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Ali TM, Alharbi MF. AF among Nurses Working in Neonatal and Paediatric Intensive Care Units: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:1574. [PMID: 39201133 PMCID: PMC11353546 DOI: 10.3390/healthcare12161574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Aim: This research study aims to determine nurses' alarm fatigue (AF) levels in paediatric critical care units in two governmental hospitals and to examine the significant differences in the mean between nurses' attributes, nurses' working environment, and nurses' alarm management with the level of fatigue caused by the alarm. Background: In recent years, AF has become a significant and growing concern among nurses. However, in the Saudi Arabian paediatrics context, the impact of AF on nurses working in intensive care units remains unexplored. Method: A descriptive cross-sectional survey was conducted using a non-probability purposive sampling method. Data were collected from 216 nurses in two governmental hospitals through self-administered questionnaires comprised of four sections: individual attributes, work environment, alarm management, and AF scale. Data analysis: The Statistical Package of Social Science (SPSS) was used to analyse the data, and ANOVA was utilised to describe the sample's demographic characteristics and determine any differences. Results: Most participants were female, held a bachelor's degree, and were aged 31 to 35. Of the participants, 62.5% reported experiencing a medium level of AF, 29.2% reported a low level, and 8.3% reported a high level. Participants expressed that recurrent false alarms disrupt patient care and decrease trust in alarm systems. Significant differences in AF levels were observed based on marital status and the percentage of non-actionable alarms. Conclusions: Nurses working in paediatric critical units with high rates of false alarms, the frequent de-activation of alarms, and decreased trust in alarm systems are more likely to experience AF. Addressing AF is crucial for patient safety; nurse training on alarm management, the collaboration between biomedical and nursing staff, and technological advancements can help mitigate this issue. Implications for Practice: To minimise the adverse effects of AF, policymakers, biomedical experts, and nursing administrators must establish comprehensive policies and protocols concerning alarms. These measures aim to ensure secure and efficient care for the well-being of patients and nurses.
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Affiliation(s)
- Taibah M. Ali
- Maternal & Child Health Nursing Department, College of Nursing, King Saud University, Riyadh 12371, Saudi Arabia
- Ministry of Health, Heraa General Hospital, Makkah 24227, Saudi Arabia
| | - Manal F. Alharbi
- Maternal & Child Health Nursing Department, College of Nursing, King Saud University, Riyadh 12371, Saudi Arabia
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Salameh B, Abdallah J, Alkubati SA, ALBashtawy M. Alarm fatigue and perceived stress among critical care nurses in the intensive care units: Palestinian perspectives. BMC Nurs 2024; 23:261. [PMID: 38654236 PMCID: PMC11036661 DOI: 10.1186/s12912-024-01897-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE The frequency of alarms generated by monitors and other electro-medical devices is undeniably valuable but can simultaneously escalate the workload for healthcare professionals, potentially subjecting intensive care unit nurses to alarm fatigue. The aim of this study is to investigate alarm fatigue and stress levels among critical care nursing personnel. Additionally, the study aims to assess predictors for both alarm fatigue and perceived stress. METHODOLOGY A descriptive cross-sectional study recruited 187 Intensive Care Unit (ICU) nurses from hospitals located in the northern and central regions of the West Bank, Palestine. Data were gathered through online surveys due to logistic concerns using the Alarm Fatigue Scale and the Perceived Stress Scale. The research was conducted between November 2023 and January 2024. RESULTS The mean overall alarm fatigue score was 23.36 (SD = 5.57) out of 44. The study showed that 62.6% of the participating ICU nurses experience average to high degree of alarm fatigue, while 69.5% experience average to high levels of perceived stress. A significant positive Pearson correlation was found between stress and alarm fatigue (0.40, P < 0.01). Important predictors of alarm fatigue include perceived stress, nurse-to-patient ratio, gender, and years of experience, while important predictors of perceived stress include alarm fatigue, type of working shift and hospital unit. CONCLUSION Alarm fatigue can compromise the timely intervention required to prevent adverse outcomes by causing delayed responses or missed critical alarm, which can have major ramifications for patient safety. Addressing stress is crucial for mitigating alarm fatigue and fostering a supportive work environment to ensure optimal patient care. Consequently, exploring strategies to alleviate the negative impacts of alarm fatigue on critical care nurses' stress merits further investigation in future research studies.
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Affiliation(s)
- Basma Salameh
- Faculty of Nursing, Arab American University, Jenin, Palestine.
| | - Jihad Abdallah
- Department of Animal Production, An-Najah National University,Nablus, Jenin, Palestine
| | - Sameer A Alkubati
- Department of Nursing, Faculty of Medicine and Health Sciences, Hodeida University, Hodeida, Yemen
- Department of Medical Surgical Nursing, College of Nursing, University of Hail, Hail, Saudi Arabia
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Erbay-Dallı Ö, Bağcı-Derinpınar K. Adaptation and validation of the Turkish version of the alarm fatigue assessment questionnaire. ENFERMERIA INTENSIVA 2024; 35:114-123. [PMID: 37805362 DOI: 10.1016/j.enfie.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
OBJECTIVE Alarm fatigue may endanger the safety of patients by negatively affecting nurses' concentration and ability to provide effective care. Identifying alarm fatigue and taking appropriate measures are critical in preventing medical errors and for nurses to work with high motivation. This study aimed to test the psychometric properties of the Turkish version of the 23-item Alarm Fatigue Assessment Questionnaire (AFAQ). METHOD The study was conducted between February 2022 and April 2022 and included nurses with at least one year of clinical or intensive care experience. The data were collected via a web-based questionnaire. During the adaptation of AFAQ, language, content, and construct validity were evaluated; reliability was examined by internal consistency analysis. RESULTS The item and scale content validity index of AFAQ were found to be high (>0.80). The Kaiser-Meyer-Olkin measure of sampling adequacy indicated an adequate sampling (0.85); Bartlett's test of sphericity χ2 was 1935.074, p<0.001. Exploratory factor analysis (EFA) showed that the 21-item scale had a five-factor structure, explaining 51.606% of the total variance, and the factor loadings of the items were >0.30 (0.422-0.803). Confirmatory factor analysis (CFA) showed that the five-factor model had a good fit index (χ2/df=1.855, SRMR=0.039, RMSEA=0.048, CFI=0.915, and TLI=0.908) and appropriate factor loadings (>0.30). The internal consistency of AFAQ (Cronbach's alpha coefficient) was 0.85, and the corrected item-total correlations were between 0.32-0.55. CONCLUSION The results indicated that the Turkish version of the Alarm Fatigue Assessment Questionnaire was sufficiently valid and reliable to measure alarm fatigue in nurses.
