Services, B. Braun Medical Inc, Allentown, PA, United States
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Wung SF, Schatz MR. Critical Care Nurses' Cognitive Ergonomics Related to Medical Device Alarms. Crit Care Nurs Clin North Am 2018; 30:191-202. [PMID: 29724438 DOI: 10.1016/j.cnc.2018.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study uniquely gained insight into the intricacy of intensive care nurses' decision-making process when responding to and managing device alarms. Difficulty in responding to alarms included low staffing, multiple job responsibilities, and competing priority tasks. Novice nurses are more tolerant of alarms sounding owing to a lower threshold of comfort with resetting or silencing alarms; more experienced nurses are more comfortable resetting alarm limits to the patient's baseline. Understanding the decision-making process used by nurses can guide the development of policies and learning experiences that are crucial clinical support for alarm management.
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Affiliation(s)
- Shu-Fen Wung
- Biobehavioral Health Science Division, The University of Arizona College of Nursing, 1305 North Martin Avenue, Tucson, AZ 85721- 0203, USA.
| | - Marilyn Rose Schatz
- Pulmonary Consultants of Mesa, 6750 E Baywood Avenue Ste 401, Mesa, AZ 85206, USA
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Abstract
Advanced informatics systems can help improve health care delivery and the environment of care for critically ill patients. However, identifying, testing, and deploying advanced informatics systems can be quite challenging. These processes often require involvement from a collaborative group of health care professionals of varied disciplines with knowledge of the complexities related to designing the modern and "smart" intensive care unit (ICU). In this article, we explore the connectivity environment within the ICU, middleware technologies to address a host of patient care initiatives, and the core informatics concepts necessary for both the design and implementation of advanced informatics systems.
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Dinis SMM, Rabiais ICM. Factors that interfere with the response of nurses in the monitoring of clinical alarms. Rev Bras Enferm 2017; 70:172-179. [PMID: 28226057 DOI: 10.1590/0034-7167-2015-0092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 08/14/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: The objective of the present study was to identify and synthesize the best empirical evidence found on factors that influence the response of nurses regarding clinical alarms. Method: An integrative literature review was conducted with searches undertaken in ten electronic databases restricted to the period from 2005 to 2016. Results: Eight articles were included by cross-checking the descriptors selected. Conclusion: In the analysis of the studies, the following possible factors that might interfere with the response of nurses in the monitoring of clinical alarms were found: high number of false alarms, inaudibility of alarms due to the competition of sounds, difficulty in distinguishing the urgency of alarms, and increase in noise caused by the raise in the number of alarms.
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Abstract
Clinical alarm systems have received significant attention in recent years following warnings from hospital accrediting and health care technology organizations regarding patient harm caused by unsafe practices. Alarm desensitization or fatigue from frequent, false, or unnecessary alarms, has led to serious events and even patient deaths. Other concerns include settings inappropriate to patient population or condition, inadequate staff training, and improper use or disabling. Research on human factors in alarm response and of functionality of medical devices will help clinicians develop appropriate policies, practices, and device settings for clinical alarms in neonatal intensive care units.
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Affiliation(s)
- Kendall R Johnson
- Department of Pediatrics, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA; Division of Neonatology, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA
| | - James I Hagadorn
- Department of Pediatrics, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA; Division of Neonatology, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA
| | - David W Sink
- Department of Pediatrics, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA; Division of Neonatology, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA.
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Alsaad AA, Alman CR, Thompson KM, Park SH, Monteau RE, Maniaci MJ. A multidisciplinary approach to reducing alarm fatigue and cost through appropriate use of cardiac telemetry. Postgrad Med J 2017; 93:430-435. [PMID: 28455284 DOI: 10.1136/postgradmedj-2016-134764] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/21/2017] [Accepted: 04/02/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Alarm fatigue (AF) is a distressing factor for staff and patients in the hospital. Using cardiac telemetry (CT) without clinical indications can create unnecessary alarms, and increase AF and cost of healthcare. We sought to reduce AF and cost associated with CT monitoring. METHODS After implementing a new protocol for CT placement, data were collected on telemetry orders, alarms and bed cost for 13 weeks from 1 January 2015 through 31 March 2015. We also retrospectively collected data on the same variables for the 13 weeks prior to the intervention. A survey was administered to nurses to assess past and present perceptions of AF. Interventions included protocol creation and education for participants. RESULTS At baseline, 77% of patients were monitored with CT. A total of 145 (31%) order discrepancies were discovered during data collection, of which 72% had no indication for CT, so CT was discontinued. The other 28% had indications, so orders were placed. A total of 8336 alarms were recorded during 4 weeks of data collection, of which 333 (4%) were classified as true actionable alarms. Postintervention data showed 67% CT assignment with 10% reduction in CT usage, with no increase in mortality (p<0.001 and >0.05, respectively). A 42% cost reduction was achieved after adjusting the patient status. Nurses reported 27% perceived reduction in AF. One-year follow-up revealed that 69% of patients were being monitored by CT, and the rate of order discrepancies due to lack of indication was 9%. CONCLUSION All hospital units may benefit from the protocols created during this study. If applied appropriately, these protocols can lead to reduced AF and cost per episode of care.
