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Sloss EA, Jones TL, Baker K, Robins JLW, Thacker LR. Factors Influencing Medication Administration Outcomes Among New Graduate Nurses Using Bar Code-Assisted Medication Administration. Comput Inform Nurs 2024; 42:199-206. [PMID: 38206171 PMCID: PMC10925919 DOI: 10.1097/cin.0000000000001083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Paramount to patient safety is the ability for nurses to make clinical decisions free from human error. Yet, the dynamic clinical environment in which nurses work is characterized by uncertainty, urgency, and high consequence, necessitating that nurses make quick and critical decisions. The aim of this study was to examine the influence of human and environmental factors on the decision to administer among new graduate nurses in response to alert generation during bar code-assisted medication administration. The design for this study was a descriptive, longitudinal, observational cohort design using EHR audit log and administrative data. The study was set at a large, urban medical center in the United States and included 132 new graduate nurses who worked on adult, inpatient units. Research variables included human and environmental factors. Data analysis included descriptive and inferential analyses. This study found that participants continued with administration of a medication in 90.75% of alert encounters. When considering the response to an alert, residency cohort, alert category, and previous exposure variables were associated with the decision to proceed with administration. It is important to continue to study factors that influence nurses' decision-making, particularly during the process of medication administration, to improve patient safety and outcomes.
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Affiliation(s)
- Elizabeth A Sloss
- Author Affiliation: School of Nursing, Virginia Commonwealth University (Dr Sloss), Richmond; College of Nursing, University of Utah (Dr Sloss), Salt Lake City; Department of Adult Health and Nursing Systems, School of Nursing, Virginia Commonwealth University (Dr Jones and Robins), Richmond, Virginia; UVA Health (Dr Baker), Charlottesville, Virginia; and Department of Biostatistics, School of Medicine, Virginia Commonwealth University (Dr Thacker)
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2
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Cen J, Jin X, Liu S, Luo H, Yan N, He X, Ma Y, Luo H, Qin J, Yang Y. [Development of Vital Signal Monitoring System Based on Accelerometer]. Zhongguo Yi Liao Qi Xie Za Zhi 2023; 47:602-607. [PMID: 38086714 DOI: 10.3969/j.issn.1671-7104.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE Reduce the number of false alarms and measurement time caused by movement interference by the sync waveform of the movement. METHODS Vital signal monitoring system based on motion sensor was developed, which collected and processed the vital signals continuously, optimized the features and results of vital signals and transmitted the vital signal results and alarms to the interface. RESULTS The system was tested in many departments, such as digestive department, cardiology department, internal medicine department, hepatobiliary surgery department and emergency department, and the total collection time was 1 940 h. The number of false electrocardiograph (ECG) alarms decreased by 82.8%, and the proportion of correct alarms increased by 28%. The average measurement time of non-invasive blood pressure (NIBP) decreased by 16.1 s. The total number of false respiratory rate measurement decreased by 71.9%. CONCLUSIONS False alarms and measurement failures can be avoided by the vital signal monitoring system based on accelerometer to reduce the alarm fatigue in clinic.
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Affiliation(s)
- Jian Cen
- Shenzhen Mindray Bio-Medical Electronics Co. Ltd., Shenzhen, 518057
| | - Xingliang Jin
- Shenzhen Mindray Bio-Medical Electronics Co. Ltd., Shenzhen, 518057
| | - Sanchao Liu
- Shenzhen Mindray Bio-Medical Electronics Co. Ltd., Shenzhen, 518057
| | - Huacheng Luo
- Shenzhen Mindray Bio-Medical Electronics Co. Ltd., Shenzhen, 518057
| | - Nong Yan
- Shenzhen Mindray Bio-Medical Electronics Co. Ltd., Shenzhen, 518057
| | - Xianliang He
- Shenzhen Mindray Bio-Medical Electronics Co. Ltd., Shenzhen, 518057
| | - Yumei Ma
- Department of Anesthesiology, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032
| | - Hanyuan Luo
- Shenzhen Mindray Bio-Medical Electronics Co. Ltd., Shenzhen, 518057
| | - Jie Qin
- Shenzhen Mindray Bio-Medical Electronics Co. Ltd., Shenzhen, 518057
| | - Yinbing Yang
- Shenzhen Mindray Bio-Medical Electronics Co. Ltd., Shenzhen, 518057
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3
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Gündoğan G, Erdağı Oral S. The effects of alarm fatigue on the tendency to make medical errors in nurses working in intensive care units. Nurs Crit Care 2023; 28:996-1003. [PMID: 37632222 DOI: 10.1111/nicc.12969] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Alarm fatigue resulting from exposure to multiple alarms is an important problem that threatens patient safety. The fact that each device in intensive care units works with different alarm systems increases the number and variety of alarms. AIM The aim of this study was to determine the effects of alarm fatigue on the tendency of nurses working in intensive care units to make medical errors. STUDY DESIGN A cross-sectional and correlational design were used in this study. The study was carried out with 382 intensive care nurses who could be reached via an electronic questionnaire. Data were collected using a 'Personal Information Form', the 'Alarm Fatigue Scale (AFS)' and the 'Medical Error Tendency Scale in Nursing (METSN)'. RESULTS The mean age of the nurses who were included in the study was 31.52 ± 5.66. While 70.2% of the participants were women, 67% had bachelor's degrees, and 65.4% had been working in the intensive care unit for 1-5 years. The mean total METSN score of the participants was 229.29 ± 15.32, and their mean total AFS score was 20.02 ± 6.15. A negative and weak significant correlation was found between the total mean AFS and METSN scores of the participants (r = -0.275; p < .001). As the alarm fatigue levels of the participants increased, their medical error tendencies increased. It was determined that a one-unit increase in the alarm fatigue level of intensive care nurses increased their tendency to make medical errors by 0.263 units (p < .001). CONCLUSIONS It was found that the nurses had a low tendency to make medical errors and moderate levels of alarm fatigue, and an increase in their alarm fatigue levels significantly increased their medical error tendencies. RELEVANCE TO CLINICAL PRACTICE Institutions should establish alarm management procedures in units with multiple alarm systems, such as intensive care units, and examine the effects of alarms on employees.
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Affiliation(s)
- Gamze Gündoğan
- Kağızman State Hospital, Ministry of Health, Kars, Turkey
| | - Semra Erdağı Oral
- Faculty of Health Sciences, Department of Surgical Nursing, Kafkas University, Kars, Turkey
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Ding S, Huang X, Sun R, Yang L, Yang X, Li X, Liu J, Yang H, Zhou H, Huang X, Su F, Shu L, Zheng X, Wang X. The relationship between alarm fatigue and burnout among critical care nurses: A cross-sectional study. Nurs Crit Care 2023; 28:940-947. [PMID: 37070292 DOI: 10.1111/nicc.12899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 01/16/2023] [Accepted: 02/28/2023] [Indexed: 04/19/2023]
Abstract
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.
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Affiliation(s)
- Shenglan Ding
- Pediatric Intensive Care Unit, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiuhua Huang
- Surgery Intensive Care Unit, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Rong Sun
- Adult Intensive Care Unit, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lili Yang
- Surgery Intensive Care Unit, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaorong Yang
- Department of Rehabilitation, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xue Li
- Surgery Intensive Care Unit, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jianhua Liu
- Adult Intensive Care Unit, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hui Yang
- Pediatric Intensive Care Unit, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hong Zhou
- Neonatal Intensive Care Unit, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoming Huang
- Pediatric Intensive Care Unit, West China Second University Hospital, Sichuan University/West China Women's and Children's Hospital, Chengdu, China
| | - Fenghua Su
- Intensive Care Unit 1, Fujian Provincial Hospital, Fuzhou, China
| | - Lingzhi Shu
- Intensive Care Unit, The Affiliated Hospital of Guizhou Medical University
| | - Xingli Zheng
- Pediatric Intensive Care Unit, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xin Wang
- Department of Nursing, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Burdick KJ, Yang S, Lopez AE, Wessel C, Schutz M, Schlesinger JJ. Auditory roughness: a delicate balance. Br J Anaesth 2023; 131:649-652. [PMID: 37537119 DOI: 10.1016/j.bja.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 08/05/2023] Open
Abstract
Auditory roughness in medical alarm sounds is an important design attribute, and has been shown to impact user performance and perception. While roughness can assist in decreased signal-to-noise ratios (perceived loudness) and communicate urgency, it might also impact patient recovery. Therefore, considerations of neuroscience correlates, music theory, and patient impact are critical aspects to investigate in order to optimise alarm design.
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Affiliation(s)
- Kendall J Burdick
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.
| | - Sean Yang
- Blair School of Music, Vanderbilt University, Nashville, TN, USA
| | | | | | | | - Joseph J Schlesinger
- Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Dehghan M, Mokhtarabadi S, Rashidi E, Rahiminejad E, Asadi N. Correlation between professional quality of life and alarm fatigue symptoms among intensive care unit nurses. Health Sci Rep 2023; 6:e1583. [PMID: 37822846 PMCID: PMC10563168 DOI: 10.1002/hsr2.1583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/03/2023] [Accepted: 09/14/2023] [Indexed: 10/13/2023] Open
Abstract
Introduction Medical devices and equipment are necessary for accurate and continuous monitoring of the patients admitted to intensive care units, one of which is alarm systems. Frequent sounds of alarms can affect nurses' concentration and accuracy when providing care. Complications such as headache, fatigue, and stress occur after repeated alarms, leading to poor quality of professional life among nurses. This study aimed to determine the relationship between quality of professional life and alarm fatigue syndrome among intensive care unit nurses. Methods This cross-sectional study used convenience sampling to select nurses working in intensive care units from three hospitals in southern Iran in 2021 (n = 201). Data were collected using three questionnaires, including sociodemographic form, the professional quality of life questionnaire (ProQOL), and the alarm fatigue symptom (AFS) scale. Results The mean scores of compassion satisfaction (CS), burnout, secondary traumatic stress (STS) (subscales of the ProQOL), and AFS were 34.66 ± 7.54, 28.98 ± 7.59, 27.69 ± 5.87, and 13.48 ± 7.32, respectively. The majority of them had no or mild AFS, moderate CS, burnout, and STS. Among the study variables, only AFS were a significant predictor of CS and STS among ICU nurses. In addition, work experience in ICU, AFS, and a second job were significant predictors of burnout among ICU nurses. Conclusions The study results showed a significant relationship between alarm fatigue syndrome, burnout, STS, and CS. Given that more than half of the nurses in the intensive care unit in the present study experienced some degree of alarm fatigue syndrome, it is necessary to plan and implement interventions to better manage the alarms in the intensive care unit.