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Affiliation(s)
- Öznur Erbay-Dallı
- Bursa Uludağ University Faculty of Health Sciences, Department of Internal Medicine Nursing, Bursa/Nilüfer, Turkey.
| | - Kübra Bağcı-Derinpınar
- Bursa Uludağ University Faculty of Health Sciences, Department of Nursing, Bursa/Nilüfer, Turkey
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Alkubati SA, Alsaqri SH, Alrubaiee GG, Almoliky MA, Alqalah TAH, Pasay-An E, Alrasheeday AM, Elsayed SM. Levels and Factors of Nurses' Alarm Fatigue in Critical Care Settings in Saudi Arabia: A Multicenter Cross-Sectional Study. J Multidiscip Healthc 2024; 17:793-803. [PMID: 38410522 PMCID: PMC10896094 DOI: 10.2147/jmdh.s452933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/16/2024] [Indexed: 02/28/2024] Open
Abstract
Background A continuous and high frequency of alarms from monitoring and treatment devices can lead to nurses' sensory exhaustion and alarm fatigue in critical care settings. Aim The purpose of this study was to evaluate the level of alarm fatigue and determine the relationship between nurses' sociodemographic and work-related factors and the level of alarm fatigue in critical care settings in Hail City, Saudi Arabia. Methods Between May and July 2023, 298 nurses who worked in the emergency, intensive care, and critical care units of all the public hospitals in Hail City participated in a cross-sectional survey. Sociodemographic and work-related sheet and the Nurses' Alarm Fatigue Questionnaire were used to collect data. Results The total mean score of alarm fatigue was 26.38±8.30 out of 44. The highest score was observed for the item "I pay more attention to the alarms in certain", while the lowest score were observed for the items "I turn off the alarms at the beginning of every shift" with mean scores of 2.51 and 1.61, respectively. Nurses who were males, older than 30 years and Saudi citizens had significantly higher mean scores of alarm fatigue than their counterparts. In addition, significantly higher mean scores of alarm fatigue were noticed for nurses experienced for 10 years or more and who had regular morning shifts. Multiple linear regression showed that male (p=0.014), age (p=0.012), and Saudi nationality (p <0.029) were the independent factors affecting the level of fatigue alarm among nurses. Conclusion Nurses working in critical care settings at hospitals in Hail city are exposed to average levels of alarm fatigue, which can be influenced by sex, age, nationality, and experience of nurses. Therefore, it is imperative to manage alarm fatigue in critical care units by considering work-related and personality-related factors to ensure patient safety.
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Affiliation(s)
- Sameer A Alkubati
- Department of Medical Surgical Nursing, University of Hail, Hail, Saudi Arabia
| | | | - Gamil G Alrubaiee
- Department of Community Health, University of Hail, Hail, Saudi Arabia
| | | | | | - Eddieson Pasay-An
- Fundamental of Nursing Department, King Khalid University, Abha, Saudi Arabia
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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] [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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Ruppel H, Dougherty M, Bonafide CP, Lasater KB. Alarm burden and the nursing care environment: a 213-hospital cross-sectional study. BMJ Open Qual 2023; 12:e002342. [PMID: 37880160 PMCID: PMC10603400 DOI: 10.1136/bmjoq-2023-002342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/23/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND High rates of medical device alarms in hospitals are a well-documented threat to patient safety. Little is known about organisational features that may be associated with nurses' experience of alarm burden. AIMS To evaluate the association between nurse-reported alarm burden, appraisals of patient safety, quality of care and hospital characteristics. METHODS Secondary analysis of cross-sectional survey data from 3986 hospital-based direct-care registered nurses in 213 acute care hospitals in New York and Illinois, USA. We evaluated associations of alarm burden with appraisals of patient safety and quality of care and hospital characteristics (work environment, staffing adequacy, size, teaching status) using χ2 tests. RESULTS The majority of respondents reported feeling overwhelmed by alarms (83%), delaying their response to alarms because they were unable to step away from another patient/task (76%), and experiencing situations where a patient needed urgent attention but no one responded to an alarm (55%). Nurses on medical-surgical units reported these experiences at higher rates than nurses working in intensive care units (p<0.001). Alarm burden items were significantly associated with poorer nurse-reported patient safety, quality of care, staffing and work environment. Findings were most pronounced for situations where a patient needed urgent attention but no one responded to the alarm, which was frequently/occasionally experienced by 72% of those who rated their hospital's safety as poor versus 38% good, p<0.001; 80% who rated overall quality of care poor/fair versus 46% good/excellent, p<0.001 and 65% from poor work environments versus 42% from good work environments, p<0.001. CONCLUSION Most nurses reported feeling overwhelmed by medical device alarms, and our findings suggest that alarm burden may be more pronounced in hospitals with unfavourable working conditions and suboptimal quality and safety. Because this was a cross-sectional study, further research is needed to explore causal relationships and the role of modifiable systems factors in reducing alarm burden.
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Affiliation(s)
- Halley Ruppel
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Clinical Futures, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maura Dougherty
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Christopher P Bonafide
- Clinical Futures, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
- Section of Hospital Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karen B Lasater
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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Wunderlich MM, Amende-Wolf S, Krampe H, Kruppa J, Spies C, Weiß B, Memmert B, Balzer F, Poncette AS. A brief questionnaire for measuring alarm fatigue in nurses and physicians in intensive care units. Sci Rep 2023; 13:13860. [PMID: 37620385 PMCID: PMC10449802 DOI: 10.1038/s41598-023-40290-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
When exposed to hundreds of medical device alarms per day, intensive care unit (ICU) staff can develop "alarm fatigue" (i.e., desensitisation to alarms). However, no standardised way of quantifying alarm fatigue exists. We aimed to develop a brief questionnaire for measuring alarm fatigue in nurses and physicians. After developing a list of initial items based on a literature review, we conducted 15 cognitive interviews with the target group (13 nurses and two physicians) to ensure that the items are face valid and comprehensible. We then asked 32 experts on alarm fatigue to judge whether the items are suited for measuring alarm fatigue. The resulting 27 items were sent to nurses and physicians from 15 ICUs of a large German hospital. We used exploratory factor analysis to further reduce the number of items and to identify scales. A total of 585 submissions from 707 participants could be analysed (of which 14% were physicians and 64% were nurses). The simple structure of a two-factor model was achieved within three rounds. The final questionnaire (called Charité Alarm Fatigue Questionnaire; CAFQa) consists of nine items along two scales (i.e., the "alarm stress scale" and the "alarm coping scale"). The CAFQa is a brief questionnaire that allows clinical alarm researchers to quantify the alarm fatigue of nurses and physicians. It should not take more than five minutes to administer.
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Affiliation(s)
- Maximilian Markus Wunderlich
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sandro Amende-Wolf
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henning Krampe
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jochen Kruppa
- Hochschule Osnabrück, University of Applied Sciences, Osnabrück, Germany
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Björn Weiß
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Belinda Memmert
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Akira-Sebastian Poncette
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
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Seok Y, Cho Y, Kim N, Suh EE. Degree of Alarm Fatigue and Mental Workload of Hospital Nurses in Intensive Care Units. NURSING REPORTS 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] [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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Lehet CR, Lopez JA, Frank RJ, Cvach M. Technological Intervention to Improve Alarm Management in Acute Care Telemetry Units. Biomed Instrum Technol 2023; 57:67-74. [PMID: 37343111 PMCID: PMC10512988 DOI: 10.2345/0899-8205-57.2.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Background: Telemetry monitoring is intended to improve patient safety and reduce harm. However, excessive monitor alarms may have the undesired effect of staff ignoring, silencing, or delaying a response due to alarm fatigue. Outlier patients, or those patients who are responsible for generating the most monitor alarms, contribute to excessive monitor alarms. Methods: Daily alarm data reports at a large academic medical center indicated that one or two patient outliers generated the most alarms daily. A technological intervention aimed at reminding registered nurses (RNs) to adjust alarm thresholds for patients who triggered excessive alarms was implemented. The notification was sent to the assigned RN's mobile phone when a patient exceeded the unit's seven-day average of alarms per day by greater than 400%. Results: A reduction in average alarm duration was observed across the four acute care telemetry units (P < 0.001), with an overall decrease of 8.07 seconds in the postintervention versus preintervention period. However, alarm frequency increased significantly (χ23 = 34.83, P < 0.001). Conclusion: Implementing a technological intervention to notify RNs to adjust alarm parameters may reduce alarm duration. Reducing alarm duration may improve RN telemetry management, alarm fatigue, and awareness. More research is needed to support this conclusion, as well as to determine the cause of the observed increase in alarm frequency.
