Reaction time of a health care team to monitoring alarms in the intensive care unit: implications for the safety of seriously ill patients

Abstract

ObjectiveTo define the characteristics and measure the reaction time of a health care team monitoring alarms in the intensive care unit.MethodsA quantitative, observational, and descriptive study developed at the coronary care unit of a cardiology public hospital in Rio de Janeiro state (RJ). Data were obtained from the information collected on the patients, the monitoring used, and the measurement of the team's reaction time to the alarms of multi-parameter monitors during a non-participatory field observation.ResultsEighty-eight patients were followed (49 during the day shift and 39 during the night shift). During the 40 hours of observation (20 hours during the day shift and 20 hours during the night shift), the total number of monitoring alarms was 227, with 106 alarms during the day shift and 121 during the night shift, an average of 5.7 alarms/hour. In total, 145 alarms unanswered by the team were observed, with 68 occurring during the day shift (64.15%) and 77 during the night shift (63.64%). This study demonstrated that the reaction time was longer than 10 minutes in more than 60% of the alarms, which were considered as unanswered alarms. The median reaction time of the answered alarms was 4 minutes and 54 seconds during the day shift and 4 minutes and 55 seconds during the night shift. The respiration monitoring was activated in only nine patients (23.07%) during the night shift. Regarding the alarm quality of these variables, the arrhythmia alarm was qualified in only 10 (20.40%) of the day-shift patients and the respiration alarm in four night-shift patients (44.44%).ConclusionThe programming and configuration of the physiological variables monitored and the parameters of alarms in the intensive care unit were inadequate; there was a delay and lack of response to the alarms, suggesting that relevant alarms may have been ignored by the health care team, thus compromising the patient safety.

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

“…417,418 A delayed response to alarm signals or no response at all compromises patient safety. 419 Alarm response is affected by the rate of exposure to nonactionable alarms, perceived alarm urgency, and workload conditions. In an observational study using video, the response time of nurses to alarm signals in creased incrementally as the number of nonactionable alarms in the preceding 120 minutes increased.…”

Slips, lapses and mistakes inthe use of equipment by nurses in an intensive care unit

“…In 40 hours of observation, 227 alarms were triggered, of which 145 were not responded to by the team, in addition to observations of inadequate programming of physiological variables and alarm parameters. This may have implied that alarms were ignored and patient safety was compromised (4) . The present study identified human error as a cause of adverse events, and one of the risk factors involved in incorporating equipment as part of the care provided in the ICU, and hence a factor that requires attention when designing initiatives for patient safety.…”

“…One of the areas of interest of the program is safe use of equipment, given the variety of devices, manufacturers, technical specifications to operate each equipment, and the need for knowledge and attention to manage these aspects (1) . This concern is based on evidence from the literature on the occurrence of user errors in the handling of equipment, especially in the intensive care unit (ICU) environment (2)(3)(4)(5) , which has a large presence of such equipment. Equipmentrelated incidents, known as adverse events (1) , have caused harm to patients, as shown in studies on this subject.…”

Ritmos cardíacos à beira do leito: conhecimento da equipe de enfermagem de unidade cardiológica [Heart rhythms at the bedside: cardiology unit nursing team’s knowledge]

“…Original Research Artículo de Investigación tura, de modo acurado, dos equipamentos e tecnologias assistenciais nos serviços de saúde 4,5 . O aperfeiçoamento dos equipamentos tecnológicos é contínuo e dinâmico e requer, igualmente, que a qualificação dos profissionais evolua na mesma intensidade e abrangência.…”

“…Entretanto, a formação profissional na área de enfermagem em cardiologia vem se apresentando deficitária, principalmente para profissionais de nível médio (auxiliares e técnicos de enfermagem). Soma-se ainda a esta situação a falta de programas de educação continuada ofertada pelas instituições de saúde, tornando-se barreiras implícitas neste contexto e que podem interferir na qualidade dos cuidados desenvolvidos pela equipe de enfermagem 5,6 . Considerando o impacto epidemiológico das doenças cardiovasculares no Brasil e no mundo e a responsabilidade da equipe de enfermagem dos serviços cardiológicos pela observação contínua, percepção e comunicação de alterações do ritmo cardíaco ao monitor, surge a questão que norteou este trabalho: como é o conhecimento dos profissionais de enfermagem de uma unidade cardiológica sobre ritmos cardíacos de pacientes cardiopatas à beira do leito?…”