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Affiliation(s)
- Mahlagha Dehghan
- Nursing Research CenterKerman University of Medical SciencesKermanIran
| | - Sima Mokhtarabadi
- Nursing Research CenterKerman University of Medical SciencesKermanIran
| | - Elham Rashidi
- Nursing Research CenterKerman University of Medical SciencesKermanIran
| | - Elham Rahiminejad
- Nursing Research CenterKerman University of Medical SciencesKermanIran
| | - Neda Asadi
- Nursing Research CenterKerman University of Medical SciencesKermanIran
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kern-Goldberger AR, Hamm RF, Raghuraman N, Srinivas SK. Reducing Alarm Fatigue in Maternal Monitoring on Labor and Delivery: A Commentary on Deimplementation in Obstetrics. Am J Perinatol 2023; 40:1378-1382. [PMID: 35235954 PMCID: PMC10134101 DOI: 10.1055/a-1785-9175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Hospital labor and delivery floors frequently operate like intensive care units (ICUs)-with continuous data feeds pouring into central monitoring stations against a background of blaring alarms. Yet the majority of obstetric patients are healthy and do not require ICU-level care. Despite limited organizational recommendations guiding the frequency of vital sign measurement, continuous pulse oximetry is used widely for laboring patients. There is also no evidence that morbidity prevention is linked to specific frequencies of vital sign monitoring in low-risk patients. In fact, studies examining the performance of maternal early warnings systems based on vital signs suggest that these may not reliably provide actionable information regarding maternal physiologic status. Furthermore, it is very possible that intrapartum maternal overmonitoring can impact care negatively by generating alarm fatigue, causing providers to miss actual abnormal vital signs that may precede morbidity. KEY POINTS: · Labor and delivery units may engage in maternal physiologic overmonitoring.. · Overmonitoring increases risk for alarm fatigue.. · Deimplementing low-value care may improve obstetric outcomes..
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Affiliation(s)
- Adina R. Kern-Goldberger
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca F. Hamm
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nandini Raghuraman
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Sindhu K. Srinivas
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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9
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Alshehri N, Alanazi A. Pharmacists' Perceptions on Safety Alerts of the Drug Utilization Review (DUR) in Electronic Health Records in a Tertiary Healthcare Hospital. Pharmacy (Basel) 2023; 11:119. [PMID: 37489350 PMCID: PMC10366836 DOI: 10.3390/pharmacy11040119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023] Open
Abstract
Electronic Drug Alarms and Drug Utilization Reviews (DURs) are crucial in improving patient safety by reducing the dispensing of contraindicated medications and minimizing adverse drug events. The DUR system often generates low-level alerts, making it challenging for pharmacists and doctors to discern more critical alerts. This can result in alert fatigue, causing burnout and jeopardizing patient safety. A cross-sectional study was conducted in a tertiary hospital to explore pharmacists' perspectives and experience with the DUR system. This study aimed to identify their responses to alerts indicating a need to change the original prescription and the difficulties encountered. Out of all the participants, 85% had prior experience with DUR alerts. However, 40% of them expressed dissatisfaction with the alerts. Moreover, 88% of the participants received highly frequent DUR alerts, but only 40% believed that DUR alerts could identify rare adverse drug reactions. Additionally, only 27% of the participants altered their prescriptions based on alerts for the MAOI/serotonin modulator. The survey showed that 66% of participants believe improvements are necessary for the DUR system. Specifically, 77% of participants felt that more information is needed on overlapping prescriptions, 82% on patients with chronic diseases, and 82% on potential reactions caused by co-administration. At the same time, 75% raised concern about the need for backup for any server breakdown. Positive perceptions about DUR lead to changing the prescription in response to an alert. Therefore, improving the DUR system is crucial to prevent pharmacists from missing important alerts and to increase their awareness of clinically significant alarm signals. By doing so, we can optimize patient safety and contribute to providing high-quality healthcare services.
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Affiliation(s)
- Nouf Alshehri
- Department of Health Informatics, College of Public Health and Health Informatics, King Saud Ibn Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 14611, Saudi Arabia
| | - Abdullah Alanazi
- Department of Health Informatics, College of Public Health and Health Informatics, King Saud Ibn Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
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10
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Seok Y, Cho Y, Kim N, Suh EE. Degree of Alarm Fatigue and Mental Workload of Hospital Nurses in Intensive Care Units. Nurs Rep 2023; 13:946-955. [PMID: 37489405 PMCID: PMC10366754 DOI: 10.3390/nursrep13030083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/24/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023] Open
Abstract
This study aimed to determine the degree of alarm fatigue and mental workload of ICU nurses, and to clarify the relationship between these two variables. A cross-sectional, descriptive research design was used. Data were collected from 90 nurses working in four ICUs in Seoul, Republic of Korea, using a questionnaire determining their degree of alarm fatigue and mental workload. Data were collected from 6 March to 26 April 2021 and were analyzed using a t-test, ANOVA, and Pearson's correlation coefficient. The average alarm-fatigue score was 28.59 out of 44. The item with the highest score was "I often hear a certain amount of noise in the ward", with a score of 3.59 out of 4. The average of the mental workload scores was 75.21 out of 100. The highest mental workload item was effort, which scored 78.72 out of 100. No significant correlation was found between alarm fatigue and mental workload. Although nurses were consistently exposed to alarm fatigue, this was not directly related to their mental workloads, perhaps owing to their professional consciousness as they strived to accomplish tasks despite alarm fatigue. However, since alarm fatigue can affect efficiency, investigations to reduce it and develop appropriate guidelines are necessary. This study was not registered.
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Affiliation(s)
- Yoonhee Seok
- Department of Nursing, Kyungil University, Gyeongsan 38428, Republic of Korea
| | - Yoomi Cho
- College of Nursing, Seoul National University, Seoul 03080, Republic of Korea
| | - Nayoung Kim
- College of Nursing, Seoul National University, Seoul 03080, Republic of Korea
| | - Eunyoung E Suh
- Center for Human-Caring Nurse Leaders for the Future by Brain Korea 21 (BK 21) Four Project, Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul 03080, Republic of Korea
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Suba S, Hoffmann TJ, Fleischmann KE, Schell-Chaple H, Marcus GM, Prasad P, Hu X, Badilini F, Pelter MM. Evaluation of premature ventricular complexes during in-hospital ECG monitoring as a predictor of ventricular tachycardia in an intensive care unit cohort. Res Nurs Health 2023. [PMID: 37127543 DOI: 10.1002/nur.22314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/17/2023] [Accepted: 04/15/2023] [Indexed: 05/03/2023]
Abstract
In-hospital electrocardiographic (ECG) monitors are typically configured to alarm for premature ventricular complexes (PVCs) due to the potential association of PVCs with ventricular tachycardia (VT). However, no contemporary hospital-based studies have examined the association of PVCs with VT. Hence, the benefit of PVC monitoring in hospitalized patients is largely unknown. This secondary analysis used a large PVC alarm data set to determine whether PVCs identified during continuous ECG monitoring were associated with VT, in-hospital cardiac arrest (IHCA), and/or death in a cohort of adult intensive care unit patients. Six PVC types were examined (i.e., isolated, bigeminy, trigeminy, couplets, R-on-T, and run PVCs) and were compared between patients with and without VT, IHCA, and/or death. Of 445 patients, 48 (10.8%) had VT; 11 (2.5%) had IHCA; and 49 (11%) died. Isolated and run PVC counts were higher in the VT group (p = 0.03 both), but group differences were not seen for the other four PVC types. The regression models showed no significant associations between any of the six PVC types and VT or death, although confidence intervals were wide. Due to the small number of cases, we were unable to test for associations between PVCs and IHCA. Our findings suggest that we should question the clinical relevance of activating PVC alarms as a forewarning of VT, and more work should be done with larger sample sizes. A more precise characterization of clinically relevant PVCs that might be associated with VT is warranted.
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Affiliation(s)
- Sukardi Suba
- School of Nursing, University of Rochester, Rochester, New York, USA
| | - Thomas J Hoffmann
- Department of Epidemiology and Biostatistics, School of Medicine, and Office of Research, School of Nursing, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Kirsten E Fleischmann
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Hildy Schell-Chaple
- Center for Nursing Excellence & Innovation, UCSF Medical Center, San Francisco, California, USA
| | - Gregory M Marcus
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Priya Prasad
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Xiao Hu
- Nell Hodgson Woodruff School of Nursing, Biomedical Informatics, School of Medicine, and Computer Science, College of Arts and Sciences, Emory University, Atlanta, Georgia, USA
| | - Fabio Badilini
- Department of Physiological Nursing, Center for Physiologic Research, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Michele M Pelter
- Department of Physiological Nursing, Center for Physiologic Research, School of Nursing, University of California, San Francisco, San Francisco, California, USA
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12
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Kern-Goldberger AR, Nicholls EM, Plastino N, Srinivas SK. The impact of an intervention to improve intrapartum maternal vital sign monitoring and reduce alarm fatigue. Am J Obstet Gynecol MFM 2023; 5:100893. [PMID: 36781120 PMCID: PMC10121943 DOI: 10.1016/j.ajogmf.2023.100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
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.