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Watterson TL, Chui MA. Subjective Perceptions of Occupational Fatigue in Community Pharmacists. PHARMACY 2023; 11:84. [PMID: 37218966 PMCID: PMC10204370 DOI: 10.3390/pharmacy11030084] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Community retail pharmacists are experiencing unsafe levels of stress and excessive demands within the workplace. One aspect of workload stress that has been overlooked among pharmacists is occupational fatigue. Occupational fatigue is a characteristic of excessive workload including increased work demands and reduced capacity and resources to complete the work. The goal of this study is to describe the subjective perceptions of occupational fatigue in community pharmacists by using (Aim 1) a previously developed Pharmacist Fatigue Instrument and (Aim 2) semi-structured interviews. METHODS Wisconsin community pharmacists were eligible to participate in the study and recruited via a practice-based research network. Participants were asked to complete a demographic questionnaire, a Pharmacist Fatigue Instrument, and semi-structured interview. Survey data were analyzed using descriptive statistics. Interview transcripts were analyzed using qualitative deductive content analysis. RESULTS Totally, 39 pharmacists participated in the study. From the Pharmacist Fatigue Instrument, 50% of the participants stated they had times where they were not able to go above and beyond standard patient care on more than half of the days they worked. A total of 30% of the participants reported that they found it necessary to take short-cuts when providing patient care on more than half of the days they worked. Pharmacist interviews were separated into overarching themes including mental fatigue, physical fatigue, active fatigue, and passive fatigue. CONCLUSIONS The findings highlighted the pharmacists' feelings of despair and mental fatigue, fatigue's connectedness to interpersonal relationships, and the complex nature of pharmacy work systems. Interventions aimed at improving occupational fatigue in community pharmacies should consider key themes of fatigue that pharmacists are experiencing.
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Affiliation(s)
- Taylor L. Watterson
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI 53705, USA
| | - Michelle A. Chui
- Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmacy, 777 Highland Avenue, Madison, WI 53705, USA
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Rios D, Katzman N, Burdick KJ, Gellert M, Klein J, Bitan Y, Schlesinger JJ. Multisensory alarm to benefit alarm identification and decrease workload: a feasibility study. J Clin Monit Comput 2023:10.1007/s10877-023-01014-4. [PMID: 37133627 PMCID: PMC10154742 DOI: 10.1007/s10877-023-01014-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/05/2023] [Indexed: 05/04/2023]
Abstract
The poor design of conventional auditory medical alarms has contributed to alarm desensitization, and eventually, alarm fatigue in medical personnel. This study tested a novel multisensory alarm system which aims to help medical personnel better interpret and respond to alarm annunciation during periods of high cognitive load such as those found within intensive care units. We tested a multisensory alarm that combined auditory and vibrotactile cues to convey alarm type, alarm priority, and patient identity. Testing was done in three phases: control (conventional auditory), Half (limited multisensory alarm), and Full (complete multisensory alarm). Participants (N = 19, undergraduates) identified alarm type, priority, and patient identity (patient 1 or 2) using conventional and multisensory alarms, while simultaneously completing a cognitively demanding task. Performance was based on reaction time (RT) and identification accuracy of alarm type and priority. Participants also reported their perceived workload. RT was significantly faster for the Control phase (p < 0.05). Participant performance in identifying alarm type, priority, and patient did not differ significantly between the three phase conditions (p = 0.87, 0.37, and 0.14 respectively). The Half multisensory phase produced the lowest mental demand, temporal demand, and overall perceived workload score. These data suggest that implementation of a multisensory alarm with alarm and patient information may decrease perceived workload without significant changes in alarm identification performance. Additionally, a ceiling effect may exist for multisensory stimuli, with only part of an alarm benefitting from multisensory integration.
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Affiliation(s)
- Derek Rios
- Department of Neuroscience Nashville, Vanderbilt University, Nashville, TN, 37235, USA
| | - Nuphar Katzman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Be'er Sheva, Beersheba, Israel
| | | | - May Gellert
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Be'er Sheva, Beersheba, Israel
| | - Jessica Klein
- Vanderbilt University School of Medicine, 1161 21st Ave South, Nashville, TN, 37232, USA
| | - Yuval Bitan
- Department of Health Policy and Management, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
| | - Joseph J Schlesinger
- Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, 37209, 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] [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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13
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Lewandowska K, Mędrzycka-Dąbrowska W, Tomaszek L, Wujtewicz M. Determining Factors of Alarm Fatigue among Nurses in Intensive Care Units-A Polish Pilot Study. J Clin Med 2023; 12:jcm12093120. [PMID: 37176561 PMCID: PMC10179395 DOI: 10.3390/jcm12093120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/22/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION With the development of medical technology, clinical alarms from various medical devices, which are rapidly increasing, are becoming a new problem in intensive care units. The aim of this study was to evaluate alarm fatigue in Polish nurses employed in Intensive Care Units and identify the factors associated with alarm fatigue. METHODS A cross-sectional study. The study used the nurses' alarm fatigue questionnaire by Torabizadeh. The study covered 400 Intensive Care Unit nurses. The data were collected from February to June 2021. RESULTS The overall mean score of alarm fatigue was 25.8 ± 5.8. Participation in training programs related to the use of monitoring devices available in the ward, both regularly (ß = -0.21) and once (ß = -0.17), negatively correlated with nurses' alarm fatigue. On the other hand, alarm fatigue was positively associated with 12 h shifts [vs. 8 h shifts and 24 h shifts] (ß = 0.11) and employment in Intensive Cardiac Surveillance Units-including Cardiac Surgery [vs. other Intensive Care Units] (ß = 0.10). CONCLUSION Monitoring device alarms constitute a significant burden on Polish Intensive Care Unit nurses, in particular those who do not take part in training on the operation of monitoring devices available in their ward. It is necessary to improve Intensive Care Unit personnel's awareness of the consequences of overburdening and alarm fatigue, as well as to identify fatigue-related factors.
