Safety Culture as a Patient Safety Practice for Alarm Fatigue

Winters, Bradford D.; Slota, Jennifer M; Bilimoria, Karl Y.

doi:10.1001/jama.2021.8316

Cited by 9 publications

(7 citation statements)

References 12 publications

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“…An extensive number of publications have also examined the impact of alert notifications on critical laboratory results. Although sometimes contradictory or pointing out the risk of alert fatigue potentially slowing the response to these alerts and harmful to the patient [ 43 , 44 , 45 ], they mostly show a significant reduction in time lag between laboratory result availability and decision making, a high degree of clinician approval, and a beneficial impact on patient care [ 25 , 46 , 47 , 48 , 49 ]. During 2018, there were an estimated 130 million ED visits in the USA.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a Mobile App in Reducing Therapeutic Turnaround Time and Facilitating Communication between Caregivers in a Pediatric Emergency Department: A Randomized Controlled Pilot Trial

Ehrler

Tuor

Trompier³

et al. 2022

JPM

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For maintaining collaboration and coordination among emergency department (ED) caregivers, it is essential to effectively share patient-centered information. Indirect activities on patients, such as searching for laboratory results and sharing information with scattered colleagues, waste resources to the detriment of patients and staff. Therefore, we conducted a pilot study to evaluate the initial efficacy of a mobile app to facilitate rapid mobile access to central laboratory results and remote interprofessional communication. A total of 10 ED residents and registered nurses were randomized regarding the use of the app versus conventional methods during semi-simulated scenarios in a pediatric ED (PED). The primary outcome was the elapsed time in minutes in each group from the availability of laboratory results to their consideration by participants. The secondary outcome was the elapsed time to find a colleague upon request. Time to consider laboratory results was significantly reduced from 23 min (IQR 10.5–49.0) to 1 min (IQR 0–5.0) with the use of the app compared to conventional methods (92.2% reduction in mean times, p = 0.0079). Time to find a colleague was reduced from 24 min to 1 min (i.e., 93.0% reduction). Dedicated mobile apps have the potential to improve information sharing and remote communication in emergency care.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of a Mobile App in Reducing Therapeutic Turnaround Time and Facilitating Communication between Caregivers in a Pediatric Emergency Department: A Randomized Controlled Pilot Trial

Ehrler

Tuor

Trompier³

et al. 2022

JPM

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“…We must also acknowledge that hypoxemia is a late indicator of respiratory depression, especially when the patient is on supplemental oxygen. This is true for conditions like sepsis, narcotic-induced respiratory depression, and congestive heart failure (15, 26). Alarms to detect hypoxia and respiratory depression using hypercapnia are triggered by different physiological changes and do not always coincide.…”

Section: Pulse Oximeters Have Accuracy Issues and Generate Too Many F...mentioning

confidence: 99%

“…Pulse oximeters are a major contributor to alarm fatigue. Although they are sensitive, they lack specificity and generate frequent false and nonactionable alarms (15). Sp o 2 is prone to motion artifacts and inaccuracies, necessitating multiple checks to confirm the signal’s quality, increasing clinical workload (16).…”

Section: Pulse Oximeters Have Accuracy Issues and Generate Too Many F...mentioning

confidence: 99%

Pulse Oximetry Con: Stop Living in the Cave

Winters

Sarwal

2023

Critical Care Medicine

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Pulse oximetry is a clinical monitoring tool that commonly serves as a biomarker for hypoxia. It is a simple, practical, noninvasive tool so deeply embedded in medicine that it is typically the first interaction a patient has with a monitoring technology. It is such an integral part of vital signs measurement in critical care that any argument questioning its efficacy or safety is ridiculed and treated as heresy. However, as described by Plato, we have been living in a cave where we are the prisoners of a false reality of the infallibility of this medical technology, like shadows cast upon the cave wall by firelight. The cave is all most of us know, and few are willing to venture out of the cave into the sunlight; the rest remaining inside considering the truth not worth seeking. Like any instrument we use in our critical care cave, pulse oximetry has become such a part of our daily existence that we may have neglected to see that both the tool itself, and our use of it may be fraught with fallacies and represent a "false reality. " As a profession, we need to venture out of the cave and reconsider the accuracy and value of pulse oximetry and respond appropriately.Pulse oximetry has several limitations. No perfect tool exists, and any tool is only as good as the operator's understanding of its perils and pitfalls in using it effectively. We describe the current state of science as it relates to the limitations of pulse oximetry, with the hope that this will become a trigger for igniting further research into improving its use.

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“…For early warnings and patient safety, multiple alarms are activated, including true, false, and non-actionable alarms. 1 According to previous studies, different medical devices in an emergency department could generate a total of 28 176 alarms during a 1-month period, and 469 alarms occurred per monitor per day. 2 The neonatal intensive care unit (NICU) reported an average of 10 alarms per hour and 603 alarms per infant.…”

Section: Introductionmentioning

confidence: 99%

“…Physiologic monitoring devices and other medical devices (e.g., infusion pumps) are used pervasively in intensive care units (ICUs). For early warnings and patient safety, multiple alarms are activated, including true, false, and non‐actionable alarms 1 . According to previous studies, different medical devices in an emergency department could generate a total of 28 176 alarms during a 1‐month period, and 469 alarms occurred per monitor per day 2 .…”

Section: Introductionmentioning

confidence: 99%

The relationship between alarm fatigue and burnout among critical care nurses: A cross‐sectional study

Ding

Huang

Sun

et al. 2023

Nursing in Critical Care

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BackgroundAlarm fatigue has significant negative impacts on nurses and patient safety. However, the relationship between alarm fatigue and burnout is still unclear.AimsThis study aimed to explore the relationship between alarm fatigue and burnout among critical care nurses.Study designA descriptive‐analytical cross‐sectional study design was used. Data were collected from five hospitals in mainland China between January 2022 and March 2022. A general information questionnaire, the Chinese version of the Intensive Care Unit Nurse Alarm Fatigue Questionnaire, and the Chinese version of the Maslach Burnout Inventory were used.ResultsA total of 236 critical care nurses were enrolled in this study. The mean score of alarm fatigue among critical care nurses was 21.11 ± 6.83. The results showed that critical care nurses experienced moderate alarm fatigue levels, and most nurses had moderate to high levels of burnout. The multiple linear regression analyses showed that alarm fatigue was independently associated with emotional exhaustion, depersonalization dimensions, and reduced personal accomplishment dimension.ConclusionsAlarm fatigue was associated with burnout among critical care nurses. Reducing critical care nurses' alarm fatigue may help to alleviate burnout.Relevance to clinical practiceManagers should provide comprehensive training for nurses and promote the application of artificial intelligence technology in alarm management to reduce alarm fatigue and improve burnout among critical care nurses.

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Safety Culture as a Patient Safety Practice for Alarm Fatigue

Abstract: This JAMA Performance Improvement article summarizes the AHRQ guideline on alarm fatigue in its health care safety series, including factors important to successfully implement approaches to reduce false alarms, total alarms, and noise levels.

Cited by 9 publications

References 12 publications

Effectiveness of a Mobile App in Reducing Therapeutic Turnaround Time and Facilitating Communication between Caregivers in a Pediatric Emergency Department: A Randomized Controlled Pilot Trial

Effectiveness of a Mobile App in Reducing Therapeutic Turnaround Time and Facilitating Communication between Caregivers in a Pediatric Emergency Department: A Randomized Controlled Pilot Trial

Pulse Oximetry Con: Stop Living in the Cave

The relationship between alarm fatigue and burnout among critical care nurses: A cross‐sectional study

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