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Affiliation(s)
- Adina R Kern-Goldberger
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Drs Kern-Goldberger and Srinivas).
| | - Erika M Nicholls
- Hospital of the University of Pennsylvania, Philadelphia, PA (Mses Nicholls and Plastino)
| | - Natalie Plastino
- Hospital of the University of Pennsylvania, Philadelphia, PA (Mses Nicholls and Plastino)
| | - Sindhu K Srinivas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Drs Kern-Goldberger and Srinivas)
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Pelter MM, Carey MG, Al-Zaiti S, Zegre-Hemsey J, Sommargren C, Isola L, Prasad P, Mortara D, Badilini F. An annotated ventricular tachycardia (VT) alarm database: Toward a uniform standard for optimizing automated VT identification in hospitalized patients. Ann Noninvasive Electrocardiol 2023:e13054. [PMID: 36892130 DOI: 10.1111/anec.13054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/12/2023] [Accepted: 02/01/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND False ventricular tachycardia (VT) alarms are common during in-hospital electrocardiographic (ECG) monitoring. Prior research shows that the majority of false VT can be attributed to algorithm deficiencies. PURPOSE The purpose of this study was: (1) to describe the creation of a VT database annotated by ECG experts and (2) to determine true vs. false VT using a new VT algorithm created by our group. METHODS The VT algorithm was processed in 5320 consecutive ICU patients with 572,574 h of ECG and physiologic monitoring. A search algorithm identified potential VT, defined as: heart rate >100 beats/min, QRSs > 120 ms, and change in QRS morphology in >6 consecutive beats compared to the preceding native rhythm. Seven ECG channels, SpO2 , and arterial blood pressure waveforms were processed and loaded into a web-based annotation software program. Five PhD-prepared nurse scientists performed the annotations. RESULTS Of the 5320 ICU patients, 858 (16.13%) had 22,325 VTs. After three levels of iterative annotations, a total of 11,970 (53.62%) were adjudicated as true, 6485 (29.05%) as false, and 3870 (17.33%) were unresolved. The unresolved VTs were concentrated in 17 patients (1.98%). Of the 3870 unresolved VTs, 85.7% (n = 3281) were confounded by ventricular paced rhythm, 10.8% (n = 414) by underlying BBB, and 3.5% (n = 133) had a combination of both. CONCLUSIONS The database described here represents the single largest human-annotated database to date. The database includes consecutive ICU patients, with true, false, and challenging VTs (unresolved) and could serve as a gold standard database to develop and test new VT algorithms.
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Affiliation(s)
- Michele M Pelter
- Department of Physiological Nursing, University of California San Francisco School of Nursing, San Francisco, California, USA
| | - Mary G Carey
- School of Nursing, University of Rochester, Rochester, New York, USA
| | - Salah Al-Zaiti
- Department of Acute & Tertiary Care Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jessica Zegre-Hemsey
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Claire Sommargren
- Department of Physiological Nursing, University of California San Francisco School of Nursing, San Francisco, California, USA
| | | | - Priya Prasad
- Department of Medicine, Division of Hospital Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - David Mortara
- Department of Physiological Nursing, University of California San Francisco School of Nursing, San Francisco, California, USA
| | - Fabio Badilini
- Department of Physiological Nursing, University of California San Francisco School of Nursing, San Francisco, California, USA
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14
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Jämsä JO, Uutela KH, Tapper AM, Lehtonen L. Clinical Alarms in a Gynaecological Surgical Unit: A Retrospective Data Analysis. Int J Environ Res Public Health 2023; 20:4193. [PMID: 36901201 PMCID: PMC10001798 DOI: 10.3390/ijerph20054193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Alarm fatigue refers to the desensitisation of medical staff to patient monitor clinical alarms, which may lead to slower response time or total ignorance of alarms and thereby affects patient safety. The reasons behind alarm fatigue are complex; the main contributing factors include the high number of alarms and the poor positive predictive value of alarms. The study was performed in the Surgery and Anaesthesia Unit of the Women's Hospital, Helsinki, by collecting data from patient monitoring device clinical alarms and patient characteristics from surgical operations. We descriptively analysed the data and statistically analysed the differences in alarm types between weekdays and weekends, using chi-squared, for a total of eight monitors with 562 patients. The most common operational procedure was caesarean section, of which 149 were performed (15.7%). Statistically significant differences existed in alarm types and procedures between weekdays and weekends. The number of alarms produced was 11.7 per patient. In total, 4698 (71.5%) alarms were technical and 1873 (28.5%) were physiological. The most common physiological alarm type was low pulse oximetry, with a total of 437 (23.3%). Of all the alarms, the number of alarms either acknowledged or silenced was 1234 (18.8%). A notable phenomenon in the study unit was alarm fatigue. Greater customisation of patient monitors for different settings is needed to reduce the number of alarms that do not have clinical significance.
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Affiliation(s)
- Juho O. Jämsä
- Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
| | | | - Anna-Maija Tapper
- Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Hyvinkää Hospital, Helsinki and Uusimaa University Hospital District, 05850 Hyvinkää, Finland
| | - Lasse Lehtonen
- Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Diagnostic Center, Helsinki University Hospital, 00260 Helsinki, Finland
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Rypicz Ł, Rozensztrauch A, Fedorowicz O, Włodarczyk A, Zatońska K, Juárez-Vela R, Witczak I. Polish Adaptation of the Alarm Fatigue Assessment Questionnaire as an Element of Improving Patient Safety. Int J Environ Res Public Health 2023; 20:1734. [PMID: 36767101 PMCID: PMC9914244 DOI: 10.3390/ijerph20031734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/11/2023] [Accepted: 01/14/2023] [Indexed: 06/18/2023]
Abstract
Medical personnel, working in medical intensive care units, are exposed to fatigue associated with alarms emitted by numerous medical devices used for diagnosing, treating, and monitoring patients. Alarm fatigue is a safety and quality problem in patient care and actions should be taken to reduce this by, among other measures, building an effective safety culture. In the present study, an adaptation of a questionnaire to assess alarm fatigue was carried out. The study obtained good reliability of the questionnaire at Cronbach's alpha level of 0.88. The Polish research team has successfully adapted the Alarm Fatigue Assessment Questionnaire so that it can be used in healthcare settings as a tool to improve patient safety.
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Affiliation(s)
- Łukasz Rypicz
- Department of Population Health, Division of Public Health, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wroclaw, Poland
| | - Anna Rozensztrauch
- Department of Nursing and Midwifery, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wroclaw, Poland
| | - Olga Fedorowicz
- Department of Clinical Pharmacology, Faculty of Pharmacy, Wroclaw Medical University, 51-618 Wroclaw, Poland
| | - Aleksander Włodarczyk
- Faculty of Medical Sciences named after Professor Zbigniew Religa, Academy of Silesia, 40-007 Katowice, Poland
| | - Katarzyna Zatońska
- Department of Population Health, Division of Public Health, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wroclaw, Poland
| | - Raúl Juárez-Vela
- Research Group GRUPAC, Faculty of Health Sciences, University of La Rioja, 26004 Logroño, Spain
| | - Izabela Witczak
- Department of Population Health, Division of Public Health, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wroclaw, Poland
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Movahedi A, Sadooghiasl A, Ahmadi F, Vaismoradi M. Smart care for dealing with nurses' alarm fatigue in the intensive care unit. J Nurs Scholarsh 2023. [PMID: 36631719 DOI: 10.1111/jnu.12870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/29/2022] [Accepted: 12/16/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Alarm fatigue is a condition in which a person experiences sensory overload or desensitization in exposure to frequent non-actionable alarms. Nurses are the main users of alarms in health care and their behaviors for alarm management influence the occurrence of alarm fatigue. OBJECTIVES This qualitative research aimed to explore strategies used by nurses in dealing with nurses' alarm fatigue in the intensive care unit (ICU). DESIGN Qualitative research was carried out. Eighteen nurses working in ICUs were selected purposefully and were invited to take part in individual semi-structured interviews. Collected data were analyzed using content analysis for developing categories and subcategories. SETTING Twelve ICUs in ten hospitals in four urban areas of Iran. RESULTS The research's main category was "smart care" consisting of two categories of "technologic actions" and "non-technologic actions." Also, six subcategories were developed: "identifying the cause and taking timely actions", "personalized alarm settings", "reducing the number of unnecessary alarms", "effective teamwork", "improving the physical environment and ward arrangement", and "self-calmness". CONCLUSION Smart care by nurses included a set of active and proactive interventions developed through thinking and reflection and the use of information, skills, and experiences in order to manage exposure to alarm fatigue. Strategies used by nurses to prevent alarm fatigue can reduce the physical and psychological burden caused by frequent exposure to alarms in the ICU and consequently can have direct impacts on the quality and safety of nursing care. CLINICAL RELEVANCE Nurses in the healthcare process often experience alarm fatigue that is influenced by the cultural-contextual aspect of care and the care environment. Smart care in terms of technologic and non-technologic actions helps with the prevention of alarm fatigue.
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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
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17
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Jeong YJ, Kim H. Critical care nurses' perceptions and practices towards clinical alarms. Nurs Crit Care 2023; 28:101-108. [PMID: 35021259 DOI: 10.1111/nicc.12751] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Muted or controlled alarms resulting from alarm fatigue have become a threat to patient safety and several institutions are aware of this risk. AIMS This study aimed to investigate critical care nurses' perceptions of medical device alarms, alarm fatigue, and alarm management practices. METHODS This descriptive study investigated 48 nurses working at two intensive care units (ICUs) within a single university hospital, in South Korea. They were asked to complete a self-administered questionnaire about their perception of the ICU medical device alarm, alarm fatigue, and related management practices. The response rate was 100%. RESULTS Critical care nurses experienced a moderate or higher level of alarm fatigue, scoring 29.1 out of 40. Participants identified the items "Frequent false alarms, which lead to reduced attention or response to alarm when they occur," and "Inadequate staff" as the most important issues for alarm management. The most frequently involved item in alarm management practice was "I only use infusion pumps for drugs that require precise dose." Alarm management practices among the nurses differed significantly according to ICU clinical career and experience of patient safety accidents. CONCLUSIONS This study highlights the need to develop a standardized medical device alarm management protocol that can help identify different alarms correctly and respond to them rapidly and appropriately. RELEVANCE TO CLINICAL PRACTICE It is necessary to reduce alarm fatigue and promote safe and effective alarm management practices among critical care nurses through sufficient education and steady training. Alarm fatigue should also be mitigated by employment of sufficient nursing personnel in ICUs.
