BackgroundIntensive care units (ICUs) are complex work environments where false alarms occur more frequently than on non-critical care units. The Joint Commission National Patient Safety Goal .06.01.01 targeted improving the safety of clinical alarm systems and required health care facilities to establish alarm systems safety as a hospital priority by July 2014. An important initial step toward this requirement is identifying ICU nurses’ perceptions and common clinical practices toward clinical alarms, where little information is available.ObjectiveOur aim was to determine perceptions and practices of transplant/cardiac ICU (TCICU) nurses toward clinical alarms and benchmark the results against the 2011 Healthcare Technology Foundation’s (HTF) Clinical Alarms Committee Survey.MethodsA quality improvement project was conducted on a 20-bed TCICU with 39 full- and part-time nurses. Nurses were surveyed about their perceptions and attitudes toward and practices on clinical alarms using an adapted HTF clinical alarms survey. Results were compared to the 2011 HTF data. Correlations among variables were examined.ResultsAll TCICU nurses provided usable responses (N=39, 100%). Almost all nurses (95%-98%) believed that false alarms are frequent, disrupt care, and reduce trust in alarm systems, causing nurses to inappropriately disable them. Unlike the 2011 HTF clinical alarms survey results, a significantly higher percentage of our TCICU nurses believed that existing devices are complex, questioned the ability and adequacy of the new monitoring systems to solve alarm management issues, pointed to the lack of prompt response to alarms, and indicated the lack of clinical policy on alarm management (P<.01). Major themes in the narrative data focused on nurses’ frustration related to the excessive number of alarms and poor usability of the cardiac monitors. A lack of standardized approaches exists in changing patients’ electrodes and individualizing parameters. Around 60% of nurses indicated they received insufficient training on bedside and central cardiac monitors. A correlation also showed the need for training on cardiac monitors, specifically for older nurses (P=.01).ConclusionsFalse and non-actionable alarms continue to desensitize TCICU nurses, perhaps resulting in missing fatal alarms. Nurses’ attitudes and practices related to clinical alarms are key elements for designing contextually sensitive quality initiatives to fight alarm fatigue. Alarm management in ICUs is a multidimensional complex process involving usability of monitoring devices, and unit, clinicians, training, and policy-related factors. This indicates the need for a multi-method approach to decrease alarm fatigue and improve alarm systems safety.

BackgroundClinical alarm systems safety is a national concern, specifically in intensive care units (ICUs) where alarm rates are known to be the highest. Interventional projects that examined the effect of changing default alarm settings on overall alarm rate and on clinicians’ attitudes and practices toward clinical alarms and alarm fatigue are scarce.ObjectiveTo examine if (1) a change in default alarm settings of the cardiac monitors and (2) in-service nursing education on cardiac monitor use in an ICU would result in reducing alarm rate and in improving nurses’ attitudes and practices toward clinical alarms.MethodsThis quality improvement project took place in a 20-bed transplant/cardiac ICU with a total of 39 nurses. We implemented a unit-wide change of default alarm settings involving 17 parameters of the cardiac monitors. All nurses received an in-service education on monitor use. Alarm data were collected from the audit log of the cardiac monitors 10 weeks before and 10 weeks after the change in monitors’ parameters. Nurses’ attitudes and practices toward clinical alarms were measured using the Healthcare Technology Foundation National Clinical Alarms Survey, pre- and postintervention.ResultsAlarm rate was 87.86 alarms/patient day (a total of 64,500 alarms) at the preintervention period compared to 59.18 alarms/patient day (49,319 alarms) postintervention (P=.01). At baseline, Arterial Blood Pressure (ABP), Pair Premature Ventricular Contractions (PVCs), and Peripheral Capillary Oxygen Saturation (SpO2) alarms were the highest. ABP and SpO2 alarms remained among the top three at the postproject period. Out of the 39 ICU nurses, 24 (62%) provided complete pre- and postproject survey questionnaires. Compared to the preintervention survey, no remarkable changes in the postproject period were reported in nurses’ attitudes. Themes in the narrative data were related to poor usability of cardiac monitors and the frequent alarms. The data showed great variation among nurses in terms of changing alarm parameters and frequency of replacing patients' electrodes. Despite the in-service, 50% (12/24) of the nurses specified their need for more training on cardiac monitors in the postproject period.ConclusionsChanging default alarm settings and standard in-service education on cardiac monitor use are insufficient to improve alarm systems safety. Alarm management in ICUs is very complex, involving alarm management practices by clinicians, availability of unit policies and procedures, unit layout, complexity and usability of monitoring devices, and adequacy of training on system use. The complexity of the newer monitoring systems requires urgent usability testing and multidimensional interventions to improve alarm systems safety and to attain the Joint Commission National Patient Safety Goal on alarm systems safety in critical care units.

