Healthc Inform Res.  2016 Jan;22(1):46-53. 10.4258/hir.2016.22.1.46.

Clinical Alarms in Intensive Care Units: Perceived Obstacles of Alarm Management and Alarm Fatigue in Nurses

Affiliations
  • 1Department of Nursing, Inha University, Incheon, Korea. khs0618@inha.ac.kr

Abstract


OBJECTIVES
The purpose of this descriptive study was to investigate the current situation of clinical alarms in intensive care unit (ICU), nurses' recognition of and fatigue in relation to clinical alarms, and obstacles in alarm management.
METHODS
Subjects were ICU nurses and devices from 48 critically ill patient cases. Data were collected through direct observation of alarm occurrence and questionnaires that were completed by the ICU nurses. The observation time unit was one hour block. One bed out of 56 ICU beds was randomly assigned to each observation time unit.
RESULTS
Overall 2,184 clinical alarms were counted for 48 hours of observation, and 45.5 clinical alarms occurred per hour per subject. Of these, 1,394 alarms (63.8%) were categorized as false alarms. The alarm fatigue score was 24.3 +/- 4.0 out of 35. The highest scoring item was "always get bothered due to clinical alarms". The highest scoring item in obstacles was "frequent false alarms, which lead to reduced attention or response to alarms".
CONCLUSIONS
Nurses reported that they felt some fatigue due to clinical alarms, and false alarms were also obstacles to proper management. An appropriate hospital policy should be developed to reduce false alarms and nurses' alarm fatigue.

Keyword

Critical Care; Nurse; Clinical Alarms; Fatigue; Recognition

MeSH Terms

Clinical Alarms*
Critical Care*
Critical Illness
Fatigue*
Humans
Intensive Care Units*

Reference

1. Borowski M, Gorges M, Fried R, Such O, Wrede C, Imhoff M. Medical device alarms. Biomed Tech (Berl). 2011; 56(2):73–83.
Article
2. ERCI Institute. Top 10 technology hazards for 2012: the risks that should be at the top of your prevention list. Health Devices. 2011; 40(11):358–373.
3. The Joint Commission. Sentinel event alert [Internet]. Washington (DC): The Joint Commission;2002. cited at 2015 Dec 17. Available from: http://www.jointcommission.org/assets/1/18/SEA_25.pdf.
4. US Food and Drug Administration. FDA patient safety news: alarms monitoring problems [Internet]. Silver Spring (MD): Food and Drug Administration;2011. cited at 2015 Dec 17. Available from: http://www.fda.gov/downloads/Safety/FDAPatientSafetyNews/UCM417915.pdf.
5. ERCI Institute. Hazard: Gorman-Rupp hypothermia machine. Health Devices. 1972; 1(8):190–191.
6. Bell L. Alarm fatigue linked to patient's death: interview by Laura Wallis. Am J Nurs. 2010; 110(7):16.
7. Christensen M, Dodds A, Sauer J, Watts N. Alarm setting for the critically ill patient: a descriptive pilot survey of nurses' perceptions of current practice in an Australian Regional Critical Care Unit. Intensive Crit Care Nurs. 2014; 30(4):204–210.
Article
8. Edworthy J, Hellier E. Alarms and human behaviour: implications for medical alarms. Br J Anaesth. 2006; 97(1):12–17.
Article
9. AACE Health Technology Foundation, Clinical Alarm Task Force. Impact of clinical alarms on patient safety: a report from the American College of Clinical Engineering Healthcare Technology Foundation. J Clin Eng. 2007; 32(1):22–33.
10. Momtahan K, Hetu R, Tansley B. Audibility and identification of auditory alarms in the operating room and intensive care unit. Ergonomics. 1993; 36(10):1159–1176.
Article
11. Association for the Advancement of Medical Instrumentation. Clinical Alarms 2011 Summit [Internet]. Arlington (VA): Association for the Advancement of Medical Instrumentation;2011. cited at 2015 Dec 17. Available from: http://s3.amazonaws.com/rdcms-aami/files/production/public/FileDownloads/Summits/2011_Alarms_Summit_publication.pdf.
12. Bell L. Monitor alarm fatigue. Am J Crit Care. 2010; 19(1):38.
Article
13. Cvach M. Monitor alarm fatigue: an integrative review. Biomed Instrum Technol. 2012; 46(4):268–277.
Article
14. Sendelbach S. Alarm fatigue. Nurs Clin North Am. 2012; 47(3):375–382.
Article
15. ERCI Institute. The hazards of alarm overload. Keeping excessive physiologic monitoring alarms from impeding care. Health Devices. 2007; 36(3):73–83.
16. Cvach MM, Biggs M, Rothwell KJ, Charles-Hudson C. Daily electrode change and effect on cardiac monitor alarms: an evidence-based practice approach. J Nurs Care Qual. 2013; 28(3):265–271.
17. Funk M, Clark JT, Bauld TJ, Ott JC, Coss P. Attitudes and practices related to clinical alarms. Am J Crit Care. 2014; 23(3):e9–e18.
Article
18. Purbaugh T. Alarm fatigue: a roadmap for mitigating the cacophony of beeps. Dimens Crit Care Nurs. 2014; 33(1):4–7.
19. Gazarian PK. Nurses' response to frequency and types of electrocardiography alarms in a non-critical care setting: a descriptive study. Int J Nurs Stud. 2014; 51(2):190–197.
Article
20. Inokuchi R, Sato H, Nanjo Y, Echigo M, Tanaka A, Ishii T, et al. The proportion of clinically relevant alarms decreases as patient clinical severity decreases in intensive care units: a pilot study. BMJ Open. 2013; 3(9):e003354.
Article
21. Baillargeon E. Alarm fatigue: a risk assessment [master's theses]. Providence (RI): Rhode Island College;2013.
22. Graham KC, Cvach M. Monitor alarm fatigue: standardizing use of physiological monitors and decreasing nuisance alarms. Am J Crit Care. 2010; 19(1):28–34.
Article
23. ACCE Healthcare Technology Foundation. Impact of clinical alarms on patient safety. Plymouth Meeting (PA): ACCE Healthcare Technology Foundation;2006.
24. Japanese Society for Occupational Health, Working Group for Occupational Fatigue. Subjective symptoms survey (Jikaku-sho Shirabe). Labor Sci. 2002; 57(5):295–298.
25. Kim SJ, Sung MS. Subjective symptoms on fatigue in hospital nurses. J Korean Acad Nurs. 1998; Dec. 28(4):908–919.
Article
26. Tsien CL, Fackler JC. Poor prognosis for existing monitors in the intensive care unit. Crit Care Med. 1997; 25(4):614–619.
Article
27. Chung CH, Kang HY. Job stress and fatigue of the nurses in the operating room. J Korea Contents Assoc. 2013; 13(12):291–298.
Article
28. Borycki E. Trends in health information technology safety: from technology-induced errors to current approaches for ensuring technology safety. Healthc Inform Res. 2013; 19(2):69–78.
Article
Full Text Links
  • HIR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr