Challenges of customizing electrocardiography alarms in intensive care units: A mixed methods study

Ruppel, Halley; Funk, Marjorie; Kennedy, Holly Powell; Bonafide, Christopher P.; Wung, Shu Fen; Whittemore, Robin

doi:10.1016/j.hrtlng.2018.06.010

Cited by 15 publications

(8 citation statements)

References 25 publications

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“…Individualizing alarm thresholds for example is an important first step 29 . Although this suggestion might seem trivial, there is a significant number of staff members that adhere to the default thresholds of the monitoring devices and do not adjust the thresholds according to an individual patient’s need 30 , 31 . This might be either due to lack of time/will or of know-how.…”

Section: Discussionmentioning

confidence: 99%

The influence of patient characteristics on the alarm rate in intensive care units: a retrospective cohort study

Sinno

Shay

Kruppa

et al. 2022

Sci Rep

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Intensive care units (ICU) are often overflooded with alarms from monitoring devices which constitutes a hazard to both staff and patients. To date, the suggested solutions to excessive monitoring alarms have remained on a research level. We aimed to identify patient characteristics that affect the ICU alarm rate with the goal of proposing a straightforward solution that can easily be implemented in ICUs. Alarm logs from eight adult ICUs of a tertiary care university-hospital in Berlin, Germany were retrospectively collected between September 2019 and March 2021. Adult patients admitted to the ICU with at least 24 h of continuous alarm logs were included in the study. The sum of alarms per patient per day was calculated. The median was 119. A total of 26,890 observations from 3205 patients were included. 23 variables were extracted from patients' electronic health records (EHR) and a multivariable logistic regression was performed to evaluate the association of patient characteristics and alarm rates. Invasive blood pressure monitoring (adjusted odds ratio (aOR) 4.68, 95%CI 4.15–5.29, p < 0.001), invasive mechanical ventilation (aOR 1.24, 95%CI 1.16–1.32, p < 0.001), heart failure (aOR 1.26, 95%CI 1.19–1.35, p < 0.001), chronic renal failure (aOR 1.18, 95%CI 1.10–1.27, p < 0.001), hypertension (aOR 1.19, 95%CI 1.13–1.26, p < 0.001), high RASS (aOR 1.22, 95%CI 1.18–1.25, p < 0.001) and scheduled surgical admission (aOR 1.22, 95%CI 1.13–1.32, p < 0.001) were significantly associated with a high alarm rate. Our study suggests that patient-specific alarm management should be integrated in the clinical routine of ICUs. To reduce the overall alarm load, particular attention regarding alarm management should be paid to patients with invasive blood pressure monitoring, invasive mechanical ventilation, heart failure, chronic renal failure, hypertension, high RASS or scheduled surgical admission since they are more likely to have a high contribution to noise pollution, alarm fatigue and hence compromised patient safety in ICUs.

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Section: Discussionmentioning

confidence: 99%

The influence of patient characteristics on the alarm rate in intensive care units: a retrospective cohort study

Sinno

Shay

Kruppa

et al. 2022

Sci Rep

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“…According to a previous study, 3%–40% of healthcare workers indicated they had never used many of the monitoring functions of a monitor (Sowan et al., 2017). In recent years, the Emergency Care Research Institute reported 216 deaths resulting from improper alarm management (Keller, 2012), and they listed alarm‐related issues as the most important factors affecting the safety of patients in consecutive years (Cvach, 2012; Ruppel, Funk, Clark, et al, 2018; Ruppel, Funk, Kennedy, et al, 2018). The adverse events reported by The Joint Commission that were caused by improper alarm management included 80 deaths, 13 permanent functional impairments and five cases of prolonged hospital stay (Commission, 2015).…”

Section: Introductionmentioning

confidence: 99%

Effects of monitor alarm management training on nurses’ alarm fatigue: A randomised controlled trial

Yin

et al. 2020

Journal of Clinical Nursing

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Background: Chaotic monitor alarm management generates a large number of alarms, which result in alarm fatigue. Intensive care unit (ICU) nurses are caretakers of critically ill patients, the effect of alarm management affect patient safety directly. Objectives: To evaluate the effect of monitor alarm management training based on the theory of planned behaviour for reducing alarm fatigue in intensive care unit nurses. Design: A randomised, single-blind trial. This article follows the requirements of CONSORT statement. Participants: The study was conducted from February 2019-May 2019 in a tertiary A-level hospital. 93 ICU clinical nurses were included, and they were randomly assigned into two groups.

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“…How to customize safely is still a challenge in the postoperative period. 28 A recommendation guide on how to customize alarms was used to increase safety and avoid wider alarm limit ranges that could miss a clinically significant change in the patient's HR. 28 Wider alarm limit ranges create the potential for a clinically significant change in the patient's HR to be missed.…”

Section: Discussionmentioning

confidence: 99%

Decreasing inconsistent alarms notifications: a pragmatic clinical trial in a post-anesthesia care unit

Silveira,

Nersessian,

Abib

et al. 2024

Brazilian Journal of Anesthesiology (English Edition)

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Challenges of customizing electrocardiography alarms in intensive care units: A mixed methods study

Abstract: Alarm customization is nuanced and requires adequate support to develop safe and effective practices. The challenges identified can inform development of strategies to improve alarm customization.

Cited by 15 publications

References 25 publications

The influence of patient characteristics on the alarm rate in intensive care units: a retrospective cohort study

The influence of patient characteristics on the alarm rate in intensive care units: a retrospective cohort study

Effects of monitor alarm management training on nurses’ alarm fatigue: A randomised controlled trial

Decreasing inconsistent alarms notifications: a pragmatic clinical trial in a post-anesthesia care unit

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