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Affiliation(s)
- Ali A Alsaad
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Carly R Alman
- Department of Nursing, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Shin H Park
- Department of Nursing, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Michael J Maniaci
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Sowan AK, Vera AG, Fonseca EI, Reed CC, Tarriela AF, Berndt AE. Nurse Competence on Physiologic Monitors Use: Toward Eliminating Alarm Fatigue in Intensive Care Units. Open Med Inform J 2017; 11:1-11. [PMID: 28567167 PMCID: PMC5420192 DOI: 10.2174/1874431101711010001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/31/2016] [Accepted: 01/25/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Studies on nurse competence on alarm management are a few and tend to be focused on limited skills. In response to Phase II of implementing the National Patient Safety Goal on clinical alarm systems safety, this study assessed nurses' perceived competence on physiologic monitors use in intensive care units (ICUs) and developed and validated a tool for this purpose. METHODS This descriptive study took place in a Magnet hospital in a Southwestern state of the U.S. A Nurse Competence on Philips Physiologic Monitors Use Survey was created and went through validation by 13 expert ICU nurses. The survey included 5 subscales with 59 rated items and two open-ended questions. Items on the first 4 subscales reflect most common tasks nurses perform using physiologic monitors. Items on the fifth subscale (advanced functions) reflect rarely used skills and were included to understand the scope of utilizing advanced physiologic monitors' features. Thirty nurses from 4 adult ICUs were invited to respond to the survey. RESULTS Thirty nurses (100%) responded to the survey. The majority of nurses were from Neuro (47%) and Surgical Trauma (37%) ICUs. The data supported the high reliability and construct validity of the survey. At least one (3%) to 8 nurses (27%) reported lack of confidence on each item on the survey. On the first four subscales, 3% - 40% of the nurses reported they had never heard of or used 27 features/functions on the monitors. No relationships were found between subscales' scores and demographic characteristics (p > .05). Nurses asked for training on navigating the central-station monitor and troubleshooting alarms, and the use of unit-specific super users to tailor training to users' needs. CONCLUSION This is the first study to create and test a list of competencies for physiologic monitors use. Rigorous, periodic and individualized training is essential for safe and appropriate use of physiologic monitors and to decrease alarm fatigue. Training should be comprehensive to include all necessary skills and should not assume proficiency on basic skills. Special attention should be focused on managing technical alarms. Increasing the number of super users is a recommended strategy for individualized and unit-specific training. There is a need for a usability testing of complex IT-equipped medical devices, such as physiologic monitors, for effective, efficient and safe navigation of the monitors.
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Affiliation(s)
- Azizeh K. Sowan
- School of Nursing, University of Texas Health, San Antonio, 7703 Floyd Curl Dr. - MC 7975, TX 78229, USA
- University Health System, 4502 Medical Drive, San Antonio, Texas 78229, USA
| | - Ana G. Vera
- University Health System, 4502 Medical Drive, San Antonio, Texas 78229, USA
| | - Elma I. Fonseca
- University Health System, 4502 Medical Drive, San Antonio, Texas 78229, USA
| | - Charles C. Reed
- University Health System, 4502 Medical Drive, San Antonio, Texas 78229, USA
| | - Albert F. Tarriela
- University Health System, 4502 Medical Drive, San Antonio, Texas 78229, USA
| | - Andrea E. Berndt
- School of Nursing, University of Texas Health, San Antonio, 7703 Floyd Curl Dr. - MC 7975, TX 78229, USA
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Sowan AK, Reed CC, Staggers N. Role of Large Clinical Datasets From Physiologic Monitors in Improving the Safety of Clinical Alarm Systems and Methodological Considerations: A Case From Philips Monitors. JMIR Hum Factors 2016; 3:e24. [PMID: 27694097 PMCID: PMC5065678 DOI: 10.2196/humanfactors.6427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 08/22/2016] [Accepted: 09/10/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Large datasets of the audit log of modern physiologic monitoring devices have rarely been used for predictive modeling, capturing unsafe practices, or guiding initiatives on alarm systems safety. OBJECTIVE This paper (1) describes a large clinical dataset using the audit log of the physiologic monitors, (2) discusses benefits and challenges of using the audit log in identifying the most important alarm signals and improving the safety of clinical alarm systems, and (3) provides suggestions for presenting alarm data and improving the audit log of the physiologic monitors. METHODS At a 20-bed transplant cardiac intensive care unit, alarm data recorded via the audit log of bedside monitors were retrieved from the server of the central station monitor. RESULTS Benefits of the audit log are many. They include easily retrievable data at no cost, complete alarm records, easy capture of inconsistent and unsafe practices, and easy identification of bedside monitors missed from a unit change of alarm settings adjustments. Challenges in analyzing the audit log are related to the time-consuming processes of data cleaning and analysis, and limited storage and retrieval capabilities of the monitors. CONCLUSIONS The audit log is a function of current capabilities of the physiologic monitoring systems, monitor's configuration, and alarm management practices by clinicians. Despite current challenges in data retrieval and analysis, large digitalized clinical datasets hold great promise in performance, safety, and quality improvement. Vendors, clinicians, researchers, and professional organizations should work closely to identify the most useful format and type of clinical data to expand medical devices' log capacity.
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Affiliation(s)
- Azizeh Khaled Sowan
- School of Nursing, Department of Health Restoration & Care Systems Management, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States.
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Diagnosing and Treating “Alarm Fatigue”: Pragmatic and Evidence-Based Approaches Needed. Jt Comm J Qual Patient Saf 2016; 42:291-2. [DOI: 10.1016/s1553-7250(16)42039-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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