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Affiliation(s)
- Katarzyna Lewandowska
- Department of Anaesthesiology and Intensive Care Nursing, Medical University of Gdansk, 7 Debinki Street, 80-211 Gdansk, Poland
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology and Intensive Care Nursing, Medical University of Gdansk, 7 Debinki Street, 80-211 Gdansk, Poland
| | - Lucyna Tomaszek
- Department of Specialist Nursing, Faculty of Medicine and Health Sciences, Kraków Academy of Andrzej Frycz Modrzewski, St. Gustawa Herlinga-Grudzińskiego 1, 30-705 Kraków, Poland
- Institute of Tuberculosis and Lung Diseases, Rabka-Zdrój Branch, 34-700 Rabka-Zdrój, Poland
| | - Magdalena Wujtewicz
- Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, 17 Smoluchowskiego Street, 80-214 Gdansk, Poland
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14
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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. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND 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] [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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Psychometric properties of the Arabic version of Barratt Impulsiveness Scale 11: The development of short form. Arch Psychiatr Nurs 2023; 43:1-8. [PMID: 37032002 DOI: 10.1016/j.apnu.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/12/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023]
Abstract
Impulsivity is an important mental health-related variable that has been associated with various human behaviors. The Barratt Impulsiveness Scale is the most frequently used measure to examine impulsivity. However, its psychometric and factor structure was not examined in Arabic speaking population. The goal of the current study was to examine the psychometric properties and factor structure of the Barratt Impulsiveness Scale in Arabic speaking population. The current study used a cross-sectional design. Two independent samples were recruited: college students (N = 250) and persons with heart failure (N = 165). Exploratory factor analysis, then a series of confirmatory factor analyses were used to assess one- and three-factor models of the Barratt Impulsiveness Scale (30 items; i.e., BIS-11) and Barratt Impulsiveness Scale (15 items; i.e., BIS-15). Because our analysis did not support the factor structure of the previous versions of the Barratt Impulsiveness Scale, we used confirmatory factor analysis to evaluate the model structure of the single-factor measure. To assess the measurement invariance, the newly developed measure was examined across different genders and populations. Due to poor psychometrics of BIS-11 and BIS-15, a short form (BIS-SF) was developed; and validity, reliability, and measurement invariance were supported. The current analysis showed that BIS-11 and BIS-15 have poor psychometrics. Thus, there was a need to improve the measure by reducing the number of items and re-evaluating the psychometrics of the new measure. The BIS-SF is a reliable, valid tool to assess impulsivity in our samples. Other studies need to support the current study findings in populations with other chronic illnesses.
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16
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Ali Al-Quraan H, Eid A, Alloubani A. Assessment of Alarm Fatigue Risk Among Oncology Nurses in Jordan. SAGE Open Nurs 2023; 9:23779608231170730. [PMID: 37124378 PMCID: PMC10134186 DOI: 10.1177/23779608231170730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/03/2023] [Accepted: 04/02/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Using technology in the clinical setting where clinical alarms frequently occur, resulting in many false alarms, which is called alarm fatigue, alarm fatigue may increase nurses' distraction, and that might negatively affect patient safety. Objective This study aimed to assess alarm fatigue among oncology nurses in Jordan. Methods A descriptive cross-sectional design was used in a non-profit specialized cancer center. A self-reported questionnaire was answered by nurses who participated in the study. Results A total of 222 questionnaires were analyzed with a more than 95% response rate. More than half of the sample (60.4%) were females. The participants were young nurses with a mean age of 25.18 ± 3.33 years. The total mean score of alarm fatigue was 31.62 ± 7.14 on a scale ranging from zero to 52. Post-hoc analysis showed that the palliative unit (25.73 ± 7.22) and emergency room (28.73 ± 6.62) had low scores of total mean alarm fatigue than remaining area of practice, such as the ICU (33.92 ± 6.99); p-value: .004. Conclusion Alarm fatigue is a global issue affecting many practice areas. An educational program is recommended for nurses to learn how to deal with alarm fatigue. In order to effectively manage alarms, nurses' education and individual training are crucial.
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Affiliation(s)
| | - Amjad Eid
- King Hussein Cancer Center, Amman, Jordan
| | - Aladeen Alloubani
- King Hussein Cancer Center, Amman, Jordan
- Aladeen Alloubani, King Hussein Cancer Center, Amman, Jordan.
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17
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Nyarko BA, Nie H, Yin Z, Chai X, Yue L. The effect of educational interventions in managing nurses' alarm fatigue: An integrative review. J Clin Nurs 2022. [PMID: 35968774 DOI: 10.1111/jocn.16479] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 06/30/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alarm fatigue is becoming more widely acknowledged as a serious safety concern in modern clinical practice. Nurses are not always proficient in the alarms' functions and capabilities, and they do not undertake training regularly. Educating nurses on alarms maintains their knowledge and abilities in complex clinical settings. Some education has been undertaken to improve clinical alarm response, but the evidence for evaluating the effectiveness of nurse education interventions is limited. OBJECTIVE To evaluate the effects of educational interventions for reducing alarm fatigue in nurses, including the reduction of excessive, false and non-actionable alarms, which are major factors causing alarm fatigue in nurses. DATA SOURCES PUBMED, EMBASE, CINAHL, SCOPUS and OVID databases were systematically searched from 2016 to 2021. DESIGN Integrative Review. REVIEW METHODS An integrative review of literature was performed using the PRISMA checklist. Critical appraisal was done using Joanna Briggs Institute level of evidence. RESULTS Thirteen studies met the inclusion criteria. The results of most studies showed that educational intervention was beneficial for reducing the total number of alarms and false alarms. Furthermore, nurses' perceptions and knowledge improved, but the reduction in nurses' alarm fatigue is uncertain. A positive effect in alarm management practices was identified after the educational intervention. CONCLUSION Educational intervention may be the way to manage nurses' alarm fatigue. The use of medical devices in hospitals is increasing exponentially, and for this reason, alarms are inevitable. The introduction of effective and continuous education and training programs for nurses concerning clinical alarm management as well as raising nurses' awareness of the occurrence of alarm fatigue is vital.
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Affiliation(s)
- Brenda Abena Nyarko
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
| | - Huiyu Nie
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
| | - Zengzhen Yin
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoya Chai
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Liqing Yue
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, China
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18
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Carelli L, Terzoni S, Destrebecq A, Formenti P, Soumahoro F, Esposito A, Ferrara P. Alarm fatigue in nurses working in intensive care units: A multicenter study. Work 2022; 72:651-656. [DOI: 10.3233/wor-210552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Technological progress improves health care efficiency, quality, safety, and cost, supporting clinical activity in various scenarios, such as Intensive Care Unit (ICU). A timely response to alarms from monitors and other ICU electromedical devices is therefore crucial. The number of false alarms tend to desensitize care providers increasing the risk of experiencing alarm fatigue and, at times, lead to severe consequences for patients. OBJECTIVES: To assess the psychometric properties of the Italian version of the Alarm Fatigue Questionnaire and to explore the phenomenon of alarm fatigue among nurses working in intensive care settings. METHODS: The CVI-I was calculated to evaluate the validity of the content of the tool. Construct validity was investigated through exploratory factor analysis. Cronbach’s alpha coefficient (α) was used to examine the internal consistency of the scale and Spearman’s rho coefficient to test for stability. We designed a multicentre cross-sectional survey. A convenience sample of nurses from 4 Major Italian hospitals was recruited. The nurses completed the Italian version of the Alarm Fatigue Questionnaire. RESULTS: The content validity index CVI-S of the scale (CVI-S) was 91.11%; Cronbach’s alpha coefficient was 0.71. The Italian version of the tool explained 67.18%of the overall variance. 396 nurses were enrolled (79.84%). The overall level of alarm fatigue was Me = 29 [22;30]. 42.17%of the sample reported prior experience with alarm fatigue incidents. CONCLUSIONS: The extension of alarm fatigue requires the adoption of a preventive intervention plan. The Italian version of the Alarm Fatigue Questionnaire shows promising psychometric properties.