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Affiliation(s)
- Yu Jin Jeong
- Department of Clinical Nursing Science, Hallym University, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, South Korea
| | - Hyunjung Kim
- School of Nursing & Research Institute of Nursing Science, Hallym University, Chuncheon, South Korea
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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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19
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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Suba S, Hoffmann TJ, Fleischmann KE, Schell-Chaple H, Prasad P, Marcus GM, Badilini F, Hu X, Pelter MM. Premature ventricular complexes during continuous electrocardiographic monitoring in the intensive care unit: Occurrence rates and associated patient characteristics. J Clin Nurs 2022. [PMID: 35712789 DOI: 10.1111/jocn.16408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/25/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES This study examined the occurrence rate of specific types of premature ventricular complex (PVC) alarms and whether patient demographic and/or clinical characteristics were associated with PVC occurrences. BACKGROUND Because PVCs can signal myocardial irritability, in-hospital electrocardiographic (ECG) monitors are typically configured to alert nurses when they occur. However, PVC alarms are common and can contribute to alarm fatigue. A better understanding of occurrences of PVCs could help guide alarm management strategies. DESIGN A secondary quantitative analysis from an alarm study. METHODS The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was followed. Seven PVC alarm types (vendor-specific) were described, and included isolated, couplet, bigeminy, trigeminy, run PVC (i.e. VT >2), R-on-T and PVCs/min. Negative binomial and hurdle regression analyses were computed to examine the association of patient demographic and clinical characteristics with each PVC type. RESULTS A total of 797,072 PVC alarms (45,271 monitoring hours) occurred in 446 patients, including six who had disproportionately high PVC alarm counts (40% of the total alarms). Isolated PVCs were the most frequent type (81.13%) while R-on-T were the least common (0.29%). Significant predictors associated with higher alarms rates: older age (isolated PVCs, bigeminy and couplets); male sex and presence of PVCs on the 12-lead ECG (isolated PVCs). Hyperkalaemia at ICU admission was associated with a lower R-on-T type PVCs. CONCLUSIONS Only a few distinct demographic and clinical characteristics were associated with the occurrence rate of PVC alarms. Further research is warranted to examine whether PVCs were associated with adverse outcomes, which could guide alarm management strategies to reduce unnecessary PVC alarms. RELEVANCE TO CLINICAL PRACTICE Targeted alarm strategies, such as turning off certain PVC-type alarms and evaluating alarm trends in the first 24 h of admission in select patients, might add to the current practice of alarm management.
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Affiliation(s)
- Sukardi Suba
- School of Nursing, University of Rochester, Rochester, New York, USA
| | - Thomas J Hoffmann
- Department of Epidemiology and Biostatistics, School of Medicine, and Office of Research, School of Nursing, University of California, San Francisco (UCSF), San Francisco, California, USA
| | | | - Hildy Schell-Chaple
- Center for Nursing Excellence & Innovation, UCSF Medical Center, San Francisco, California, USA
| | - Priya Prasad
- Department of Medicine, School of Medicine, UCSF, San Francisco, California, USA
| | - Gregory M Marcus
- Department of Medicine, School of Medicine, UCSF, San Francisco, California, USA
| | - Fabio Badilini
- Department of Physiological Nursing, School of Nursing, UCSF, San Francisco, California, USA
| | - Xiao Hu
- School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Michele M Pelter
- Department of Physiological Nursing, School of Nursing, UCSF, San Francisco, California, USA
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22
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Akturan S, Güner Y, Tuncel B, Üçüncüoğlu M, Kurt T. Evaluation of alarm fatigue of nurses working in the COVID-19 Intensive Care Service: A mixed methods study. J Clin Nurs 2022; 31:2654-2662. [PMID: 34985160 DOI: 10.1111/jocn.16190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/27/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022]
Abstract
AIMS AND OBJECTIVES To reveal the existence of alarms in COVID-19 intensive care units, where medical devices with alarm function are frequently used, the effects of alarms on nurses, especially their on-the-job performances and social lives, and their coping methods. METHODOLOGY/METHODS This was a mixed design, including descriptive and qualitative research methods with two stages, and was carried out between March and April 2021. The study adhered to the STROBE checklist for cross-sectional studies and the COREQ guidelines for qualitative studies. SETTING Nurses in the COVID-19 intensive care unit of a university hospital constituted the sample. 58 nurses participated in the quantitative data phase, and 18 nurses in the qualitative interviews. RESULTS More than half of the nurses worked in the COVID-19 intensive care unit for more than 5 months and overtime, and 87.9 had day and night shifts. The monthly income level of 65.5% was between the hunger and poverty lines, and 12.1 % received psychiatric support in the last 6 months. A positive and significant relationship was found between the mean score obtained from the alarm fatigue questionnaire and the level of discomfort felt due to the alarms (1-10 points) (p = 0.001). Five themes and thirty sub-themes were emerged in the focus group interviews. CONCLUSION The number of alarms of the medical devices in the COVID-19 intensive care units was more than the other intensive care units, resulting in fatigue in nurses. Since alarm fatigue is directly related to patient safety, the effective management of medical device alarms can reduce alarm fatigue and prevent potentially dangerous outcomes. RELEVANCE TO CLINICAL PRACTICE Nurses care for patients with severe clinical conditions in COVID-19 intensive care units. This situation caused them to be exposed to more alarms. Nurses should make efforts to reduce their alarm intensity.
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Affiliation(s)
- Selçuk Akturan
- Faculty of Medicine, Department of Medical Education, Karadeniz Technical University, Trabzon, Turkey
| | - Yasemin Güner
- Faculty of Medicine, Department of Medical Education, Karadeniz Technical University, Trabzon, Turkey
| | - Bilge Tuncel
- Faculty of Medicine, Department of Medical Education, Karadeniz Technical University, Trabzon, Turkey
| | - Melek Üçüncüoğlu
- Faculty of Medicine, Department of Medical Education, Karadeniz Technical University, Trabzon, Turkey
| | - Tuğba Kurt
- Faculty of Medicine, Biostatistics and Medical Informatics, Karadeniz Technical University, Trabzon, Turkey
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Dee SA, Tucciarone J, Plotkin G, Mallilo C. Determining the Impact of an Alarm Management Program on Alarm Fatigue among ICU and Telemetry RNs: An Evidence Based Research Project. SAGE Open Nurs 2022; 8:23779608221098713. [PMID: 35592038 PMCID: PMC9112316 DOI: 10.1177/23779608221098713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
This evidence-based research project provides an appraisal of current research on how an alarm management program impacts alarm fatigue among registered nurses (RNs) in both intensive care units (ICUs) and telemetry units. Alarm fatigue is a major problem recognized by both the American Association of Critical-Care Nurses (AACN) and the Joint Commission. RNs are the primary caretakers of critically ill patients in ICUs and telemetry units and therefore are at the greatest risk for alarm fatigue. The researchers performed an evidence synthesis to determine the impact of an alarm management program on alarm fatigue among ICU and telemetry RNs. A literature search was conducted using scientific databases such as PubMed, CINAHL, Trip, Cochrane Review, and Google Scholar. Our search strategy included the following terms: adult registered nurse, inpatient registered nurse, ICU registered nurses, RNs, Nurse Practitioners, alarm fatigue, alarm management strategy, education, cardiac monitor alarm, alarm strategies, alarm bundle, telemetry alarm, and cardiac monitor. Any studies involving the pediatric population, pulse oximeter alarms, and ventilator alarms were excluded. Due to the lack of available randomized control trials and cohort studies, the authors included two quality improvement (QI) projects. Finally, six studies were taken into consideration for review. The authors appraised each of the six articles using the Critical Appraisal Skills Programme Checklist (CASP) Tool. This tool allowed the authors to synthesize information based on the outcomes and determine the level of the evidence of each article in order to make evidence-based practice recommendations on implementing alarm management programs. Conclusion: Despite extensive literature highlighting the astronomical prevalence of alarm fatigue in RNs, there was a lack of current high-quality data related to implementing alarm management programs. Therefore, more research is needed to support the utilization of alarm management programs in ICUs and telemetry units to improve alarm fatigue among RNs.
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Affiliation(s)
- Stacie A. Dee
- Hofstra Northwell School of Nursing and Physician
Assistant Studies, Hempstead, NY, USA
| | - Jessica Tucciarone
- Hofstra Northwell School of Nursing and Physician
Assistant Studies, Hempstead, NY, USA
| | - Gary Plotkin
- Hofstra Northwell School of Nursing and Physician
Assistant Studies, Hempstead, NY, USA
| | - Christina Mallilo
- Hofstra Northwell School of Nursing and Physician
Assistant Studies, Hempstead, NY, USA
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He X, Liu M, Liu S, Sun Z, Wang C, Li Y. [Research on Patient Monitoring Alarms in ICU and NICU]. Zhongguo Yi Liao Qi Xie Za Zhi 2021; 45:585-590. [PMID: 34628778 DOI: 10.3969/j.issn.1671-7104.2021.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The patient monitors were used to explore the alarm actuality in a ICU and NICU to investigate the awareness and reaction of medical staff to alarms. METHODS A series of surveys and interviews were taken to acquire clinicians' feelings and attitudes to monitoring alarms. The researchers were scheduled to track the alarms with annotations, and collect the alarm data of patient monitors using central monitoring system. RESULTS A total of 235 387 and 67 783 alarms occurred in ICU and NICU respectively. The average alarm rate was about 142 alarms/patient-day in ICU and 96 alarms/patient-day in NICU. CONCLUSIONS There remains alarm fatigue in ICU and NICU, the main reason is the large number of false alarms and clinically irrelevant alarms. In addition, patient monitor is still in the level of threshold alarms or combined alarms, the data integrity and intelligence level need to be improved in future.
