Nurse Competence on Physiologic Monitors Use: Toward Eliminating Alarm Fatigue in Intensive Care Units

Abstract

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.

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

“…Nurses are the primary users and maintainers of monitors (Ruppel et al., 2019); thus, their alarm management behaviour is key in determining the occurrence of nonactionable alarms and alarm fatigue. 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).…”

Nurses’ use of monitors in patient surveillance: an ethnographic study on a coronary care unit

“…5,8,[13][14][15] A recent study demonstrated a lack of nurse competence on physiological monitor use, emphasising the need for further monitor education and training for nurses. 16 Additional knowledge and understanding of how nurses use monitors and how nuisance alarms can be decreased to enhance patient safety and quality of care is needed. With these considerations, the aim of this study was to explore both how nurses use monitors in patient surveillance within coronary care and the impact that monitors have on nurses' work.…”

The Effect of Alarm Fatigue Nursing Management Protocol on Critical Care Nurses' Experience

“…Nearby 566 records of patient dooms related to screening apparatus alarms during 2005-2008 obtained through the FDA Administration. In additional definite pattern, the FDA 2010 received more than 2500 adverse incident determination connected with mechanical ventilator utilize, wherein one third of the episodes indicated an alarm fatigue linked topics (Bach, Berglund, & Turk, 2018, Sowan et al, 2017. This information is recommended to be an underestimation of an overlooked patient safety issue.…”