Cerrahi Yoğun Bakım Ünitelerinde Alarm Yorgunluğu ve Alarm Yönetimi

Öz

Cerrahi yoğun bakım üniteleri hem hastalar hem de hemşireler için oldukça karmaşık birimlerdir. Bu karmaşıklık içerisinde hastaların güvenilir bir şekilde izlenmesi ve takip edilmesi önemlidir. Bu takipler de hasta başı monitörler ve diğer cihazlar aracılığıyla yapılmaktadır. Kullanılan her bir cihaz farklı alarm ve uyarı sistemlerine sahiptir. Hepsinin amacı hastanın klinik durumunda normalden sapmalar olduğu zaman hemşire ve diğer sağlık personellerine durumu bildirmektir. Aynı anda birden fazla cihazın uyarı vermesi, boş ve yanlış alarm oranının yüksekliği ve farklı monitörlerden çıkan yüksek seslerin gürültü yaratması sebebiyle hemşireler alarm yorgunluğu yaşamaktadır. Hemşirelerin yaşadığı bu alarm yorgunluğunun önüne geçebilmek için alarm yönetimini doğru şekilde yapmak önemlidir. Bu derlemede amaç, cerrahi yoğun bakım ünitesinde alarm yorgunluğuna neden olan durumları ve alarm yönetimini incelemektir.

Anahtar Kelimeler

• Alarm yorgunluğu
• alarm yönetimi
• hasta güvenliği
• monitör alarmları
• yoğun bakım ünitesi.

Alarm Fatigue and Alarm Management in Surgical Intensive Care Units

Öz

Surgical intensive care units are very complex units for both patients and nurses. Within this complexity, it is important to monitor and track patients reliably. This is done through bedside monitors and other devices. Each device has different alarm and warning systems. The purpose of all of them is to notify nurses and other healthcare personnel when there are deviations from the normal clinical condition of the patient. Nurses experience alarm fatigue due to multiple devices alerting at the same time, high rate of empty and false alarms, and loud noises from different monitors creating noise. In order to prevent this alarm fatigue experienced by nurses, it is important to perform alarm management correctly. The aim of this review is to examine the conditions that cause alarm fatigue and alarm management in the surgical intensive care unit.

Anahtar Kelimeler

• Alarm fatigue
• alarm management
• intensive care unit
• monitor alarms
• patient safety.

Kaynakça

1. 1. Imhoff M, Kuhls S. Alarm algorithms in critical care monitoring. Anesth Analg 2006;102(5):1525-37. 2. Mosch L, Sümer M, Flint AR, Feufel M, Balzer F, Mörike F, et al. Alarm management in intensive care: Qualitative triangulation study. JMIR Hum Factors. 2024;11:e55571.
2. 3. Alastalo M, Salminen L, Lakanmaa RL, LeinoKilpi H. Seeing beyond monitors—Critical care nurses’ multiple skills in patient observation: Descriptive qualitative study. Intensive Crit Care Nurs. 2017;42:80-7. 4. Sendelbach S, Funk M. Alarm fatigue a patient safety concern. AACN Advanced Critical Care. 2013;24(4):378-86.
3. 5. Cvach M. Monitor alarm fatigue: An integrative review. Biomed Instrum Technol.2012;46(4):268-77. 6. 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 Jul 7;13(3):946-55. 7. Andrade-Méndez B, Arias-Torres DO, GómezTovar LO. Alarm fatigue in the intensive care unit: Relevance and response time. Enfermería Intensiva (English Ed.). 2020;31(3):147-53.
4. 8. Nyarko BA, Yin Z, Chai X, Yue L. Nurses’ alarm fatigue, influencing factors, and its relationship with burnout in the critical care units: A cross-sectional study. Australian Critical Care. 2024;37(2):273-80. 9. Ceylan İ, Karakoç E. Evaluation of alarm fatigue in nurses working in intensive care units. Kastamonu Medical Journal. 2023;3(1):27-31.
5. 10. Shaoru C, Hui Z, Su W, Ruxin J, Huiyi Z, Hongmei Z, et al. Determinants of medical equipment alarm fatigue in practicing nurses: A systematic review. SAGE Open Nurs. 2023 Nov 1;9:23779608231207227. 11. Ünal A, Arsava EM, Çağlar G, Topçuoğlu MA. Alarms in a neurocritical care unit: A prospective study. J Clin Monit Comput. 2022;36(4):995-1001.
6. 12. Honan L, Funk M, Maynard M, Fahs D, Clark JT, David Y. Nurses’ perspectives on clinical alarms. Am J Crit Care. 2015;24(5):387-95. 13. Ruskin KJ, Hueske-Kraus D. Alarm fatigue: Impacts on patient safety. Curr Opin Anaesthesiol. 2015;28(6):685-90.
7. 14. Bi J, Yin X, Li H, Gao R, Zhang Q, Zhong T, et al. Effects of monitor alarm management training on nurses' alarm fatigue: A randomised controlled trial. J Clin Nurs. 2020;29(21-22):4203-16. 15. van Pul C, vd Mortel HPME, vd Bogaart JJL, Mohns T, Andriessen P. Safe patient monitoring is challenging but still feasible in a neonatal intensive care unit with single family rooms. Acta Paediatr. 2015;104(6):e247- 54.
8. 16. Atzema C, Schull MJ, Borgundvaag B, Slaughter GR, Lee CK. Alarmed: Adverse events in low-risk patients with chest pain receiving continuous electrocardiographic monitoring in the emergency department. A pilot study. The American Journal of Emergency Medicine. 2006;24(1):62-7.