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Affiliation(s)
- Xianliang He
- Shenzhen Mindray Bio-Medical Electronics Co. Ltd., Shenzhen, 518057
| | - Mengxing Liu
- Shenzhen Mindray Bio-Medical Electronics Co. Ltd., Shenzhen, 518057
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518000
| | - Sanchao Liu
- Shenzhen Mindray Bio-Medical Electronics Co. Ltd., Shenzhen, 518057
| | - Zehui Sun
- Shenzhen Mindray Bio-Medical Electronics Co. Ltd., Shenzhen, 518057
| | - Cheng Wang
- Shenzhen Mindray Bio-Medical Electronics Co. Ltd., Shenzhen, 518057
| | - Ye Li
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518000
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Jämsä JO, Uutela KH, Tapper A, Lehtonen L. Clinical alarms and alarm fatigue in a University Hospital Emergency Department-A retrospective data analysis. Acta Anaesthesiol Scand 2021; 65:979-985. [PMID: 33786815 DOI: 10.1111/aas.13824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/04/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alarm fatigue is hypothesized to be caused by vast amount of patient monitor alarms. Objectives were to study the frequency and types of patient monitor alarms, to evaluate alarm fatigue, and to find unit specific alarm threshold values in a university hospital emergency department. METHODS We retrospectively gathered alarm data from 9 September to 6 October 2019, in Jorvi Hospital Emergency department, Finland. The department treats surgical, internal and general medicine patients aged 16 and older. The number of patients is on average 4600 to 5000 per month. Eight out of 46 monitors were used for data gathering and the monitored modalities included electrocardiography, respiratory rate, blood pressure, and pulse oximetry. RESULTS Total number of alarms in the study monitors was 28 176. Number of acknowledged alarms (ie acknowledgement indicator pressed in the monitor) was 695 (2.5%). The most common alarm types were: Respiratory rate high, 9077 (32.2%), pulse oximetry low, 4572 (16.2%) and pulse oximetry probe off, 4036 (14.3%). Number of alarms with duration under 10 s was 14 936 (53%). Number of individual alarm sounds was 105 000, 469 per monitor per day. Of respiratory rate high alarms, 2846 (31.4%) had initial value below 30 breaths min-1 . Of pulse oximetry low alarms, 2421 (53.0%) had initial value above 88%. CONCLUSIONS Alarm sound load, from individual alarm sounds, was nearly continuous in an emergency department observation room equipped with nine monitors. Intervention by the staff to the alarms was infrequent. More than half of the alarms were momentary.
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Affiliation(s)
- Juho O. Jämsä
- Jorvi Hospital Emergency Department Helsinki University Hospital Helsinki Finland
- University of Helsinki Helsinki Finland
| | - Kimmo H. Uutela
- Jorvi Hospital Emergency Department Helsinki University Hospital Helsinki Finland
- University of Helsinki Helsinki Finland
| | - Anna‐Maija Tapper
- Jorvi Hospital Emergency Department Helsinki University Hospital Helsinki Finland
- University of Helsinki Helsinki Finland
| | - Lasse Lehtonen
- Jorvi Hospital Emergency Department Helsinki University Hospital Helsinki Finland
- University of Helsinki Helsinki Finland
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Liu P, Xu M, Wang H, Pi H, Xie P, Li Y, Liu M. [A Survey of Patient Monitoring Alarms in Cardiac Care Units]. Zhongguo Yi Liao Qi Xie Za Zhi 2021; 45:450-453. [PMID: 34363377 DOI: 10.3969/j.issn.1671-7104.2021.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The patient monitors were used to explore the alarm fatigue in a cardiac care unit and to investigate the awareness and reaction of nurse to alarms. METHODS A semi-structured survey was taken to acquire nurses' feeling and knowledge about monitoring alarm. Three full-time researchers were scheduled to track the alarms with annotations, and analyze the alarm data of 12 patient monitors using central monitoring system. RESULTS A total of 72 310 unique alarms occurred in the 67-day study period. About 75.7% of them were physiological alarms and less than 10% of medium-low alarms were false positives. The average alarm rate was 128 alarms/patient-day. CONCLUSIONS There remains alarm fatigue in CCU, the alarm accuracy has improved than the past by applying new technologies. In some cases, clinicians will pay more attention to trend alarm and combination alarm.
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Affiliation(s)
- Puping Liu
- Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, 518000
| | - Meng Xu
- Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, 518000
| | - Huizhi Wang
- Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, 518000
| | - Hua Pi
- Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, 518000
| | - Peiyi Xie
- Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, 518000
| | - Ye Li
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518000
| | - Mengxing Liu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518000
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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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Poncette AS, Wunderlich MM, Spies C, Heeren P, Vorderwülbecke G, Salgado E, Kastrup M, Feufel MA, Balzer F. Patient Monitoring Alarms in an Intensive Care Unit: Observational Study With Do-It-Yourself Instructions. J Med Internet Res 2021; 23:e26494. [PMID: 34047701 PMCID: PMC8196351 DOI: 10.2196/26494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/11/2021] [Accepted: 04/02/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND As one of the most essential technical components of the intensive care unit (ICU), continuous monitoring of patients' vital parameters has significantly improved patient safety by alerting staff through an alarm when a parameter deviates from the normal range. However, the vast number of alarms regularly overwhelms staff and may induce alarm fatigue, a condition recently exacerbated by COVID-19 and potentially endangering patients. OBJECTIVE This study focused on providing a complete and repeatable analysis of the alarm data of an ICU's patient monitoring system. We aimed to develop do-it-yourself (DIY) instructions for technically versed ICU staff to analyze their monitoring data themselves, which is an essential element for developing efficient and effective alarm optimization strategies. METHODS This observational study was conducted using alarm log data extracted from the patient monitoring system of a 21-bed surgical ICU in 2019. DIY instructions were iteratively developed in informal interdisciplinary team meetings. The data analysis was grounded in a framework consisting of 5 dimensions, each with specific metrics: alarm load (eg, alarms per bed per day, alarm flood conditions, alarm per device and per criticality), avoidable alarms, (eg, the number of technical alarms), responsiveness and alarm handling (eg alarm duration), sensing (eg, usage of the alarm pause function), and exposure (eg, alarms per room type). Results were visualized using the R package ggplot2 to provide detailed insights into the ICU's alarm situation. RESULTS We developed 6 DIY instructions that should be followed iteratively step by step. Alarm load metrics should be (re)defined before alarm log data are collected and analyzed. Intuitive visualizations of the alarm metrics should be created next and presented to staff in order to help identify patterns in the alarm data for designing and implementing effective alarm management interventions. We provide the script we used for the data preparation and an R-Markdown file to create comprehensive alarm reports. The alarm load in the respective ICU was quantified by 152.5 (SD 42.2) alarms per bed per day on average and alarm flood conditions with, on average, 69.55 (SD 31.12) per day that both occurred mostly in the morning shifts. Most alarms were issued by the ventilator, invasive blood pressure device, and electrocardiogram (ie, high and low blood pressure, high respiratory rate, low heart rate). The exposure to alarms per bed per day was higher in single rooms (26%, mean 172.9/137.2 alarms per day per bed). CONCLUSIONS Analyzing ICU alarm log data provides valuable insights into the current alarm situation. Our results call for alarm management interventions that effectively reduce the number of alarms in order to ensure patient safety and ICU staff's work satisfaction. We hope our DIY instructions encourage others to follow suit in analyzing and publishing their ICU alarm data.
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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
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Maximilian Markus Wunderlich
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 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
| | - Patrick Heeren
- 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
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gerald Vorderwülbecke
- 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
| | - Eduardo Salgado
- 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
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marc Kastrup
- 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
| | - Markus A Feufel
- Department of Psychology and Ergonomics (IPA), Division of Ergonomics, Technische Universität Berlin, 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
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Langga L, Oh J, López D, Blake N, McField E, Hotz J, Nava-Guerra L, Knox K, Chinnock R. Prevalence, Proportionality, and Cause of Ventilator Alarms in a Pediatric Intensive Care Setting. Respir Care 2021; 66:541-550. [PMID: 33293363 PMCID: PMC9993984 DOI: 10.4187/respcare.07200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Clinical alarms play an important role in monitoring physiological parameters, vital signs and medical device function in the hospital intensive care environment. Delays in staff response to alarms are well documented as health care providers become desensitized to increased rates of nuisance alarms. Patients can be at increased risk of harm due to alarm fatigue. Current literature suggests alarms from ventilators contribute significantly to nonactionable alarms. A greater understanding of which specific ventilator alarms are most common and the rates at which they occur is fundamental to improving alarm management. METHODS A retrospective review was performed on alarms that occurred on the Avea and Servo-i ventilators used in the pediatric ICU and pediatric cardiothoracic ICU at a major metropolitan children's hospital. High- and medium-priority alarms, as classified by the manufacturer, were studied between June 1, 2017, and November 31, 2017. Descriptive data analysis and a 2-proportion z-test were performed to identify proportionality, cause, and prevalence rates in the pediatric ICU and the cardiothoracic ICU. RESULTS Eleven distinct ventilator alarms were identified during 2,091 d of mechanical ventilation. The Inspiratory Flow Overrange alarm (42.4%) on the Servo-i, Low VTE (20.4%; expiratory tidal volume) and Circuit Integrity alarm (20.0%) on the Avea were the most prevalent causes according to ventilator type. Medium-priority alarms comprised 68.7% of all Servo-i alarms, and high-priority alarms comprised 84% of all Avea alarms. The 2-sample test of proportions was significant for differences between both areas (P < .001). The overall alarm prevalence rate was 22.5 ventilator alarms per ventilator-day per patient. CONCLUSIONS The cause and proportion of alarms varied by ventilator and care unit. High-priority alarms were most common with the Avea and medium-priority alarms for the Servo-i. The overall combined ventilator alarm prevalence rate was 22.5 alarms per ventilator-day per patient.
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Affiliation(s)
- Leo Langga
- Department of Respiratory Care, Children's Hospital Los Angeles, Los Angeles, California.
- School of Public Health, Health Policy and Leadership, Loma Linda University, Loma Linda, California
| | - Jisoo Oh
- School of Public Health, Health Policy and Leadership, Loma Linda University, Loma Linda, California
| | - David López
- Department of Cardiopulmonary Sciences, School of Allied Health Profession, Loma Linda University, Loma Linda, California
| | - Nancy Blake
- Harbor UCLA Medical Center, Torrance, California
| | - Edward McField
- Center for Community Health Policy, Loma Linda, California
| | - Justin Hotz
- Department of Respiratory Care, Children's Hospital Los Angeles, Los Angeles, California
- Anesthesia Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Leonardo Nava-Guerra
- Anesthesia Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California
- Medtronic, Los Angeles, California
| | - Kelby Knox
- Anesthesia Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California
- University of Southern California, Los Angeles, California
| | - Richard Chinnock
- School of Public Health, Health Policy and Leadership, Loma Linda University, Loma Linda, California
- Loma Linda University Children's Hospital, Loma Linda, California
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Abstract
OBJECTIVE In order to solve alarm fatigue, the algorithm optimization strategies were researched to reduce false and worthless alarms. METHODS A four-lead arrhythmia analysis algorithm, a multiparameter fusion analysis algorithm, an intelligent threshold reminder, a refractory period delay technique were proposed and tested with collected 28 679 alarms in multi-center study. RESULTS The sampling survey indicate that the 80.8% of arrhythmia false alarms were reduced by the four-lead analysis, the 55.9% of arrhythmia and pulse false alarms were reduced by the multi-parameter fusion analysis, the 28.0% and 29.8% of clinical worthless alarms were reduced by the intelligent threshold and refractory period delay techniques respectively. Finally, the total quantity of alarms decreased to 12 724. CONCLUSIONS To increase the dimensionality of parametric analysis and control the alarm limits and delay time are conducive to reduce alarm fatigue in intensive care units.
