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Evaluation of Clinical Alarms and Alarm Management in Intensive Care Units

중환자실에서 사용되는 의료장비의 경보음 발생과 관리 현황

  • Jeong, Yu Jin (Hallym University Chuncheon Sacred Heart Hospital) ;
  • Kim, Hyunjung (Division of Nursing.Research Institute of Nursing Science, Hallym University)
  • 정유진 (한림대학교 춘천성심병원) ;
  • 김현정 (한림대학교 간호학부.간호학연구소)
  • Received : 2018.09.14
  • Accepted : 2018.11.13
  • Published : 2018.11.30

Abstract

Purpose: This study aimed to investigate the clinical alarm occurrence and management of nurses toward clinical alarms in the intensive care unit (ICU). Methods: This observational study was conducted with 40 patients and nurses cases in two ICUs of a university hospital. This study divided 24 hours into the unit of an hour and conducted two times of direct observation per unit hour for 48 hours targeting the medical devices applied to 40 patients. Data were analyzed using IBM SPSS Statistics 23. Results: On average, 3.8 units of medical devices were applied for each patient and the ranges of alarm settings were wide. During 48 hours, 184 cases of clinical alarm were occurred by four types of medical devices including physiological monitors, mechanical ventilators, infusion pumps, and continuous renal replacement therapy. Among them, false alarm was 110 cases (59.8%). As for the alarm management by ICU nurses, two-minute alarm mute took up most at 38.0% (70 cases), and no response was second most at 32.6% (60 cases). When valid alarm sounded, nurses showed no response at 43.2%. Conclusion: The findings suggest that a standard protocol for alarm management should be developed for Korean ICU settings. Based on the protocol, continuous training and education should be provided to nurses for appropriate alarm management.

Keywords

References

  1. Pam C, Mary Z, Allen E, Samantha J, Lynn R, Marilyn NF. Improving clinical alarm management: Guidance and strategies. Biomedical Instrumentation & Technology. 2017;51(2) 109-115. https://doi.org/10.2345/0899-8205-51.2.109
  2. Solet JM, Barach PR. Managing alarm fatigue in cardiac care. Progress in Pediatric Cardiology. 2012;33(1):85-90. https://doi.org/10.1016/j.ppedcard.2011.12.014
  3. Top ten health technology hazards for 2015 [Internet]. Plymouth Meeting (PA): Emergency Care Research Institute; 2014 [cited 2017 May 1]. Available from: https://www.ecri.org/Documents/White_papers/Top_10_2015.pdf
  4. Medical device alarm safety in hospitals. Sentinel Event Alert [Internet]. Oakbrook Terrace (IL): The Joint Commission; 2013 [cited 2017 Apr 15]. Available from: http://www.jointcommission.org/assets/1/6/SEA_50_alarms_4_26_16.pdf
  5. Clinical alarms. A siren call to action: Priority issues from the medical device alarms summit [Internet]. Arlington (VA): Association for the Advancement of Medical Instrumentation; 2011 [cited 2017 Apr 20]. Available from: http://kami.camp9.org/Resource/Pictures/2011%20Alarms%20Summit%20Report.pdf
  6. Borowski M, Gorges M, Fried R, Such O, Wrede C, Imhoff M. Medical device alarms. Biomedical Engineering/ Biomedizinische Technik. 2011;56(2):73-83. https://doi.org/10.1515/bmt.2011.005
  7. Honan L, Funk M, Maynard M, Fahs D, Clark JT, David Y. Nurses' perspectives on clinical alarms. American Journal of Critical Care. 2015;24(5):387-395. https://doi.org/10.4037/ajcc2015552
  8. Hyman W. Clinical alarm effectiveness and alarm fatigue. Revista de Pesquisa: Cuidado e Fundamental Online. 2012;4(1).
  9. Funk M, Clark JT, Bauld TJ, Ott JC, Coss P. Attitudes and practices relate to clinical alarms. American Journal of Critical Care. 2014;23(3):9-18. http://dx.doi.org/10.4037/ajcc2014315
  10. Graham K, Cvach M. Monitor alarm fatigue: Standardizing use of physiological monitors and decreasing nuisance alarms. American Journal of Critical Care. 2010;19(1):28-34. http://dx.doi.org/10.4037/ajcc2010651
  11. Cho OM. Fatigue of nurse, perceptions, and interfering factors of alarm management on clinical alarms in intensive care unit [master's thesis]. Incheon: Inha University; 2015. p. 76.
  12. Park MY. Alarm perception of nurse, alarm hazards on clinical alarms in intensive care units [master's thesis]. Daejeon: Chungnam National University; 2016. p. 56.
  13. Han SY. Influencing factors on performance of clinical alarm management in intensive care unit nurses [master's thesis]. Daejeon: Chungnam National University; 2016. p. 76.
  14. Impact of clinical alarms on patient safety [Internet]. Plymouth Meeting (PA): Healthcare Technology Foundation; 2006 [cited 2017 May 10]. Available from: http://thehtf.org/white%20paper.pdf
  15. Emergency Care Research Institute. The harzard of alarm overload: Keeping excessive physiologic monitoring alarms from impeding care. Health Devices. 2007;36(3):73-83.
  16. Baillargeon E. Alarm fatigue: A risk assessment. [master's thesis]. Rhode Island: Rhode Island College; 2013. p. 43.
  17. Gazarian PK. Nurses' response to frequency and type of electrocardiography alarms in a non-critical care setting: A descriptive study. International Journal of Nursing Studies. 2014;51(2):190-197. https://doi.org/10.1016/j.ijnurstu.2013.05.014
  18. Berglund B, Lindvall T, Schwela DH. Guidelines for community noise. [Internet]. Geneva: World Health Organization; 1999 [cited 2017 Nov 24]. Available from: http://apps.who.int/iris/handle/10665/66217
  19. Chalotta E. Goran P. Biological mechanisms related to cardiovascular and metabolic effect by environmental noise [Internet]. Copenhagen: World Health Organization Regional Office for Europe; 2018 [cited 2017 Oct 5]. Available from: http://www.euro.who.int/__data/assets/pdf_file/0004/378076/review-noise-bio-effects-eng.pdf
  20. American Association of Critical-Care Nurses. Alarm management. Critical Care Nurse. 2013;33(5):83-86. https://doi.org/10.4037/ccn2013783
  21. Cvach MM. Monitor alarm fatigue: An integrative review. Biomedical Instrumentation & Technology, 2012;46(4):268-277. https://doi.org/10.2345/0899-8205-46.4.268
  22. Healthcare Technology Foundation. 2011 National Clinical Alarms Survey: Perception, Issues, Improvements, and Prioirities of Healthcare Professionals [Internet]. Plymouth Meeting (PA): Healthcare Technology Foundation; 2011 [cited 2017 Dec 3]. Available from: http://thehtf.org/documents/2011_HTFAlarmsSurveyOveralPesults.pdf
  23. Piepenbrink J. Taking alarm standardization to the floors with a telemetry training system. Biomedical Instrumentation Technology. 2011;45(Suppl 1):24-28. https://doi.org/10.2345/0899-8205-45.s1.24