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Affiliation(s)
- Lara Carelli
- ASST Santi Paolo e Carlo, San Paolo Bachelor School of Nursing, San Paolo Teaching Hospital, Milan, Italy
| | - Stefano Terzoni
- ASST Santi Paolo e Carlo, San Paolo Bachelor School of Nursing, San Paolo Teaching Hospital, Milan, Italy
| | | | - Paolo Formenti
- Emergency Department, San Paolo Teaching Hospital, Milan, Italy
| | | | | | - Paolo Ferrara
- ASST Santi Paolo e Carlo, San Paolo Bachelor School of Nursing, San Paolo Teaching Hospital, Milan, Italy
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Asadi N, Salmani F, Asgari N, Salmani M. Alarm fatigue and moral distress in ICU nurses in COVID-19 pandemic. BMC Nurs 2022; 21:125. [PMID: 35610610 PMCID: PMC9126748 DOI: 10.1186/s12912-022-00909-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/17/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Most ICU nurses feel overwhelmed by the variety of alarms at the same time. Therefore, nurses experience very stressful situations in relation to many responsibilities and care demands. This stressful condition has recently been exacerbated by COVID-19 and potentially endangers patient safety. The aim of this study was to investigate the alarm fatigue and moral distress of ICU nurses in COVID-19 crisis. METHOD This is a descriptive-analytical cross-sectional study (April-May 2021). Sampling was done by convenience among ICU nurses affiliated to Isfahan University of Medical Sciences, Iran. Data were collected using Nurses' alarm fatigue and the moral distress scale (MDS). Data were analyzed using ANOVA, independent t-test and multivariate logistic regression. RESULT The results showed that the mean score of alarm fatigue was moderate)19.08 ± 6.26 (and moral distress was low (33.80 ± 11.60). The results showed that there was a significant relationship between alarm fatigue and related training courses)P = .012(.So that, alarm fatigue in nurses who were trained in working with ventilators and alarm settings was significantly less than other nurses. Also, a significant relationship was found between moral distress and marital status(P = .001) and Shift type(P = .01). On the other hand, the risk of alarm fatigue was higher in participants who have a PhD. The results showed that no significant correlation was found between alarm fatigue and moral distress (r = 0.111, P = 0.195). CONCLUSION It is suggested that practical training courses on alarm management be included in the curriculum and the ICU nurses should have practical training before starting work in the ICU and on an annual basis. In order to protect nurses and ensure quality care of patients, nurse managers should reduce the number of rotating shifts of ICU nurses.
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Affiliation(s)
- Neda Asadi
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Salmani
- Nursing and Midwifery Sciences Development Research Center, Najafabad Branch, Islamic Azad University, Najafabad, Iran
| | - Narges Asgari
- 9 DAY Manzariyeh Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mahin Salmani
- Department of Mathematics and Statistics, University of New Brunswick, Fredericton, Canada
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20
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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] [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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21
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ALAN H, TİRYAKİ ŞEN H, BİLGİN O, POLAT Ş. Alarm Fatigue Questionnaire: Turkish Validity and Reliability Study. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.38079/igusabder.981451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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22
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Mohebbi Z, Ershadpoor R, Ostovari M, Rakhshan M. Radiation Protection Capability of Operating Room Personnel: Development and Psychometric Properties of a Questionnaire. J Biomed Phys Eng 2021; 11:603-612. [PMID: 34722405 PMCID: PMC8546165 DOI: 10.31661/jbpe.v0i0.2008-1161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/20/2020] [Indexed: 11/20/2022]
Abstract
Background: Radiation protection is an important principle in some wards of the hospital such as radiology, catheterization laboratory and operating room.
Due to the increasing use of radiation in the operating room, there is a need to design an accurate and appropriate tool to evaluate the radiation protection capability of operating room personnel. Objective: This study aims to test the psychometric properties of a questionnaire on radiation protection capability. Material and Methods: This cross-sectional study was conducted in two stages. The first stage was designing items based on the review of available literature,
and the second stage was measuring the validity and reliability of the questionnaire using face validity and content validity Content Validity Index (CVI)
and Content Validity Ratio (CVR). Then the questionnaire was filled out by 200 operating room nurses to evaluate the construct validity by Principal
Component Analysis method. Reliability of the questionnaire was evaluated by test–retest and Cronbach’s alpha analysis method. Results: Due to the results, test–retest correlation coefficient was 0.912, and Cronbach’s alpha coefficient was 0.824, indicating a desirable internal consistency. Conclusion: This study introduces a valid and reliable questionnaire for evaluating the radiation protection capability of operating room nurses.
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Affiliation(s)
- Zinat Mohebbi
- PhD, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Roya Ershadpoor
- MSc, Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Ostovari
- PhD, Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahnaz Rakhshan
- PhD, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Seifert M, Tola DH, Thompson J, McGugan L, Smallheer B. Effect of bundle set interventions on physiologic alarms and alarm fatigue in an intensive care unit: A quality improvement project. Intensive Crit Care Nurs 2021; 67:103098. [PMID: 34393010 DOI: 10.1016/j.iccn.2021.103098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 04/15/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine if the implementation of an evidence-based bundle designed to reduce the number of physiologic monitor alarms reduces alarm fatigue in intensive care nurses. DESIGN This quality improvement project retrospectively reviewed alarm data rates, types, and frequency to identify the top three problematic physiologic alarms in an intensive care unit. An alarm management bundle was implemented to reduce the number of alarms. The Nurses' Alarm Fatigue Questionnaire was used to measure nurses' alarms fatigue pre- and post-implementation of the bundle. SETTING A combined medical surgical intensive care unit at an accredited hospital in the United States. RESULTS The top three problematic alarms identified during the pre-implementation phase were arrhythmia, invasive blood pressure, and respiration alarms. All three identified problematic physiologic alarms had a reduction in frequency with arrhythmia alarms demonstrating the largest decrease in frequency (46.82%). When measuring alarm fatigue, the overall total scores increased from pre- (M = 30.59, SD = 5.56) to post-implementation (M = 32.60, SD = 4.84) indicating no significant difference between the two periods. CONCLUSION After implementing an alarm management bundle, all three identified problematic physiologic alarms decreased in frequency. Despite the reduction in these alarms, there was not a reduction in nurses' alarm fatigue.
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Affiliation(s)
- Micah Seifert
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710, United States.
| | - Denise H Tola
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710, United States.
| | - Julie Thompson
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710, United States.
| | - Lynn McGugan
- Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, United States.
| | - Benjamin Smallheer
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710, United States.
