Decreasing Pediatric PACU Noise Level and Alarm Fatigue: A Quality Improvement Initiative to Improve Safety and Satisfaction

The impact of the use of continuous pulse oximetry monitoring to monitor patients at high risk of respiratory depression on nursing practice

AIM

To describe the impact on nursing practice of using continuous pulse oximetry monitoring to monitor patients at high risk for respiratory depression after surgery.

DESIGN

A convergent mixed method design.

METHODS

Thirty (30) hours of non-participant structured observation and explanatory interviews were conducted with 10 nurses from the surgery care unit and intensive care unit.

RESULTS

We found that nursing practice to evaluate and monitor at-risk patients through continuous pulse oximetry monitoring is mainly linked to technical care. Nurses generally meet the frequency of bedside monitoring required by established protocols. During the structured non-participant observation periods, it was observed that 90% of the alarms were false (unsustained desaturations). This was confirmed by the nurses during the explanatory interviews. Noisy environments, high number of false alarms, poor communication between nurses and various operational failures might have a negative impact on nursing practice.

CONCLUSION

Several challenges must be overcome for this technology to achieve the desired outcomes of continuous surveillance and rapid detection of respiratory depression episodes for post-surgical patients. No Patient or Public Contribution.

The effect of interventions made in intensive care units to reduce alarms: A systematic review and meta-analysis study

OBJECTIVES

This study examines the effects of the interventions in alarm management in intensive care units on reducing alarms on the basis of current evidence.

METHODOLOGY

This systematic review and meta-analysis study was conducted between January 1, 2010 and October 31, 2021 by searching 16 databases through an independent search by three researchers. The acronym of PICOS was used and the keywords as well as inclusion/exclusion criteria were determined. The Joanna Briggs Institute meta-Analysis of Statistics Assessment and Review Instruments (JBI-MAStARI) were used to assess methodological quality. Professional meta-analysis Software (ProMeta 3) statistical software package was used for data analysis. The study is preregistered on PROSPERO (CRD42021286770).

SETTING

Intensive care units.

RESULTS

The systematic review included 25 studies, whereas the meta-analysis included 15. According to the heterogeneity test in the study, alarm-reducing interventions yielded a heterogeneous distribution. The overall effect size value of all studies, which was found using the random-effects model, was determined to be -0.03 [95 % confidence interval (CI)], a value between -0.16 and 0.10 CI. Based on the results, individual studies showed that the strategies suggesting to ensure alarm safety were effective in reducing the number of alarms; the combined results of the studies in this meta-analysis showed that the interventions made to reduce alarms had too little effect.

CONCLUSION

This study showed that the interventions have a very weak effect size on reducing the number of alarms.

Application of Continuous Sacral Block Guided by Ultrasound After Comprehensive Sacral Canal Scanning in Children Undergoing Laparoscopic Surgery: A Prospective, Randomized, Double-Blind Study

Purpose

The present study aimed to explore the effects of continuous sacral block on the postoperative pain of children and the satisfaction of the nurses in post-anesthesia care unit (PACU). Also, the influence of the modified protocol of continuous sacral block was investigated.

Patients and Methods

A total of 60 children undergoing laparoscopic surgery were randomly divided into two groups: GI and GC groups. The general anesthesia was induced with midazolam, propofol, sufentanil and succinylcholine in both groups. In addition, the patients were subjected to continuous sacral block with levobupivacaine in group GC. The modified protocol of continuous sacral block was divided into three steps: comprehensive lumbar and sacral vertebral canal scanning by ultrasound, catheterization and administration. The EVENDOL pain scales and pediatric anesthesia emergence delirium scales of the children were evaluated at 5 min after extubation (T₃), 90 min (T₄), and 4 h (T₅) after the operation. The nurses' satisfaction scores at T₃ -T₄ and adverse events, such as nausea and vomiting, were also recorded, after the operation.

Results

After ultrasonic scanning, one patient in group GC was excluded due to the sacral hiatus atresia, which might lead to failure of catheterization. Data of 59 patients were collected for statistical analysis. Compared to the GI group, the EVENDOL scores and the pediatric anesthesia emergence delirium scales were reduced at T₃, T₄, and T₅ (P < 0.05) in group GC. Furthermore, there was a higher rank of PACU nurses' satisfaction in the GC group compared to the GI group (P < 0.05).

Conclusion

Based on the modified protocol, continuous sacral block provides reliable and safety analgesia for children undergoing laparoscopic surgery, thereby improving the satisfaction of PACU nurses.

The effect of educational interventions in managing nurses' alarm fatigue: An integrative review

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.