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Affiliation(s)
- Mengxing Liu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518000
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, 518057
| | - Zehui Sun
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, 518057
| | - Wenyu Ye
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, 518057
| | - Sanchao Liu
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, 518057
| | - Xianliang He
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, 518057
| | - Cheng Wang
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, 518057
| | - Ye Li
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518000
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31
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Storm J, Chen HC. The relationships among alarm fatigue, compassion fatigue, burnout and compassion satisfaction in critical care and step-down nurses. J Clin Nurs 2020; 30:443-453. [PMID: 33174282 DOI: 10.1111/jocn.15555] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/04/2020] [Accepted: 10/31/2020] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES The study purpose was to investigate if compassion fatigue, burnout, compassion satisfaction and personal characteristics are associated with alarm fatigue and predict alarm fatigue in critical care nurses. BACKGROUND The phenomena of alarm fatigue, compassion fatigue and burnout place nurses, patients and the healthcare environment in potentially harmful situations and represent the opposite of the foundation of caring and compassion satisfaction in nursing. It has been noted that healthcare organisations should address alarm fatigue as mandated by the Joint Commission based on the higher number of alarms sounding in the critical care environment and based on factors influencing nurses to respond to the alarm. DESIGN This was a correlational and predictive quantitative study. METHODS The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for research reporting of observational studies was followed in this study. Nurses working in the step-down and intensive care units from three hospitals in a selected healthcare network in Pennsylvania were recruited using convenience sampling (n = 52). Observation, the ProQOL and demographic surveys were used to collect data on alarm fatigue, compassion fatigue, burnout, compassion satisfaction and personal characteristics of critical care nurses. Methods of data analyses included descriptive statistics, chi-square, Spearman's ρ and binary logistic regression. RESULTS The study results revealed that the participating critical care nurses showed alarm fatigue, were at risk for compassion fatigue and were near risk for burnout. CONCLUSIONS This study illuminated the significant relationships among alarm fatigue and the characteristics of gender, nursing unit, nurse-to-patient ratio and age in critical care nurses. RELEVANCE TO CLINICAL PRACTICE The study results can help critical care nurses take the initiative to not only help themselves prevent or overcome alarm fatigue, compassion fatigue and burnout, but also help their coworkers in this area.
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Affiliation(s)
| | - Hsiu-Chin Chen
- Department of Nursing, Utah Valley University, Orem, UT, USA
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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. Int J Environ Res Public Health 2020; 17:ijerph17228409. [PMID: 33202907 PMCID: PMC7697990 DOI: 10.3390/ijerph17228409] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Bi J, Yin X, Li H, Gao R, Zhang Q, Zhong T, Zan T, Guan B, Li Z. Effects of monitor alarm management training on nurses' alarm fatigue: A randomised controlled trial. J Clin Nurs 2020; 29:4203-4216. [PMID: 32780921 DOI: 10.1111/jocn.15452] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 07/02/2020] [Accepted: 07/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chaotic monitor alarm management generates a large number of alarms, which result in alarm fatigue. Intensive care unit (ICU) nurses are caretakers of critically ill patients, the effect of alarm management affect patient safety directly. OBJECTIVES To evaluate the effect of monitor alarm management training based on the theory of planned behaviour for reducing alarm fatigue in intensive care unit nurses. DESIGN A randomised, single-blind trial. This article follows the requirements of CONSORT statement. PARTICIPANTS The study was conducted from February 2019-May 2019 in a tertiary A-level hospital. 93 ICU clinical nurses were included, and they were randomly assigned into two groups. INTERVENTION Nurses in the experimental group (n = 47) received a 12-week alarm management training course based on the theory of planned behaviour. Nurses in the control group (n = 46) received regular training. All nurses' alarm fatigue scores were measured with a questionnaire before and after the study period. Total number of alarms, nonactionable alarms and true crisis alarms were recorded continuously throughout the study period. RESULTS For baseline comparisons, no significant differences were found. By the analysis of independent samples one-way ANCOVAs, the nurses' adjusted alarm fatigue scores at the post-test in the experimental group were significantly lower than those in the control group (p < .001). After the study period, adjusted total number of alarms and nonactionable alarms recorded in the experimental group were both significantly lower than those recorded in the control group (p < .001). After the study period, no significant difference between the two groups was noted in the adjusted number of true crisis alarms (p > .05). The interventions did not cause adverse events in either group of patients and did not cause adverse events in patients. CONCLUSION Intensive care unit nurses' alarm fatigue was effectively decreased by the monitor alarm management training based on the theory of planned behaviour. RELEVANCE TO CLINICAL PRACTICE (1) Monitor alarm training based on the theory of planned behaviour is effective in reducing nonactionable alarms and lowering alarm fatigue in ICU nurses. (2) The intervention considering the social psychological aspects of behaviour is effective in rebuilding the nurses' awareness and behaviour of alarm management. (3) Nurses are the direct users of monitoring technology. Hospital administrators should attach importance to the role of nurses in the medical monitoring system. We suggest that nursing managers implement training programmes in more ICUs in the future to improve alarm management ability and lower alarm fatigue in ICU nurses.
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Affiliation(s)
- Jiasi Bi
- Nursing Department, The First Bethune Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Xin Yin
- Nursing Department, The First Bethune Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Hongyan Li
- Nursing Department, The First Bethune Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Ruitong Gao
- Nursing School of Jilin University, Changchun City, Jilin Province, China
| | - Qing Zhang
- Gastric Department, The First Bethune Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Tangsheng Zhong
- Nursing Department, The First Bethune Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Tao Zan
- Intensive Care Unit, The First Bethune Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Baoxing Guan
- Intensive Care Unit, The First Bethune Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Zhen Li
- Nursing Department, The First Bethune Hospital of Jilin University, Changchun City, Jilin Province, China
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Fernandes C, Miles S, Lucena CJP. Detecting False Alarms by Analyzing Alarm-Context Information: Algorithm Development and Validation. JMIR Med Inform 2020; 8:e15407. [PMID: 32432551 PMCID: PMC7270842 DOI: 10.2196/15407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/15/2019] [Accepted: 01/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background Although alarm safety is a critical issue that needs to be addressed to improve patient care, hospitals have not given serious consideration about how their staff should be using, setting, and responding to clinical alarms. Studies have indicated that 80%-99% of alarms in hospital units are false or clinically insignificant and do not represent real danger for patients, leading caregivers to miss relevant alarms that might indicate significant harmful events. The lack of use of any intelligent filter to detect recurrent, irrelevant, and/or false alarms before alerting health providers can culminate in a complex and overwhelming scenario of sensory overload for the medical team, known as alarm fatigue. Objective This paper’s main goal is to propose a solution to mitigate alarm fatigue by using an automatic reasoning mechanism to decide how to calculate false alarm probability (FAP) for alarms and whether to include an indication of the FAP (ie, FAP_LABEL) with a notification to be visualized by health care team members designed to help them prioritize which alerts they should respond to next. Methods We present a new approach to cope with the alarm fatigue problem that uses an automatic reasoner to decide how to notify caregivers with an indication of FAP. Our reasoning algorithm calculates FAP for alerts triggered by sensors and multiparametric monitors based on statistical analysis of false alarm indicators (FAIs) in a simulated environment of an intensive care unit (ICU), where a large number of warnings can lead to alarm fatigue. Results The main contributions described are as follows: (1) a list of FAIs we defined that can be utilized and possibly extended by other researchers, (2) a novel approach to assess the probability of a false alarm using statistical analysis of multiple inputs representing alarm-context information, and (3) a reasoning algorithm that uses alarm-context information to detect false alarms in order to decide whether to notify caregivers with an indication of FAP (ie, FAP_LABEL) to avoid alarm fatigue. Conclusions Experiments were conducted to demonstrate that by providing an intelligent notification system, we could decide how to identify false alarms by analyzing alarm-context information. The reasoner entity we described in this paper was able to attribute FAP values to alarms based on FAIs and to notify caregivers with a FAP_LABEL indication without compromising patient safety.
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Affiliation(s)
- Chrystinne Fernandes
- Department of Informatics, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, Brazil
| | - Simon Miles
- Department of Informatics, King's College London, London, United Kingdom
| | - Carlos José Pereira Lucena
- Department of Informatics, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, Brazil
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Cvach M, Doyle P, Wong SY, Letnaunchyn K, Dell D, Mamaril M. Decreasing Pediatric PACU Noise Level and Alarm Fatigue: A Quality Improvement Initiative to Improve Safety and Satisfaction. J Perianesth Nurs 2020; 35:357-364. [PMID: 32362515 DOI: 10.1016/j.jopan.2020.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To describe how a pediatric postanesthesia care unit used a two-phased approach of bundled interventions to reduce unit noise levels and improve staff perceptions of their work environment. DESIGN Pre/post design. METHODS Postanesthesia care unit sound levels and monitor alarms were measured at baseline and after implementing both project phases. Nursing staff members were surveyed at baseline and after completion of the project. FINDINGS Monitor alarms were reduced by more than 50% after Phase I. However, noise measurement data did not reflect a difference in sound levels between baseline and intervention phases. Despite this, staff perceived the unit as much quieter. CONCLUSIONS The reduction in monitor alarms did not cause an appreciable change in sound levels as measured by noise dosimeters in either intervention phase. Despite these findings, nurses perceived a quieter and more pleasant workplace. These impressions might have resulted from subjective expectations versus actual volume levels, or they might owe to the reduction in incidence of alarms themselves, which they had viewed as nuisance sounds.