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Yu D, Obuseh M, DeLaurentis P. Quantifying the Impact of Infusion Alerts and Alarms on Nursing Workflows: A Retrospective Analysis. Appl Clin Inform 2021; 12:528-538. [PMID: 34192773 DOI: 10.1055/s-0041-1730031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Smart infusion pumps affect workflows as they add alerts and alarms in an information-rich clinical environment where alarm fatigue is already a major concern. An analytic approach is needed to quantify the impact of these alerts and alarms on nursing workflows and patient safety. OBJECTIVES To analyze a detailed infusion dataset from a smart infusion pump system and identify contributing factors for infusion programming alerts, operational alarms, and alarm resolution times. METHODS We analyzed detailed infusion pump data across four hospitals in a health system for up to 1 year. The prevalence of alerts and alarms was grouped by infusion type and a selected list of 32 high-alert medications (HAMs). Logistic regression was used to explore the relationship between a set of risk factors and the occurrence of alerts and alarms. We used nonparametric tests to explore the relationship between alarm resolution times and a subset of predictor variables. RESULTS The study dataset included 745,641 unique infusions with a total of 3,231,300 infusion events. Overall, 28.7% of all unique infusions had at least one operational alarm, and 2.1% of all unique infusions had at least one programming alert. Alarms averaged two per infusion, whereas at least one alert happened in every 48 unique infusions. Eight percent of alarms took over 4 minutes to resolve. Intravenous fluid infusions had the highest rate of error-state occurrence. HAMs had 1.64 more odds for alerts than the rest of the infusions. On average, HAMs had a higher alert rate than maintenance fluids. CONCLUSION Infusion pump alerts and alarms impact clinical care, as alerts and alarms by design interrupt clinical workflow. Our study showcases how hospital system leadership teams can leverage infusion pump informatics to prioritize quality improvement and patient safety initiatives pertaining to infusion practices.
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Affiliation(s)
- Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana, United States.,Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana, United States
| | - Marian Obuseh
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana, United States.,Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana, United States
| | - Poching DeLaurentis
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana, United States
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Claudio D, Deb S, Diegel E. A Framework to Assess Alarm Fatigue Indicators in Critical Care Staff. Crit Care Explor 2021; 3:e0464. [PMID: 34151285 PMCID: PMC8205220 DOI: 10.1097/cce.0000000000000464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This article examines work-related and Personality personality factors that could influence health providers in experiencing alarm fatigue. The purpose of this study is to provide a basis to determine factors that may predict the potential of alarm fatigue in critical care staff. DESIGN A questionnaire-based survey and an observational study were conducted to assess factors that could contribute to indicators of alarm fatigue. INTERVENTIONS Factors included patient-to-staff ratio, criticality of the alarm, priority of different tasks, and personality traits. SETTING The study was conducted at an eight-bed ICU in a mid-size hospital in Montana. SUBJECTS Data were collected for six day shifts and six night shifts involving 24 critical care professionals. Within each 12-hour shift, six 15-minute intervals were randomly generated through work sampling for 6 days; a total of 1,080 observations were collected. MEASUREMENTS Alarm fatigue was assessed with the subjective workload assessment technique and Boredom, Apathy, and Distrust Affects, which were measured through validated questionnaires. The Big Five Personality model was used to assess personality traits. MAIN RESULTS Work factors including task prioritization, nurse-to-patient ratio, and length of shifts were associated with indicators of alarm fatigue. Personality traits of openness, conscientiousness, and neuroticism were also associated. CONCLUSIONS We recommend assessing personality traits for critical care staff to be aware of how their individualities can affect their behavior towards alarm fatigue. We also recommend an examination of alternative strategies to reduce alarm fatigue, including examining the use of breaks, work rotation, or shift reduction.
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Affiliation(s)
- David Claudio
- Department of Mechanical and Industrial Engineering, Montana State University
| | - Shuchisnigdha Deb
- Department of Industrial, Manufacturing, and Systems Engineering, University of Texas
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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] [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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Busquet-Duran X, Jiménez-Zafra EM, Tura-Poma M, Bosch-de la Rosa O, Moragas-Roca A, Martin-Moreno S, Martínez-Losada E, Crespo-Ramírez S, Lestón-Lado L, Salamero-Tura N, Llobera-Estrany J, Oriol-Peregrina N, Moreno-Gabriel E, Manresa-Domínguez JM, Torán-Monserrat P. Assessing Face Validity of the HexCom Model for Capturing Complexity in Clinical Practice: A Delphi Study. Healthcare (Basel) 2021; 9:healthcare9020165. [PMID: 33557220 PMCID: PMC7913893 DOI: 10.3390/healthcare9020165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
Abstract
Capturing complexity is both a conceptual and a practical challenge in palliative care. The HexCom model has proved to be an instrument with strong reliability and to be valid for describing the needs and strengths of patients in home care. In order to explore whether it is also perceived to be helpful in enhancing coordinated and patient-centred care at a practical level, a methodological study was carried out to assess the face validity of the model. In particular, a Delphi method involving a group of 14 experts representing the full spectrum of healthcare professionals involved in palliative care was carried out. The results show that there is a high level of agreement, with a content validity index-item greater than 0.92 both with regard to the complexity model and the HexCom-Red, HexCom-Basic, and the HexCom-Clin instruments, and higher than 0.85 regarding the HexCom-Figure and the HexCom-Patient instruments. This consensus confirms that the HexCom model and the different instruments that are derived from it are valued as useful tools for a broad range of healthcare professional in coordinately capturing complexity in healthcare practice.
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Affiliation(s)
- Xavier Busquet-Duran
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain; (E.M.-G.); (J.M.M.-D.); (P.T.-M.)
- Nursing Department, Fundació Universitària Bages (FUB), University of Vic, 08500 Vic, Spain
- Correspondence:
| | - Eva Maria Jiménez-Zafra
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Magda Tura-Poma
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Olga Bosch-de la Rosa
- Red Cross Psychosocial Care Team (EAPS), 08402 Granollers, Spain; (O.B.-d.l.R.); (S.C.-R.)
| | - Anna Moragas-Roca
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Susana Martin-Moreno
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Emilio Martínez-Losada
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Silvia Crespo-Ramírez
- Red Cross Psychosocial Care Team (EAPS), 08402 Granollers, Spain; (O.B.-d.l.R.); (S.C.-R.)
| | - Lola Lestón-Lado
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Núria Salamero-Tura
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Joana Llobera-Estrany
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Núria Oriol-Peregrina
- Degree in Speech and Language Therapy, University of Vic-Central University of Catalonia/UOC, 08242 Manresa, Spain;
- Sociosanitari Vallparadís, 08221 Terrassa, Spain
| | - Eduard Moreno-Gabriel
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain; (E.M.-G.); (J.M.M.-D.); (P.T.-M.)
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Barcelona, Spain
| | - Josep Maria Manresa-Domínguez
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain; (E.M.-G.); (J.M.M.-D.); (P.T.-M.)
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Barcelona, Spain
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Pere Torán-Monserrat
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain; (E.M.-G.); (J.M.M.-D.); (P.T.-M.)