9. 17. Topçu I, Türkmen E, Badır A, Göktepe N, Miral M, Albayrak S, ve ark. Relationship between nurses' practice environments and nursing outcomes in Turkey. International nursing review. 2016;63(2):242-9.
10. 18. Lacker C. Physiologic alarm management. Pennsylvania Patient Safety Advisory 2011;8(3):105-8. 19. Gül G, İntepeler ŞS. Yoğun bakım ünitesindeki monitör alarmları ve hemşirelerin alarm yönetimi: Gözlemsel çalışma. Sağlık ve Hemşirelik Yönetimi Dergisi. 2021;8(3):429-38.
11. 20. Gül G, İntepeler SS, Bektas M. Effectiveness of interventions developed to reduce alarm fatigue in intensive care units: Systematic review and meta-analysis study. Fatigue Biomed Health Behav. 2024;12(3):177-95. 21. Despins LA. Factors influencing when intensive care unit nurses go to the bedside to investigate patient related alarms: A descriptive qualitative study. Intensive Crit Care Nurs. 2017;43:101107.
12. 22. Graham KC, Cvach M. Monitor alarm fatigue: Standardizing use of physiological monitors and decreasing nuisance alarms. Am J Crit Care. 2010;19(1):28-34. 23. Sendelbach S, Wahl S, Anthony A, Shotts P. Stop the noise: A quality improvement project to decrease electrocardiographic nuisance alarms. Crit Care Nurse. 2015;35(4):15-22.
13. 24. Lewandowska K, Weisbrot M, Cieloszyk A, Mędrzycka-Dąbrowska W, Krupa S, Ozga D. Impact of alarm fatigue on the work of nurses in an ıntensive care environment-A systematic review. Int J Environ Res Public Health. 2020 Nov 13;17(22):8409.
14. 25. Joint Commission on Accreditation of Healthcare Organizations. The Joint Commission announces 2014 National Patient Safety Goal. Jt Comm Perspect. 2013 Jul;33(7):13-4. 26. Donovan AL, Aldrich JM, Gross AK, Barchas DM, Thornton KC, Schell-Chaple HM, et al. Interprofessional care and teamwork in the ICU. Critical care medicine. 2018;46(6):980-90. 27. Kol E, İlaslan E, İnce S. Yoğun bakım ünitelerinde gürültü kaynakları ve gürültü düzeyleri/Noise sources and levels in intensive care units. Türk Yoğun Bakım Dergisi. 2015;13(3):122. 28. Konkani A, Oakley B. Noise in hospital intensive care units: A critical review of a critical topic. J Crit Care. 2012;27:522.
15. 29. Cropp AJ, Woods LA, Raney D, Bredle DL. Name that tone: The proliferation of alarms in the intensive care unit. Chest. 1994;105(4):1217-20.
16. 30. Alkubati SA, Alsaqri SH, Alrubaiee GG, Almoliky MA, Alqalah TAH, Pasay-An E, et al. Levels and factors of nurses' alarm fatigue in critical care settings in Saudi Arabia: A multicenter cross-sectional study. J Multidiscip Healthc. 2024 Feb 22;17:793-803.
17. 31. Asadi N, Salmani F, Asgari N, Salmani M. Alarm fatigue and moral distress in ICU nurses in COVID-19 pandemic. BMC Nurs. 2022;21(1):125. 32. Whalen DA, Covelle PM, Piepenbrink JC, Villanova KL, Cuneo CL, Awtry EH. Novel approach to cardiac alarm management on telemetry units. J Cardiovasc Nurs. 2014;29(5):E13-E22
18. 33. Rayo MF, Mansfield J, Eiferman D, Mignery T, White S, Moffatt-Bruce SD. Implementing an institution-wide quality improvement policy to ensure appropriate use of continuous cardiac monitoring: A mixed-methods retrospective data analysis and direct observation study. BMJ Qual Saf. 2016;25(10):796-802.
19. 34. Cho OM, Kim H, Lee YW, Cho I. Clinical alarms in ıntensive care units: Perceived obstacles of alarm management and alarm fatigue in nurses. Healthc Inform Res. 2016 Jan;22(1):46-53.
20. 35. Özcan E, Gommers D. Nine nurse-recommended design strategies to improve alarm management in the ICU: A qualitative study. ICU Management & Practice. 2020;2:129- 33.
21. 36. Wang L, He W, Chen Y, Wu Q, Du X, Li Q, et al. Intensive care unit nurses' perceptions and practices regarding clinical alarms: A descriptive study. Nurs Open. 2023 Aug;10(8):5531-40