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Affiliation(s)
- Maria Cvach
- Department of Integrated Healthcare Delivery, Johns Hopkins Health System, Baltimore, MD.
| | - Peter Doyle
- Department of Clinical Engineering, The Johns Hopkins Hospital, Baltimore, MD
| | - Sereniti Young Wong
- Department of Nursing, The Johns Hopkins Hospital-The Charlotte R. Bloomberg Children's Center, Baltimore, MD
| | - Kimberly Letnaunchyn
- Department of Nursing, The Johns Hopkins Hospital-The Charlotte R. Bloomberg Children's Center, Baltimore, MD
| | - Deborah Dell
- Department of Nursing, The Johns Hopkins Hospital-The Charlotte R. Bloomberg Children's Center, Baltimore, MD
| | - Myrna Mamaril
- Department of Nursing, The Johns Hopkins Hospital-The Charlotte R. Bloomberg Children's Center, Baltimore, MD
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Qiu C, Cheng E, Winnick SR, Nguyen VT, Hou FC, Yen SS, Custodio GD, Dang JH, LaPlace D, Morkos A, Chung EP, Desai VN. Respiratory Volume Monitoring in the Perioperative Setting Across Multiple Centers. Respir Care 2020; 65:482-491. [PMID: 31992667 DOI: 10.4187/respcare.07187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The prevalence of nuisance (technical) alarms is the leading cause of alarm fatigue resulting in decreased awareness and a reduction in effective care. The Joint Commission identified in their National Patient Safety goals alarm fatigue as a major safety issue. The introduction of noninvasive respiratory volume monitoring (RVM) has implications for effective perioperative respiratory status management. We evaluated this within the Kaiser Permanente health system. METHODS This observational study was conducted at 4 hospitals in the Kaiser Permanente system. Standard data from RVM, pulse oximetry, and capnography were collected postoperatively in the post-anesthesia care unit (PACU) and/or on the general hospital floor. Device-specific alarm types, rates, and respective actions were recorded and analyzed by non-study staff. RESULTS RVM was applied to 247 subjects (143 females, body mass index 32.3 ± 8.7 kg/m2, age 60.9 ± 13.9 y) providing 2,321 h. RVM alarms occurred 605 times (0.25 alarms/h); 64% were actionable and addressed, 17% were not addressed, 13% were self-resolved, and only 6% were nuisance. In a subgroup, RVM completed all 127 h of monitoring, whereas oximetry with capnography only completed 51 h with 12.9 alarms/h (73% nuisance). The overall RVM alarm rate was significantly lower than with either pulse oximeters or capnography monitors. We saw a nearly 1,000-fold reduction in nuisance alarms compared to capnography and a 20-50-fold reduction in nuisance alarms compared to pulse oximetry. CONCLUSIONS Our study indicates that alarm fatigue due to nuisance alarms continues to be a clinical challenge in perioperative settings. Among the 3 common technologies for respiratory function monitoring, RVM had the lowest rate of overall technical alarms and the highest rate of compliance. Furthermore, with early interventions, none of the subjects monitored with RVM suffered any negative outcomes.
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Affiliation(s)
- Chunyuan Qiu
- Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California.
| | - Eugene Cheng
- Department of Anesthesiology, Kaiser Permanente San Jose Medical Center, San Jose, California
| | - Shawn R Winnick
- Department of Anesthesiology, Kaiser Permanente Fontana Ontario Medical Center, Fontana, California
| | - Vu T Nguyen
- Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
| | - Fang-Chen Hou
- Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
| | - Sally Shou Yen
- Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
| | - Gonzalo D Custodio
- Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
| | - Jennifer H Dang
- Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
| | - Diana LaPlace
- Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
| | - Atef Morkos
- Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
| | - Elena P Chung
- Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
| | - Vimal N Desai
- Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
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Cantillon DJ, Burkle A, Kirkwood D, Loy M, Amuthan R, Pengel S, Tote J, Morris W, Houghtaling PL, Hamilton AC, Petre M, Khot UN, Lindsay BD. Indication-specific event rates among hospitalized patients undergoing continuous cardiac monitoring. Clin Cardiol 2019; 42:952-957. [PMID: 31407351 PMCID: PMC6788477 DOI: 10.1002/clc.23244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/22/2019] [Accepted: 08/02/2019] [Indexed: 01/20/2023] Open
Abstract
Background Cardiac telemetry monitoring is widely utilized for a variety of clinical indications, yet indication‐specific event rates for monitored patients are seldomly reported. Hypothesis High‐risk hospitalized patients for clinical deterioration can be identified using standardized telemetry monitoring indications. Methods Adjudicated data from events triggering emergency response team (ERT) activation were systematically characterized at the Cleveland Clinic from among standardized telemetry indications ordered over a 13‐month period. Results Among 72 199 orders created for telemetry monitored patients, ERT activation occurred in 2677 patients (3.7%), of which 1326 (49.5%) were cardiac‐related. Patients with deep venous thrombosis or pulmonary embolism (DVT/PE) demonstrated the highest overall event rate (ERT: n = 41 of 593 pts [6.9%]; 25/41 cardiac related [61%]). Cardiac‐related events were proportionally highest among patients with coronary disease awaiting revascularization (ERT: n = 19 of 847 patients [2.2%]; 13/19 cardiac‐related [68.4%]). Arrhythmia‐specific events were highest among patients who underwent cardiac surgery (n = 78 of 193 cardiac‐related ERT [40.4%]), and patients with known or suspected tachyarrhythmias (n = 318 of 788 cardiac‐related ERT [40.4%]). Bubble plot analysis identified patients hospitalized with DVT/PE, drug or alcohol exposures, and acute coronary syndrome as among the highest overall and cardiac‐related events while identifying patients with respiratory disorder monitoring indications as carrying the highest noncardiac event rate. Conclusion High‐risk hospitalized patients can be identified by telemetry indication and prioritized according to concerns for cardiac, arrhythmia‐specific and noncardiac clinical deterioration. This is particularly useful when monitored bed resources are constrained.
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Affiliation(s)
| | - Alicia Burkle
- Nursing Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Molly Loy
- Nursing Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ram Amuthan
- Internal Medicine/Hospital Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - John Tote
- Nursing Institute, Cleveland Clinic, Cleveland, Ohio
| | - William Morris
- Internal Medicine/Hospital Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Penny L Houghtaling
- Lerner Research Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Aaron C Hamilton
- Community Medicine/Hospital Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Marc Petre
- Clinical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - Umesh N Khot
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bruce D Lindsay
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Mechanical ventilation alarms and alerts, both audible and visual, provide the clinician with vital information about the patient's physiologic condition and the status of the machine's function. Not all alarms generated by the mechanical ventilator provide actionable information. Over time, clinicians can become desensitized to audible alarms due to alarm fatigue and may potentially ignore an actionable situation that results in patient harm. Alarm fatigue has been recognized by multiple agencies as a major patient-safety issue. To date, mechanical ventilator alarm settings do not have standardized nomenclature. The aim of this review was to examine and report on the literature that pertains to mechanical ventilation alarms and alarm fatigue and to propose recommendations for future research that may lead to safer mechanical ventilation alarm practices.
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Pascale MT, Sanderson P, Liu D, Mohamed I, Brecknell B, Loeb RG. The Impact of Head-Worn Displays on Strategic Alarm Management and Situation Awareness. Hum Factors 2019; 61:537-563. [PMID: 30608190 DOI: 10.1177/0018720818814969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate whether head-worn displays (HWDs) help mobile participants make better alarm management decisions and achieve better situation awareness than alarms alone. BACKGROUND Patient alarms occur frequently in hospitals but often do not require clinical intervention. Clinicians may become desensitized to alarms and fail to respond to clinically relevant alarms. HWDs could make patient information continuously accessible, support situation awareness, and help clinicians prioritize alarms. METHOD Experiment 1 ( n = 76) tested whether nonclinicians monitoring simulated patients benefited from vital sign information continuously displayed on an HWD while they performed a secondary calculation task. Experiment 2 ( n = 13) tested, across three separate experimental sessions, how effectively nursing trainees monitored simulated patients' vital signs under three different display conditions while they assessed a simulated patient. RESULTS In Experiment 1, participants who had access to continuous patient information on an HWD responded to clinically important alarms 25.9% faster and were 6.7 times less likely to miss alarms compared to participants who only heard alarms. In Experiment 2, participants using an HWD answered situation awareness questions 18.9% more accurately overall than when they used alarms only. However, the effect was significant in only two of the three experimental sessions. CONCLUSION HWDs may help users maintain continuous awareness of multiple remote processes without affecting their performance on ongoing tasks. APPLICATION The outcomes may apply to contexts where access to continuous streams of information from remote locations is useful, such as patient monitoring or clinical supervision.
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Liu PL, Chou PL, Liu KC, Lee TY, Chen SH, Cheng PW. [Improving the Surveillance Alarm Response Rate Among Nurses in the Internal Medicine Intensive Care Unit]. Hu Li Za Zhi 2019; 66:85-92. [PMID: 30924518 DOI: 10.6224/jn.201904_66(2).11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND & PROBLEMS According to the Emergency Care Research Institute, "not responding to alarms" is a top-ten health-technology hazard that ranked first between 2008 and 2014. The failure of clinical nurses to respond to alarms in time due to lack of awareness, fatigue, or other cause represents a great threat to patient safety. Between August 2014 and August 2015, two patients in this unit died because the red alert on the physiological alarm surveillance system was not answered and dealt with promptly. PURPOSE To raise the 10-second response rate to red alerts from 22% to 100% in order to enhance inpatient safety. METHODS Establish standard operating procedures for alarms and for the handling of physiologic monitor devices when alarms sound; form a gatekeeper system; and arrange on-the-job training. RESULTS The 10-second response rate to red alerts increased from 22% to 100% between November 2016 and November 2017. CONCLUSIONS By following standard operating procedures, personnel now have a guide to respond to and handle red alerts comprehensively. Implementing the gatekeeper system also increased the team spirit of the unit and helped personnel appreciate the importance of cooperation in handling alarms. In addition, the functions of the physiologic monitor devices and the 10-second response rate for red alerts will be included in the annual quality control checklist of the unit for follow up, review, and further improvement.