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Barcelona, Spain
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Lewandowska K, Weisbrot M, Cieloszyk A, Mędrzycka-Dąbrowska W, Krupa S, Ozga D. Impact of Alarm Fatigue on the Work of Nurses in an Intensive Care Environment-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228409. [PMID: 33202907 PMCID: PMC7697990 DOI: 10.3390/ijerph17228409] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022]
Abstract
Background: In conditions of intensive therapy, where the patients treated are in a critical condition, alarms are omnipresent. Nurses, as they spend most of their time with patients, monitoring their condition 24 h, are particularly exposed to so-called alarm fatigue. The purpose of this study is to review the literature available on the perception of clinical alarms by nursing personnel and its impact on work in the ICU environment. Methods: A systematic review of the literature was carried out according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol. The content of electronic databases was searched through, i.e., PubMed, OVID, EBSCO, ProQuest Nursery, and Cochrane Library. The keywords used in the search included: “intensive care unit,” “nurse,” “alarm fatigue,” “workload,” and “clinical alarm.” The review also covered studies carried out among nurses employed at an adult intensive care unit. Finally, seven publications were taken into consideration. Data were analyzed both descriptively and quantitatively, calculating a weighted average for specific synthetized data. Results: In the analyzed studies, 389 nurses were tested, working in different intensive care units. Two studies were based on a quality model, while the other five described the problem of alarms in terms of quantity, based on the HTF (Healthcare Technology Foundation) questionnaire. Intensive care nurses think that alarms are burdensome and too frequent, interfering with caring for patients and causing reduced trust in alarm systems. They feel overburdened with an excessive amount of duties and a continuous wave of alarms. Having to operate modern equipment, which is becoming more and more advanced, takes time that nurses would prefer to dedicate to their patients. There is no clear system for managing the alarms of monitoring devices. Conclusion: Alarm fatigue may have serious consequences, both for patients and for nursing personnel. It is necessary to introduce a strategy of alarm management and for measuring the alarm fatigue level.
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Affiliation(s)
- Katarzyna Lewandowska
- Department of Anaesthesiology Nursing & Intensive Care, Medical University in Gdansk, 80211 Gdansk, Poland;
| | - Magdalena Weisbrot
- Intensive Care Unit, University Clinical Centre in Gdansk, 80211 Gdansk, Poland;
| | - Aleksandra Cieloszyk
- Independent Team of Physiotherapists, University Clinical Centre in Gdansk, 80211 Gdansk, Poland;
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology Nursing & Intensive Care, Medical University in Gdansk, 80211 Gdansk, Poland;
- Correspondence:
| | - Sabina Krupa
- Departament of Emergency, Institute of Health Sciences Medical College of Rzeszow University, 35310 Rzeszow, Poland; (S.K.); (D.O.)
| | - Dorota Ozga
- Departament of Emergency, Institute of Health Sciences Medical College of Rzeszow University, 35310 Rzeszow, Poland; (S.K.); (D.O.)
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Torabizadeh C, Bahmani T, Molazem Z, Moayedi SA. Development and Psychometric Evaluation of a Professional Communication Questionnaire for the Operating Room. HEALTH COMMUNICATION 2019; 34:1313-1319. [PMID: 29902060 DOI: 10.1080/10410236.2018.1484268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Effective communications play a significant role in environments where health care is provided. A review of the available literature did not yield a valid scale for evaluation of operating room nurse-doctor communication. Accordingly, the present study is an attempt at development and psychometric evaluation of a professional communication questionnaire for the operating room. The present study is a methodological work conducted in two steps. In the first stage of the study, 56 items on a 5-point Likert scale were developed according to the results of a review of relevant literature and several meetings with experts. Next, following a qualitative and quantitative evaluation of the face and content validity of the questionnaire, 41 items remained. An assessment of the construct validity of the questionnaire using factor analysis yielded six factors. In this stage, 410 operating room nurses and doctors who were randomly selected from six hospitals affiliated with the university participated. Cronbach's alpha for the internal homogeneity of the instrument was found to be .88; the results of the test-retest showed its consistency to be .91. The findings show that the developed instrument has enough validity and reliability to be used to evaluate professional communication in operating rooms.
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Affiliation(s)
| | - Tayebeh Bahmani
- Student Research Committee, Shiraz University of Medical Sciences
| | - Zahra Molazem
- Department of Nursing, Shiraz University of Medical Sciences
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SAVIOR ICU: sonification and vibrotactile interface for the operating room and intensive care unit. J Clin Monit Comput 2019; 34:787-796. [PMID: 31456073 DOI: 10.1007/s10877-019-00381-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/20/2019] [Indexed: 01/09/2023]
Abstract
Alarm fatigue is an issue for healthcare providers in the intensive care unit, and may result from desensitization of overbearing and under-informing alarms. To directly increase the overall identification of medical alarms and potentially contribute to a downstream decrease in the prevalence of alarm fatigue, we propose advancing alarm sonification by combining auditory and tactile stimuli to create a multisensory alarm. Participants completed four trials-two multisensory (auditory and tactile) and two unisensory (auditory). Analysis compared the unisensory trials to the multisensory trials based on the percentage of correctly identified point of change, direction of change and identity of three physiological parameters (indicated by different instruments): heart rate (drums), blood pressure (piano), blood oxygenation (guitar). A repeated-measures of ANOVA yielded a significant improvement in performance for the multisensory group compared to the unisensory group (p < 0.05). Specifically, the multisensory group had better performance in correctly identifying parameter (p < 0.05) and point of change (p < 0.05) compared to the unisensory group. Participants demonstrated a higher accuracy of identification with the use of multisensory alarms. Therefore, multisensory alarms may relieve the auditory burden of the medical environment and increase the overall quality of care and patient safety.
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Hravnak M, Pellathy T, Chen L, Dubrawski A, Wertz A, Clermont G, Pinsky MR. A call to alarms: Current state and future directions in the battle against alarm fatigue. J Electrocardiol 2018; 51:S44-S48. [PMID: 30077422 PMCID: PMC6263784 DOI: 10.1016/j.jelectrocard.2018.07.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 07/24/2018] [Accepted: 07/27/2018] [Indexed: 10/28/2022]
Abstract
Research demonstrates that the majority of alarms derived from continuous bedside monitoring devices are non-actionable. This avalanche of unreliable alerts causes clinicians to experience sensory overload when attempting to sort real from false alarms, causing desensitization and alarm fatigue, which in turn leads to adverse events when true instability is neither recognized nor attended to despite the alarm. The scope of the problem of alarm fatigue is broad, and its contributing mechanisms are numerous. Current and future approaches to defining and reacting to actionable and non-actionable alarms are being developed and investigated, but challenges in impacting alarm modalities, sensitivity and specificity, and clinical activity in order to reduce alarm fatigue and adverse events remain. A multi-faceted approach involving clinicians, computer scientists, industry, and regulatory agencies is needed to battle alarm fatigue.
