Determining the Impact of an Alarm Management Program on Alarm Fatigue among ICU and Telemetry RNs: An Evidence Based Research Project

Nurses' Alarm Fatigue Levels in Adult Intensive Care Units and Their Strategies to Reduce Fatigue: A Convergent Parallel Design

BACKGROUND

Alarm fatigue is a challenge for nurses and patients. Also, feasible strategies to reduce/manage alarm fatigue are still unclear.

AIM

This study aimed to identify adult intensive care nurses' alarm fatigue levels and strategies to reduce alarm fatigue.

DESIGN

A convergent parallel design was employed.

METHOD

The study was conducted between January and June 2022 in adult intensive care units of a university hospital, with 67 nurses in the quantitative phase and 14 in the qualitative phase. Quantitative data were collected using a personal information form, the Satisfaction Visual Analog Scale and the Nurses' Alarm Fatigue Questionnaire. Qualitative data were collected using a semi-structured interview form. Descriptive analyses, Mann-Whitney U, Kruskal-Wallis and Multiple Linear Regression analysis were used to evaluate quantitative data. The inductive content analysis method was utilised to evaluate qualitative data. The STROBE and COREQ checklists were employed to report the study.

RESULTS

In the quantitative phase, increased intensive care unit working hours, available alarm management support for managing alarms, and increased satisfaction level were negatively associated with alarm fatigue. Three main themes ("building an alarm management culture", "safe care environment" and "improving the features of alarm equipment/devices") and 10 sub-themes were elicited from interview data about the reduction of alarm fatigue.

CONCLUSIONS

In the study, adult intensive care nurses' alarm fatigue levels and strategies to reduce fatigue were revealed. These strategies should be applied to reduce alarm fatigue in intensive care units.

IMPLICATIONS FOR PRACTICE

Healthcare providers should develop and implement proactive strategies through effective organisational management to prevent and reduce alarm fatigue so that an alarm management culture can be built, employee satisfaction can be increased, a safe care environment can be provided, and the features of alarm devices can be improved.

REPORTING METHOD

The study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and Consolidated Criteria for Reporting Qualitative Research (COREQ) checklists.

PATIENT CONTRIBUTIONS

No patient or public contribution.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT05163340.

Experiences and Challenges for Critical Care Nurses in Work Related to Medical Device Alarms: A Qualitative Study

Critical care nurses, who are at the frontline of recognizing and answering alarms, face various challenges while undertaking this task. The purpose of this qualitative study is to gain more insight into the experiences of critical care nurses working with medical equipment alarms. A qualitative, descriptive design was used to explore this area. Fifteen critical care nurses, recruited using purposive sampling, participated in semistructured interviews. These were recorded and coded, and data were analyzed using content analysis. Four themes and fifteen related subthemes emerged, including: (1) emotional experience (sub: anxiety/dysphoria, helplessness, worry, ambivalence); (2) physical symptoms (sub: hearing disorder, sleep disturbances, exhaustion, inattention); (3) new challenges (sub: multiple nursing roles, inconsistent practice guidelines, unsatisfactory human-machine interaction, nurse attribute); and (4) coping strategies (sub: positive alarm culture, effective teamwork, development of technology). Healthcare administrators should focus not only on the nurses themselves, but also on objective factors such as organization and technology, which contribute to the empowerment of ICU nurses and can encourage them to participate in clinical alarm management.

The introduction of a sound reduction bundle in the intensive care unit and its impact on sound levels and patients

BACKGROUND

ICU outcomes are continuing to improve. However, this has not been matched by similar improvements of the ICU bedspace environment, which can detrimentally impact on patient outcomes. Excessive sound and noise, especially, has been linked with adverse and potentially preventable patient outcomes and staff errors. There are many sources of sound in the ICU, with alarms from bedside equipment frequently listed as a main source. The number of alarms is increasing in parallel with the introduction of new and more sophisticated technologies to monitor and support patients. However, most alarms are not accurate or critical and are commonly ignored by staff.

OBJECTIVE

The objective of this study was to evaluate the impact of a sound reduction bundle on sound levels, number of alarms, and patients' experience and perceived quality of sleep in the ICU.

METHODS

This was a pre-post, quasi-experimental study investigating the impact of three study interventions implemented sequentially (staff education, visual warnings when sound levels exceeded the preset levels, and monitor alarm reconfigurations). Effects of staff education were evaluated using pre-education and post-education questionnaires, and the impact on patients was evaluated via self-report questionnaires. A sound-level monitor was used to evaluate changes in sound levels between interventions. Alarm audits were completed before and after alarm reconfiguration.