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Affiliation(s)
- Pei-Lin Liu
- BSN, RN, Nurse Practitioner, Department of Nursing, Kaohsiung Medical University Hospital, Taiwan, ROC
| | - Pi-Ling Chou
- PhD, RN, Associate Professor, School of Nursing, Kaohsiung Medical University, and Co-Operative Supervisor, Department of Nursing, Kaohsiung Medical University Hospital, Taiwan, ROC
| | - Kuei-Chun Liu
- MS, RN, Head Nurse, Medical Intensive Care Unit, Kaohsiung Medical University Hospital, Taiwan, ROC.
| | - Tsai-Yi Lee
- BSN, RN, Medical Intensive Care Unit, Kaohsiung Medical University Hospital, Taiwan, ROC
| | - Sue-Hui Chen
- MSN, RN, Supervisor, Department of Nursing, Kaohsiung Medical University Hospital, Taiwan, ROC
| | - Pei-Wen Cheng
- BSN, RN, Medical Intensive Care Unit, Kaohsiung Medical University Hospital, Taiwan, ROC
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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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lin Z, Zheng K, Shen Y, Wu Y. [Research on the Clinical Alarm Management Mechanism Based on Closed-loop Control Theory]. Zhongguo Yi Liao Qi Xie Za Zhi 2018; 42:173-175. [PMID: 29885121 DOI: 10.3969/j.issn.1671-7104.2018.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This paper proposes a clinical alarm management system based on the theory of the closed loop control. The alarm management mechanism can be divided into the expected standard, improving execution rule, rule execution, medical devices with alarm functions, results analysis strategy and the output link. And, we make relevant application and discussion. Results showed that the mechanism can be operable and effective.
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Affiliation(s)
- Zhongkuan Lin
- The Children's Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, 310003. ##Email#
| | - Kun Zheng
- The Children's Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, 310003. ##Email#
| | - Yunming Shen
- The Children's Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, 310003. ##Email#
| | - Yunyun Wu
- The Children's Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, 310003. ##Email#
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Poole S, Shah N. Addressing vital sign alarm fatigue using personalized alarm thresholds. Pac Symp Biocomput 2018; 23:472-483. [PMID: 29218906 PMCID: PMC6587573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Alarm fatigue, a condition in which clinical staff become desensitized to alarms due to the high frequency of unnecessary alarms, is a major patient safety concern. Alarm fatigue is particularly prevalent in the pediatric setting, due to the high level of variation in vital signs with patient age. Existing studies have shown that the current default pediatric vital sign alarm thresholds are inappropriate, and lead to a larger than necessary alarm load. This study leverages a large database containing over 190 patient-years of heart rate data to accurately identify the 1st and 99th percentiles of an individual's heart rate on their first day of vital sign monitoring. These percentiles are then used as personalized vital sign thresholds, which are evaluated by comparing to non-default alarm thresholds used in practice, and by using the presence of major clinical events to infer alarm labels. Using the proposed personalized thresholds would decrease low and high heart rate alarms by up to 50% and 44% respectively, while maintaining sensitivity of 62% and increasing specificity to 49%. The proposed personalized vital sign alarm thresholds will reduce alarm fatigue, thus contributing to improved patient outcomes, shorter hospital stays, and reduced hospital costs.
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Affiliation(s)
- Sarah Poole
- Center for Biomedical Informatics Research, Stanford University Stanford, CA, United States
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Lin Z, Zheng K, Shen Y, Zheng C, Cheng X. [Survey and Discussion on Ventilator Alarm Status in ICU]. Zhongguo Yi Liao Qi Xie Za Zhi 2017; 41:460-463. [PMID: 29862712 DOI: 10.3969/j.issn.1671-7104.2017.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The article aims at survey and analysis on ventilator alarm status in pediatric hospital. METHODS First, we design the statistical table of ventilator, and analyze the reliability of statistical table. Then we evaluate the effectiveness of the alarm. Finally, we evaluate the alarm information synthetically through investigation and statistics. RESULTS The ventilator alarm is ineffective, a large number of nonsensical alarms, leading to lower alert sensitivity of medical staff. CONCLUSIONS According to the survey results, we should analyze the cause of the problem, and propose the corresponding alarm management method.
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Affiliation(s)
- Zhongkuan Lin
- The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003
| | - Kun Zheng
- The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003
| | - Yunming Shen
- The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003
| | - Caixian Zheng
- The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003
| | - Xiaoying Cheng
- The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003
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Li SYW, Tang TL, Hickling A, Yau S, Brecknell B, Sanderson PM. Spearcons for Patient Monitoring: Laboratory Investigation Comparing Earcons and Spearcons. Hum Factors 2017; 59:765-781. [PMID: 28570832 DOI: 10.1177/0018720817697536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objective We compared the effectiveness of single-tone earcons versus spearcons in conveying information about two commonly monitored vital signs: oxygen saturation and heart rate. Background The uninformative nature of many medical alarms-and clinicians' lack of response to alarms-is a widespread problem that can compromise patient safety. Auditory displays, such as earcons and spearcons (speech-based earcons), may help clinicians maintain awareness of patients' well-being and reduce their reliance on alarms. Earcons are short abstract sounds whose properties represent different types and levels of information, whereas spearcons are time-compressed spoken phrases that directly state their meaning. Listeners might identify patient vital signs more accurately with spearcons than with earcons. Method In Experiment 1 we compared how accurately 40 nonclinician participants using either (a) single-tone earcons differentiated by timbre and tremolo or (b) Cantonese spearcons recorded using a female Cantonese voice could identify both oxygen saturation and heart rate levels. In Experiment 2 we tested the identification performance of six further nonclinician participants with spearcons recorded using a male Cantonese voice. Results In Experiment 1, participants using spearcons identified both vital signs together more accurately than did participants using earcons. Participants using Cantonese spearcons also learned faster, completed trials faster, identified individual vital signs more accurately, and felt greater ease and more confident when identifying oxygen saturation levels. Experiment 2 verified the previous findings with male-voice Cantonese spearcons. Conclusion Participants identified vital signs more accurately using spearcons than with the single-tone earcons. Application Spearcons may be useful for patient monitoring in situations in which intermittently presented information is desirable.
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Harris PR, Zègre-Hemsey JK, Schindler D, Bai Y, Pelter MM, Hu X. Patient characteristics associated with false arrhythmia alarms in intensive care. Ther Clin Risk Manag 2017; 13:499-513. [PMID: 28458554 PMCID: PMC5403122 DOI: 10.2147/tcrm.s126191] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION A high rate of false arrhythmia alarms in the intensive care unit (ICU) leads to alarm fatigue, the condition of desensitization and potentially inappropriate silencing of alarms due to frequent invalid and nonactionable alarms, often referred to as false alarms. OBJECTIVE The aim of this study was to identify patient characteristics, such as gender, age, body mass index, and diagnosis associated with frequent false arrhythmia alarms in the ICU. METHODS This descriptive, observational study prospectively enrolled patients who were consecutively admitted to one of five adult ICUs (77 beds) at an urban medical center over a period of 31 days in 2013. All monitor alarms and continuous waveforms were stored on a secure server. Nurse scientists with expertise in cardiac monitoring used a standardized protocol to annotate six clinically important types of arrhythmia alarms (asystole, pause, ventricular fibrillation, ventricular tachycardia, accelerated ventricular rhythm, and ventricular bradycardia) as true or false. Total monitoring time for each patient was measured, and the number of false alarms per hour was calculated for these six alarm types. Medical records were examined to acquire data on patient characteristics. RESULTS A total of 461 unique patients (mean age =60±17 years) were enrolled, generating a total of 2,558,760 alarms, including all levels of arrhythmia, parameter, and technical alarms. There were 48,404 hours of patient monitoring time, and an average overall alarm rate of 52 alarms/hour. Investigators annotated 12,671 arrhythmia alarms; 11,345 (89.5%) were determined to be false. Two hundred and fifty patients (54%) generated at least one of the six annotated alarm types. Two patients generated 6,940 arrhythmia alarms (55%). The number of false alarms per monitored hour for patients' annotated arrhythmia alarms ranged from 0.0 to 7.7, and the duration of these false alarms per hour ranged from 0.0 to 158.8 seconds. Patient characteristics were compared in relation to 1) the number and 2) the duration of false arrhythmia alarms per 24-hour period, using nonparametric statistics to minimize the influence of outliers. Among the significant associations were the following: age ≥60 years (P=0.013; P=0.034), confused mental status (P<0.001 for both comparisons), cardiovascular diagnoses (P<0.001 for both comparisons), electrocardiographic (ECG) features, such as wide ECG waveforms that correspond to ventricular depolarization known as QRS complex due to bundle branch block (BBB) (P=0.003; P=0.004) or ventricular paced rhythm (P=0.002 for both comparisons), respiratory diagnoses (P=0.004 for both comparisons), and support with mechanical ventilation, including those with primary diagnoses other than respiratory ones (P<0.001 for both comparisons). CONCLUSION Patients likely to trigger a higher number of false arrhythmia alarms may be those with older age, confusion, cardiovascular diagnoses, and ECG features that indicate BBB or ventricular pacing, respiratory diagnoses, and mechanical ventilatory support. Algorithm improvements could focus on better noise reduction (eg, motion artifact with confused state) and distinguishing BBB and paced rhythms from ventricular arrhythmias. Increasing awareness of patient conditions that apparently trigger a higher rate of false arrhythmia alarms may be useful for reducing unnecessary noise and improving alarm management.
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Affiliation(s)
- Patricia R Harris
- Department of Nursing, School of Health and Natural Sciences, Dominican University of California, San Rafael.,Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Jessica K Zègre-Hemsey
- School of Nursing.,Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, NC
| | - Daniel Schindler
- Intensive Care Unit, The Neuroscience Center, Sutter Eden Medical Center, Castro Valley
| | - Yong Bai
- Hu Research Laboratory, Department of Physiological Nursing, School of Nursing, University of California, San Francisco
| | - Michele M Pelter
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA.,ECG Monitoring Research Lab, Department of Physiological Nursing, School of Nursing
| | - Xiao Hu
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA.,Physiological Nursing and Neurological Surgery, Affiliate Faculty of Institute for Computational Health Sciences Core Faculty UCB/UCSF Joint Bio-Engineering Graduate Program, University of California, San Francisco, CA, USA
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Affiliation(s)
- Christopher P. Bonafide
- Division of General Pediatrics, The Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia,
PA, USA
| | - Patrick W. Brady
- Division of Hospital Medicine, Cincinnati Children’s Hospital
Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine,
Cincinnati, OH, USA
| | - Carrie Daymont
- Children’s Hospital Research Institute of Manitoba, Winnipeg,
Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg,
Manitoba, Canada
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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