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Affiliation(s)
| | | | - Lujie Chen
- Auton Lab, Robotics Institute, School of Computer Science, Carnegie Mellon University, United States
| | - Artur Dubrawski
- Auton Lab, Robotics Institute, School of Computer Science, Carnegie Mellon University, United States
| | - Anthony Wertz
- Auton Lab, Robotics Institute, School of Computer Science, Carnegie Mellon University, United States
| | - Gilles Clermont
- Schools of Medicine, University of Pittsburgh, United States
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Critical care nurses’ knowledge of alarm fatigue and practices towards alarms: A multicentre study. Intensive Crit Care Nurs 2018; 48:36-41. [DOI: 10.1016/j.iccn.2018.05.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/07/2018] [Indexed: 11/23/2022]
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Winters BD. Effective approaches to control non-actionable alarms and alarm fatigue. J Electrocardiol 2018; 51:S49-S51. [PMID: 30045808 DOI: 10.1016/j.jelectrocard.2018.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/14/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Bradford D Winters
- Department of Anesthesiology and Critical Care Medicine, The Armstrong Institute for Patient Safety and Quality, The Johns Hopkins University School of Medicine, 9127 Zayed 1800 Orleans Street, Baltimore, MD 21287, United States of America.
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Flohr L, Beaudry S, Johnson KT, West N, Burns CM, Ansermino JM, Dumont GA, Wensley D, Skippen P, Gorges M. Clinician-Driven Design of VitalPAD-An Intelligent Monitoring and Communication Device to Improve Patient Safety in the Intensive Care Unit. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2018; 6:3000114. [PMID: 29552425 PMCID: PMC5853765 DOI: 10.1109/jtehm.2018.2812162] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/19/2018] [Accepted: 02/12/2018] [Indexed: 01/22/2023]
Abstract
The pediatric intensive care unit (ICU) is a complex environment, in which a multidisciplinary team of clinicians (registered nurses, respiratory therapists, and physicians) continually observe and evaluate patient information. Data are provided by multiple, and often physically separated sources, cognitive workload is high, and team communication can be challenging. Our aim is to combine information from multiple monitoring and therapeutic devices in a mobile application, the VitalPAD, to improve the efficiency of clinical decision-making, communication, and thereby patient safety. We observed individual ICU clinicians, multidisciplinary rounds, and handover procedures for 54 h to identify data needs, workflow, and existing cognitive aid use and limitations. A prototype was developed using an iterative participatory design approach; usability testing, including general and task-specific feedback, was obtained from 15 clinicians. Features included map overviews of the ICU showing clinician assignment, patient status, and respiratory support; patient vital signs; a photo-documentation option for arterial blood gas results; and team communication and reminder functions. Clinicians reported the prototype to be an intuitive display of vital parameters and relevant alerts and reminders, as well as a user-friendly communication tool. Future work includes implementation of a prototype, which will be evaluated under simulation and real-world conditions, with the aim of providing ICU staff with a monitoring device that will improve their daily work, communication, and decision-making capacity. Mobile monitoring of vital signs and therapy parameters might help improve patient safety in wards with single-patient rooms and likely has applications in many acute and critical care settings.
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Affiliation(s)
- Luisa Flohr
- Faculty of MedicineThe University of British ColumbaVancouverBCV6T 1Z3Canada
| | - Shaylene Beaudry
- Department of AnesthesiologyPharmacology and TherapeuticsThe University of British ColumbaVancouverBCV6T 1Z3Canada
| | - K Taneille Johnson
- Faculty of MedicineThe University of British ColumbaVancouverBCV6T 1Z3Canada
| | - Nicholas West
- Department of AnesthesiologyPharmacology and TherapeuticsThe University of British ColumbaVancouverBCV6T 1Z3Canada
| | - Catherine M Burns
- Department of Systems Design EngineeringUniversity of WaterlooWaterlooONN2L 3G1Canada
| | - J Mark Ansermino
- Department of AnesthesiologyPharmacology and TherapeuticsThe University of British ColumbaVancouverBCV6T 1Z3Canada.,BC Children's Hospital Research InstituteVancouverBCV5Z 4H4Canada
| | - Guy A Dumont
- Department of Electrical and Computer EngineeringThe University of British ColumbaVancouverBCV6T 1Z4Canada
| | - David Wensley
- Department of PediatricsThe University of British ColumbaVancouverBCV6H 3V4Canada
| | - Peter Skippen
- Department of PediatricsThe University of British ColumbaVancouverBCV6H 3V4Canada
| | - Matthias Gorges
- Department of AnesthesiologyPharmacology and TherapeuticsThe University of British ColumbaVancouverBCV6T 1Z3Canada.,BC Children's Hospital Research InstituteVancouverBCV5Z 4H4Canada
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Joshi R, van de Mortel H, Feijs L, Andriessen P, van Pul C. The heuristics of nurse responsiveness to critical patient monitor and ventilator alarms in a private room neonatal intensive care unit. PLoS One 2017; 12:e0184567. [PMID: 28981515 PMCID: PMC5628801 DOI: 10.1371/journal.pone.0184567] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/25/2017] [Indexed: 11/18/2022] Open
Abstract
Aim Alarm fatigue is a well-recognized patient safety concern in intensive care settings. Decreased nurse responsiveness and slow response times to alarms are the potentially dangerous consequences of alarm fatigue. The aim of this study was to determine the factors that modulate nurse responsiveness to critical patient monitor and ventilator alarms in the context of a private room neonatal intensive care setting. Methods The study design comprised of both a questionnaire and video monitoring of nurse-responsiveness to critical alarms. The Likert scale questionnaire, comprising of 50 questions across thematic clusters (critical alarms, yellow alarms, perception, design, nursing action, and context) was administered to 56 nurses (90% response rate). Nearly 6000 critical alarms were recorded from 10 infants in approximately 2400 hours of video monitoring. Logistic regression was used to identify patient and alarm-level factors that modulate nurse-responsiveness to critical alarms, with a response being defined as a nurse entering the patient’s room within the 90s of the alarm being generated. Results Based on the questionnaire, the majority of nurses found critical alarms to be clinically relevant even though the alarms did not always mandate clinical action. Based on video observations, for a median of 34% (IQR, 20–52) of critical alarms, the nurse was already present in the room. For the remaining alarms, the response rate within 90s was 26%. The median response time was 55s (IQR, 37-70s). Desaturation alarms were the most prevalent and accounted for more than 50% of all alarms. The odds of responding to bradycardia alarms, compared to desaturation alarms, were 1.47 (95% CI = 1.21–1.78; <0.001) while that of responding to a ventilator alarm was lower at 0.35 (95% CI = 0.27–0.46; p <0.001). For every 20s increase in the duration of an alarm, the odds of responding to the alarm (within 90s) increased to 1.15 (95% CI = 1.1–1.2; p <0.001). The random effect per infant improved the fit of the model to the data with the response times being slower for infants suffering from chronic illnesses while being faster for infants who were clinically unstable. Discussion Even though nurses respond to only a fraction of all critical alarms, they consider the vast majority of critical and yellow alarms as useful and relevant. When notified of a critical alarm, they seek waveform information and employ heuristics in determining whether or not to respond to the alarm. Conclusion Amongst other factors, the category and duration of critical alarms along with the clinical status of the patient determine nurse-responsiveness to alarms.
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Affiliation(s)
- Rohan Joshi
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Clinical Physics, Máxima Medical Center, Veldhoven, The Netherlands
- * E-mail:
| | - Heidi van de Mortel
- Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Loe Feijs
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Peter Andriessen
- Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Pediatrics, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - Carola van Pul
- Department of Clinical Physics, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands
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