Background
Alarm fatigue from frequent nonactionable physiologic monitor alarms
is frequently named as a threat to patient safety.
Purpose
To critically examine the available literature relevant to alarm
fatigue.
Data Sources
Articles published in English, Spanish, or French between January
1980 and April 2015 indexed in PubMed, CINAHL, Scopus, Cochrane Library,
Google Scholar, and ClinicalTrials.gov.
Study Selection
Articles focused on hospital physiologic monitor alarms addressing
any of the following: 1) the proportion of alarms that are actionable, 2)
the relationship between alarm exposure and nurse response time, and 3) the
effectiveness of interventions in reducing alarm frequency.
Data Extraction
We extracted data on setting, collection methods, proportion of
alarms determined to be actionable, nurse response time, and associations
between interventions and alarm rates.
Data Synthesis
Our search produced 24 observational studies focused on alarm
characteristics and response time and 8 studies evaluating interventions.
Actionable alarm proportion ranged from <1% to 36%
across a range of hospital settings. Two studies showed relationships
between high alarm exposure and longer nurse response time. Most
intervention studies included multiple components implemented
simultaneously. While studies varied widely, and many had high risk of bias,
promising but still unproven interventions include widening alarm
parameters, instituting alarm delays, and using disposable
electrocardiographic wires or frequently changed electrocardiographic
electrodes.
Conclusions
Physiologic monitor alarms are commonly nonactionable, and evidence
supporting the concept of alarm fatigue is emerging. Several interventions
have the potential to reduce alarms safely, but more rigorously designed
studies with attention to possible unintended consequences are needed.
Pain went untreated on a modest number of days, and many patients relied on relatively ineffective single analgesics. Other patients and families appropriately used potent analgesic combinations in a time-contingent and intensity-dependent pattern. This study suggests that recurrent acute pain from SCD can be successfully managed at home with appropriate training and supervision, and suggests several areas for intervention to improve patient outcomes.
Cognitive and academic deficits have been identified in school-aged children with sickle cell disease (SCD). However, there have been very few identified studies that examine neuropsychological functioning in preschool-age children with SCD. It is important to understand effects of SCD from a developmental perspective and to consider the contribution of environmental factors in this at-risk population. Neuropsychological functioning of preschool-age children with SCD and no history of overt stroke (n = 26) was examined across several domains (language, immediate memory/brief attention, visuospatial/visuoconstructional, motor/visuomotor). The mean Full Scale IQ for the sample was 89.0. Performance on the Immediate Memory/ Brief Attention domain was significantly higher than the other domains, although the pattern of performance was relatively consistent, with mean standard scores ranging from 88.0 to 95.0. Disease severity was not significantly related to cognitive functioning in this group of young children with SCD. Socioeconomic status (SES) was significantly correlated with most domain scores and, based on regression analyses, accounted for 18% to 47% of the variance in functioning. Psychosocial factors, such as number of children living in the home and parental stress levels, were negatively associated with Motor/Visuomotor skills, and weekly hours in school/day care was positively associated with language-related skills. Results suggest that, at this young age, psychosocial risk factors appear to be appropriate targets for intervention, with the goal of improving long-term outcome in children with SCD. Further investigations should include comparison to a matched control group.
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