Ensuring Specificity as a Strategy for Increasing Alarm Safety

Yıl 2023, Cilt: 7 Sayı: 3, 139 - 147, 30.09.2023

Gülnur Gül Şeyda Seren İntepeler

https://doi.org/10.30621/jbachs.1251111

Öz

Backround: Alarms are systems created to ensure patient safety. However, when its specificity is not ensured, false positive alarms occur, causing the crying wolf phenomenon and compromising patient safety.
Purpose: This study aimed to decrease the number of false-positive alarms by ensuring the standardization and specificity of alarms.
Methods: This prospective, quasi-experimental study with a pre/post intervention study was conducted in the adult intensive care unit of a training and research hospital through repeated measurements at the beginning and after the intervention.
Results: The total alarm load decreased by 46% after the intervention, with the heart rate, saturation, and blood pressure alarms being reduced at a rate of 59%, 56%, and 23%, respectively. The hourly mean number of alarms decreased from 16.8 to 9. Differences between heart rate, oxygen saturation, and blood pressure alarms in terms of the parameter were statistically significant (p<0.05).
Conclusion: The study showed that the number of alarms can be decreased by standardizing the alarms and ensuring specificity in the adult intensive care unit.

Anahtar Kelimeler

clinical alarms, critical care, patient monitoring, alarm management

Kaynakça

• Schmid F, Goepfert MS, Kuhnt D, et al. The wolf is crying in the operating room: Patient monitor and anesthesia workstation alarming patterns during cardiac surgery. Anesthesia and Analgesia, 2011, 112(1), 78–83. https://doi.org/10.1213/ANE.0b013e3181fcc504.
• American Anesthesiology Association. Standards for Postanesthesia Care Committee. In Αγαη, 2019, 8, (5). https://www.asahq.org/standards-and-guidelines/standards-for-postanesthesia-care.
• Apfelbaum JL, Silverstein JH, Chung FF, et al. Practice guidelines for postanesthetic care. Anesthesiology, 2013, 118(2), 291–307. https://doi.org/10.1097/aln.0b013e31827773e9.
• American College of Clinical Engineering Healthcare Technology Foundation. JCE_Alarms_Paper.pdf. Journal of Clinical Engineering, 2017, January-March, 22–33.
• Lewis CL, Oster CA. Research outcomes of implementing CEASE: An innovative, nurse-driven, evidence-based, patient-customized monitoring bundle to decrease alarm fatigue in the intensive care unit/step-down unit. Dimensions of Critical Care Nursing, 2019, 38(3), 160–173. https://doi.org/10.1097/DCC.0000000000000357.
• Kuckartz Pergher A, Carlos Lyra da Silva R. Alarms Fatigue: Integrative Review Fadiga De Alarmes: Revisão Integrativa Fatiga De Alarma: Revisión Integradora Integrative Review Article. J Nurs UFPE line. 2013;7(4):1241-124. doi:10.5205/reuol.3188-26334-1-LE.0704201322.
• Drew B J, Harris P, Zègre-Hemsey JK, et al. Insights into the problem of alarm fatigue with physiologic monitor devices: A comprehensive observational study of consecutive intensive care unit patients. PLoS ONE, 2014, 9 (10). https://doi.org/10.1371/journal.pone.0110274.
• Dursun Ergezen F, Kol E. Nurses’ responses to monitor alarms in an intensive care unit: An observational study. Intensive and Critical Care Nursing, 2020, 59, 102845. https://doi.org/10.1016/j.iccn.2020.102845.
• Siebig S, Kuhls S, Imhoff M, et al. Intensive care unit alarms-How many do we need? Critical Care Medicine, 2010, 38(2), 451–456. https://doi.org/10.1097/CCM.0b013e3181cb0888.
• Vreman J, Van Loon LM, Van den Biggelaar W, et al. Contribution of alarm noise to average sound pressure levels in the ICU: An observational cross-sectional study. Intensive and Critical Care Nursing, 2020, Van, 102901. https://doi.org/10.1016/j.iccn.2020.102901.
• Yeh J, Wilson R, Young L, et al. Team-Based intervention to reduce the impact of nonactionable alarms in an adult intensive care unit. Journal of Nursing Care Quality, 2020, 35(2), 115–122. https://doi.org/10.1097/NCQ.0000000000000436.
• Sendelbach S, Funk M. Alarm fatigue: A patient safety concern. AACN Advanced Critical Care, 2013, 24(4), 378–386. https://doi.org/10.1097/NCI.0b013e3182a903f9.
• Varisco G, Mortel H, Cabrera-Quiros L, et al. Optimization of clinical workflow and monitor settings safely reduce alarms in the NICU. Acta Pediatrica. 2021; 110:1141–1150. https://doi.org/10.1111/apa.15615
• Larson A. Clinical alarms management in the intermediate cardiology and cardiovascular intensive care units at the university of Iowa hospital and clinics by. 2018, https://ir.uiowa.edu/honors_theses/176. 15. Lawless S. Crying wolf: False alarms in a pediatric intensive care unit. Critical Care Medicine, 1994, 22(6), 981–985.
• Suba S, Hu X, Pelter M, Sandoval C. ECG monitoring during end-of-life care: Implications on alarm fatigue (Vol. 3, Issue 1). Multimodal Technol Interact. 2019, 3, 18; doi:10.3390/mti3010018.