RESULTS

Staff knowledge improved; however, sound levels did not change across interventions. The number of monthly monitor alarms reduced from 600,452 to 115,927. No significant differences were found in patients' subjective rating of their experience and sleep.

CONCLUSION

The interventions did not lead to a sound-level reduction; however, there was a large reduction in ICU monitor alarms without any alarm-related adverse events. As the sources of sound are diverse, multidimensional interventions, including staff education, alarm management solutions, and environmental redesign, are likely to be required to achieve a relevant, lasting, and significant sound reduction.

AF among Nurses Working in Neonatal and Paediatric Intensive Care Units: A Cross-Sectional Study

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.

Evaluation of a Clinical Decision Support Tool to Guide Adoption of the American Heart Association Telemetry Monitoring Practice Standards

BACKGROUND

The objectives of this study were to (1) evaluate telemetry use pre- and postimplementation of clinical decision support tools to support American Heart Association practice standards for telemetry monitoring and (2) understand the factors that may contribute to variation of telemetry monitoring in practice.

METHODS AND RESULTS

First, we captured overall variability in telemetry use pre- and postimplementation of the clinical decision support intervention. We then conducted semistructured interviews with telemetry-ordering providers to identify key barriers and facilitators to adoption. During the study period, 399 physicians met criteria for inclusion and were divided into excessive and nonexcessive orderers. Distribution of telemetry use was bimodal. Among nonexcessive users, 24.4% of patient days were with telemetry compared with 51.6% among excessive users. On average, both excessive (6.1% reduction) and nonexcessive users (2.8% reduction) decreased telemetry use postimplementation, and these reductions were sustained over a 16-month period. Sixteen interviews were conducted. Physicians believed that the tool was successful because it caused them to more closely consider if telemetry was indicated for each patient. Physicians also voiced frustration with interruptions to their workflow, and some noted that they commonly use telemetry outside of practice standards to monitor patients who were acutely but not critically ill.

CONCLUSIONS

Embedding telemetry practice standards into the electronic health record in the form of clinical decision support is effective at reducing excess telemetry use. Although the intervention was well received, there are persistent barriers, such as preexisting views on telemetry and existing workflow habits, that may inhibit higher adoption of standards.

Alarm fatigue and perceived stress among critical care nurses in the intensive care units: Palestinian perspectives

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.

Creating an Implementation Enhancement Plan for a Digital Patient Fall Prevention Platform Using the CFIR-ERIC Approach: A Qualitative Study

(1) Background: Inpatient falls are a major cause of hospital-acquired complications (HAC) and inpatient harm. Interventions to prevent falls exist, but it is unclear which are most effective and what implementation strategies best support their use. This study uses existing implementation theory to develop an implementation enhancement plan to improve the uptake of a digital fall prevention workflow. (2) Methods: A qualitative approach using focus groups/interview included 12 participants across four inpatient wards, from a newly built, 300-bed rural referral hospital. Interviews were coded to the Consolidated Framework for Implementation Research (CFIR) and then converted to barrier and enabler statements using consensus agreement. Barriers and enablers were mapped to the Expert Recommendations for Implementing Change (ERIC) tool to develop an implementation enhancement plan. (3) Results: The most prevalent CFIR enablers included: relative advantage (n = 12), access to knowledge and information (n = 11), leadership engagement (n = 9), patient needs and resources (n = 8), cosmopolitanism (n = 5), knowledge and beliefs about the intervention (n = 5), self-efficacy (n = 5) and formally appointed internal implementation leaders (n = 5). Commonly mentioned CFIR barriers included: access to knowledge and information (n = 11), available resources (n = 8), compatibility (n = 8), patient needs and resources (n = 8), design quality and packaging (n = 10), adaptability (n = 7) and executing (n = 7). After mapping the CFIR enablers and barriers to the ERIC tool, six clusters of interventions were revealed: train and educate stakeholders, utilize financial strategies, adapt and tailor to context, engage consumers, use evaluative and iterative strategies and develop stakeholder interrelations. (4) Conclusions: The enablers and barriers identified are similar to those described in the literature. Given there is close agreement between the ERIC consensus framework recommendations and the evidence, this approach will likely assist in enhancing the implementation of Rauland's Concentric Care fall prevention platform and other similar workflow technologies that have the potential to disrupt team and organisational routines. The results of this study will provide a blueprint to enhance implementation that will be tested for effectiveness at a later stage.