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

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

BACKGROUND

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

LOCAL PROBLEM

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Levels and Factors of Nurses' Alarm Fatigue in Critical Care Settings in Saudi Arabia: A Multicenter Cross-Sectional Study

Background

A continuous and high frequency of alarms from monitoring and treatment devices can lead to nurses' sensory exhaustion and alarm fatigue in critical care settings.

Aim

The purpose of this study was to evaluate the level of alarm fatigue and determine the relationship between nurses' sociodemographic and work-related factors and the level of alarm fatigue in critical care settings in Hail City, Saudi Arabia.

Methods

Between May and July 2023, 298 nurses who worked in the emergency, intensive care, and critical care units of all the public hospitals in Hail City participated in a cross-sectional survey. Sociodemographic and work-related sheet and the Nurses' Alarm Fatigue Questionnaire were used to collect data.

Results

The total mean score of alarm fatigue was 26.38±8.30 out of 44. The highest score was observed for the item "I pay more attention to the alarms in certain", while the lowest score were observed for the items "I turn off the alarms at the beginning of every shift" with mean scores of 2.51 and 1.61, respectively. Nurses who were males, older than 30 years and Saudi citizens had significantly higher mean scores of alarm fatigue than their counterparts. In addition, significantly higher mean scores of alarm fatigue were noticed for nurses experienced for 10 years or more and who had regular morning shifts. Multiple linear regression showed that male (p=0.014), age (p=0.012), and Saudi nationality (p <0.029) were the independent factors affecting the level of fatigue alarm among nurses.

Conclusion

Nurses working in critical care settings at hospitals in Hail city are exposed to average levels of alarm fatigue, which can be influenced by sex, age, nationality, and experience of nurses. Therefore, it is imperative to manage alarm fatigue in critical care units by considering work-related and personality-related factors to ensure patient safety.

Experiences, barriers and expectations regarding current patient monitoring systems among ICU nurses in a University Hospital in Lebanon: a qualitative study

Purpose

The aim of the study is to assess the experiences, barriers, and expectations regarding current patient monitoring systems among intensive care unit nurses at one university hospital.

Methods

A qualitative exploratory study approach was adopted to test the research questions.

Results

Intensive care unit personnel placed a high value on practical criteria such as user friendliness and visualization while assessing the present monitoring system. Poor alarm handling was recognized as possible patient safety hazards. The necessity of high accessibility was highlighted once again for a prospective system; wireless, noninvasive, and interoperability of monitoring devices were requested; and smart phones for distant patient monitoring and alert management improvement were required.

Conclusion

Core comments from ICU personnel are included in this qualitative research on patient monitoring. All national healthcare involved parties must focus more on user-derived insights to ensure a speedy and effective introduction of digital health technologies in the ICU. The findings from the alarm control or mobile device studies might be utilized to train ICU personnel to use new technology, minimize alarm fatigue, increase medical device accessibility, and develop interoperability standards in critical care practice.

The effect of intelligent management interventions in intensive care units to reduce false alarms: An integrative review

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.

Interdisciplinary collaboration in critical care alarm research: A bibliometric analysis

BACKGROUND

Alarm fatigue in nurses is a major patient safety concern in the intensive care unit. This is caused by exposure to high rates of false and non-actionable alarms. Despite decades of research, the problem persists, leading to stress, burnout, and patient harm resulting from true missed events. While engineering approaches to reduce false alarms have spurred hope, they appear to lack collaboration between nurses and engineers to produce real-world solutions. The aim of this bibliometric analysis was to examine the relevant literature to quantify the level of authorial collaboration between nurses, physicians, and engineers.

METHODS

We conducted a bibliometric analysis of articles on alarm fatigue and false alarm reduction strategies in critical care published between 2010 and 2022. Data were extracted at the article and author level. The percentages of author disciplines per publication were calculated by study design, journal subject area, and other article-level factors.

RESULTS

A total of 155 articles with 583 unique authors were identified. While 31.73 % (n = 185) of the unique authors had a nursing background, publications using an engineering study design (n = 46), e.g., model development, had a very low involvement of nursing authors (mean proportion at 1.09 %). Observational studies (n = 58) and interventional studies (n = 33) had a higher mean involvement of 52.27 % and 47.75 %, respectively. Articles published in nursing journals (n = 32) had the highest mean proportion of nursing authors (80.32 %), while those published in engineering journals (n = 46) had the lowest (9.00 %), with 6 (13.04 %) articles having one or more nurses as co-authors.

CONCLUSION

Minimal involvement of nursing expertise in alarm research utilizing engineering methodologies may be one reason for the lack of successful, real-world solutions to ameliorate alarm fatigue. Fostering a collaborative, interdisciplinary research culture can promote a common publication culture across fields and may yield sustainable implementation of technological solutions in healthcare.

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

BACKGROUND

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

AIMS

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

STUDY DESIGN

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

RESULTS

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

CONCLUSIONS

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

RELEVANCE TO CLINICAL PRACTICE

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

The impact of an intervention to improve intrapartum maternal vital sign monitoring and reduce alarm fatigue

BACKGROUND

The infrastructure of many labor and delivery units in the United States may dispose clinicians to overuse continuous and automated maternal physiological monitors. Overmonitoring low-risk patients can negatively affect patient care, primarily through generating alarm fatigue.

OBJECTIVE

Given the national attention to reducing alarm fatigue across healthcare settings and the concern for vital sign monitoring overuse on our labor and delivery unit, this quality improvement study aimed to evaluate vital sign monitoring patterns and alarm rates, and nursing experiences of alarm fatigue, before and after implementing a vital sign monitoring guideline for low-risk obstetrical patients.

STUDY DESIGN

This was a quality improvement study conducted on the labor and delivery unit of an urban, academic, tertiary hospital. The lack of guidance for maternal vital sign assessment in low-risk patients was identified as a potential safety challenge. A vital sign guideline was developed with multidisciplinary input, followed by a pre-post-implementation study evaluating vital sign volume and alarm rates. Total vital signs and alarm rates for all patients delivered during designated calendar days were assessed as a rate of vital signs per patient and compared across baseline, peri-intervention, and follow-up periods. Data were examined in p-type statistical process control charts and with time-series analysis. Patient characteristics and severe maternal morbidity, as a balancing metric, were compared across periods. Nursing perceptions of vital sign monitoring and experience of alarm fatigue were assessed via survey before and after implementation of the guideline.

RESULTS

A total of 35 individual 24-hour periods were evaluated with regard to vital sign and alarm volume. There was a decrease in vital signs per patient from a mean of 208.34 to 135.46 (incidence rate ratio, 0.65) and in alarms per patient from a mean of 14.31 to 10.51 (incidence rate ratio, 0.73) after implementation, with no difference in severe maternal morbidity. There were 85 total respondents to the nursing surveys, and comparison of modified task-load index scores before and after implementation demonstrated overall lower scores in the postperiod, although these were not statistically significant.

CONCLUSION

Introducing a maternal vital sign guideline for low-risk patients on the labor and delivery unit decreased vital signs measured as well as alarms, which may ultimately reduce alarm fatigue. This strategy should be considered on labor and delivery units widely to improve patient safety and optimize outcomes.