• West P, Abbott P, Probst P. Alarm fatigue: A concept analysis. Online Journal of Nursing Informatics, 2014, 18(2).
• Joint Commission on Accreditation of Healthcare Organizations. Sound the alarm: Managing physiologic monitoring systems. In Joint Commission Perspectives on Patient Safety, 2011, (Vol. 11, Issue 12). https://www.jointcommission.org/-/media/deprecated-unorganized/imported-assets/tjc/system folders/asset manager/perspectives alarm pdf. (Accessed on 11 March 2018).
• American Association of Critical Care Nurses. AACN Practice alert. Critical Care Nurse, 2013, 33(5), 83–87.
• Emergency Care Research Institute. 2014. The path to alarm safety (Issue March). https://www.ecri.org/Resources/In_the_News/The_Path_to_Alarm_Safety(TechNation).pdf (accessed on15 June, 2019).
• Joint Commission on Accreditation of Healthcare Organizations. Alarm system safety, R 3 Report. Requirement, Rationale, Reference. 2013, Issue 5, December 11, https://www.jointcommission.org/standards/r3-report/r3-report-issue-5-alarm-system-safety (accessed on 15 March 2018).
• Joint Commission on Accreditation of Healthcare Organizations. National patient safety goals effective, 2019 (Issue January) https://www.jointcommissioninternational.org/standards/international-patient-safety goals/ (accessed on 5 April 2019).
• American Society of Peri Anesthesia Nurses. A position statement on alarm management. 2019, https://www.aspan.org/Portals/6/docs/ClinicalPractice/PositionStatement/Current/PS_12.pdf?ver=2021-01-12-150829-287.
• Welch J, Rayo M, Kanter B, et al. Framework for alarm management process maturity. Biomedical Instrumentation and Technology, 2016, 50(3), 165–179. https://doi.org/10.2345/0899-8205-50.3.165.
• Winters BD. Effective approaches to control non-actionable alarms and alarm fatigue. Journal of Electro Cardiology, 2018, 51(6), S49–S51. https://doi.org/10.1016/j.jelectrocard.2018.07.007.
• Gross B, Dahl D, Nielsen L. Physiologic monitoring alarm load on medical/surgical floors of a community hospital. Biomedical Instrumentation and Technology, 2011, 45(SPRING), 29–36. https://doi.org/10.2345/0899-8205-45.s1.29
• Graham KC, Cvach M. Monitor alarm fatigue: Standardizing use of physiological monitors and decreasing nuisance alarms. American Journal of Critical Care, 2010, 19(1), 28–34. https://doi.org/10.4037/ajcc2010651
• Sowan AK, Gomez TM, Tarriela AF, et al. Changes in default alarm settings and standard in-service are insufficient to improve alarm fatigue in an intensive care unit: A pilot project. JMIR Human Factors, 2016, 3(1), e1. https://doi.org/10.2196/humanfactors.5098.
• Poncette AS, Mosch L, Spies C, et al. Improvements in patient monitoring in the intensive care unit: Survey study. Journal of Medical Internet Research, 2020, 22(6). https://doi.org/10.2196/19091.
• Dandoy CE, Davies SM, Flesch L, et al. A team-based approach to reducing cardiac. Pediatrics, 2014, 134(6), e1686–e1694. https://doi.org/10.1542/peds.2014-1162.
• Chambrin MC, Calvelo-Aros D, Jaborska A, et al. Multicentric study at monitoring alarms in the adult intensive care unit (ICU): A descriptive analysis. Intensive Care Medicine, 1999, 25(12), 1360–1366. https://doi.org/10.1007/s001340051082.
• Koski EMJ, Mäkivirta A, Sukuvaara T, Kari A. Clinicians’ opinions on alarm limits and urgency of therapeutic responses. International Journal of Clinical Monitoring and Computing, 1995, 12(2), 85–88. https://doi.org/10.1007/BF01142488.
• Sahoo T, Joshi M, Madathil S, et al. Quality improvement initiative for reduction of false alarms from multiparameter monitors in neonatal intensive care unit. J Educ Health Promote, 2019; 8, 203.
• Cvach M, Doyle P, Wong SY, et al. Decreasing pediatric PACU noise level and alarm fatigue: A quality improvement initiative to improve safety and satisfaction. Journal of Peri Anesthesia Nursing, 2020, 35(4), 357–364. https://doi.org/10.1016/j.jopan.2020.01.011.
• Salous M, Alkhawaldeh J, Kewan S, et al. Nurses’ attitudes related to alarm fatigue in critical care units: A systematic review. IOSR Journal of Nursing and Health Science, 2017, 6(2), 62–66. https://doi.org/10.9790/1959-0602076266.
• Emergency Care Research Institute. The alarm safety handbook. 2017, https://www.ecri.org/alarm-safety-handbook (accessed on 15 June, 2019).
• Joint Commission on Accreditation of Healthcare Organizations. Hospital national patient safety goals. Hospital national patient safety goals, 2016, 1–17. www.jointcommission.org (accessed on 11 March 2018).
• Bi J, Yin X, Li H, et al. Effects of monitor alarm management training on nurses’ alarm fatigue: A randomized controlled trial. Journal of Clinical Nursing, 2020, July, 1–14. https://doi.org/10.1111/jocn.15452.
• Wilken M, Klausen A, Röhrig R, et al. Alarm fatigue: Causes and effects. Studies in Health Technology and Informatic, 2017, 243. https://doi.org/10.3233/978-1-61499-808-2-107.