Background:Studies on nurse competence on alarm management are a few and tend to be focused on limited skills. In response to Phase II of implementing the National Patient Safety Goal on clinical alarm systems safety, this study assessed nurses’ perceived competence on physiologic monitors use in intensive care units (ICUs) and developed and validated a tool for this purpose.Methods:This descriptive study took place in a Magnet hospital in a Southwestern state of the U.S. A Nurse Competence on Philips Physiologic Monitors Use Survey was created and went through validation by 13 expert ICU nurses. The survey included 5 subscales with 59 rated items and two open-ended questions. Items on the first 4 subscales reflect most common tasks nurses perform using physiologic monitors. Items on the fifth subscale (advanced functions) reflect rarely used skills and were included to understand the scope of utilizing advanced physiologic monitors’ features. Thirty nurses from 4 adult ICUs were invited to respond to the survey.Results:Thirty nurses (100%) responded to the survey. The majority of nurses were from Neuro (47%) and Surgical Trauma (37%) ICUs. The data supported the high reliability and construct validity of the survey. At least one (3%) to 8 nurses (27%) reported lack of confidence on each item on the survey. On the first four subscales, 3% - 40% of the nurses reported they had never heard of or used 27 features/functions on the monitors. No relationships were found between subscales’ scores and demographic characteristics (p > .05). Nurses asked for training on navigating the central-station monitor and troubleshooting alarms, and the use of unit-specific super users to tailor training to users’ needs.Conclusion:This is the first study to create and test a list of competencies for physiologic monitors use. Rigorous, periodic and individualized training is essential for safe and appropriate use of physiologic monitors and to decrease alarm fatigue. Training should be comprehensive to include all necessary skills and should not assume proficiency on basic skills. Special attention should be focused on managing technical alarms. Increasing the number of super users is a recommended strategy for individualized and unit-specific training. There is a need for a usability testing of complex IT-equipped medical devices, such as physiologic monitors, for effective, efficient and safe navigation of the monitors.

Background The integration of clinical practice guidelines (CPGs) into the nursing care plan and documentation systems aims to translate evidence into practice, improve safety and quality of care, and standardize care processes. Objective This study aimed to evaluate nurses’ perceptions of the usability of a nursing care plan solution that includes 234 CPGs. Methods A total of 100 nurses from 4 adult intensive care units (ICUs) responded to a survey measuring nurses’ perceptions of system usability. The survey included 37 rated items and 3 open-ended questions. Results Nurses’ perceptions were favorable with more than 60.0% (60/100) in agreement on 12 features of the system and negative to moderate with 20.0% (20/100), to 59.0% (59/100) in agreement on 19 features. The majority of the nurses (80/100, 80.0% to 90/100, 90.0%) agreed on 4 missing safety features within the system. More than half of the nurses believed they would benefit from refresher classes on system use. Overall satisfaction with the system was just above average (54/100, 54.0%). Common positive themes from the narrative data were related to the system serving as a reminder for complete documentation and individualizing patient care. Common negative aspects were related to duplicate charting, difficulty locating CPGs, missing unit-specific CPGs, irrelevancy of information, and lack of perceived system value on patient outcomes. No relationship was found between years of system use or ICU experience and satisfaction with the system ( P =.10 to P =.25). Conclusions Care plan systems in ICUs should be easy to navigate; support efficient documentation; present relevant, unit-specific, and easy-to-find information; endorse interdisciplinary communication; and improve safety and quality of care.

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