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Journal of Clinical Nursing Jul 2023Alarm fatigue is becoming more widely acknowledged as a serious safety concern in modern clinical practice. Nurses are not always proficient in the alarms' functions and... (Review)
Review
BACKGROUND
Alarm fatigue is becoming more widely acknowledged as a serious safety concern in modern clinical practice. Nurses are not always proficient in the alarms' functions and capabilities, and they do not undertake training regularly. Educating nurses on alarms maintains their knowledge and abilities in complex clinical settings. Some education has been undertaken to improve clinical alarm response, but the evidence for evaluating the effectiveness of nurse education interventions is limited.
OBJECTIVE
To evaluate the effects of educational interventions for reducing alarm fatigue in nurses, including the reduction of excessive, false and non-actionable alarms, which are major factors causing alarm fatigue in nurses.
DATA SOURCES
PUBMED, EMBASE, CINAHL, SCOPUS and OVID databases were systematically searched from 2016 to 2021.
DESIGN
Integrative Review.
REVIEW METHODS
An integrative review of literature was performed using the PRISMA checklist. Critical appraisal was done using Joanna Briggs Institute level of evidence.
RESULTS
Thirteen studies met the inclusion criteria. The results of most studies showed that educational intervention was beneficial for reducing the total number of alarms and false alarms. Furthermore, nurses' perceptions and knowledge improved, but the reduction in nurses' alarm fatigue is uncertain. A positive effect in alarm management practices was identified after the educational intervention.
CONCLUSION
Educational intervention may be the way to manage nurses' alarm fatigue. The use of medical devices in hospitals is increasing exponentially, and for this reason, alarms are inevitable. The introduction of effective and continuous education and training programs for nurses concerning clinical alarm management as well as raising nurses' awareness of the occurrence of alarm fatigue is vital.
Topics: Humans; Clinical Alarms; Education, Continuing; Nurses; Monitoring, Physiologic
PubMed: 35968774
DOI: 10.1111/jocn.16479 -
Journal of Hospital Medicine Feb 2016Alarm fatigue from frequent nonactionable physiologic monitor alarms is frequently named as a threat to patient safety. (Review)
Review
BACKGROUND
Alarm fatigue from frequent nonactionable physiologic monitor alarms is frequently named as a threat to patient safety.
PURPOSE
To critically examine the available literature relevant to alarm fatigue.
DATA SOURCES
Articles published in English, Spanish, or French between January 1980 and April 2015 indexed in PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Cochrane Library, Google Scholar, and ClinicalTrials.gov.
STUDY SELECTION
Articles focused on hospital physiologic monitor alarms addressing any of the following: (1) the proportion of alarms that are actionable, (2) the relationship between alarm exposure and nurse response time, and (3) the effectiveness of interventions in reducing alarm frequency.
DATA EXTRACTION
We extracted data on setting, collection methods, proportion of alarms determined to be actionable, nurse response time, and associations between interventions and alarm rates.
DATA SYNTHESIS
Our search produced 24 observational studies focused on alarm characteristics and response time and 8 studies evaluating interventions. Actionable alarm proportion ranged from <1% to 36% across a range of hospital settings. Two studies showed relationships between high alarm exposure and longer nurse response time. Most intervention studies included multiple components implemented simultaneously. Although studies varied widely, and many had high risk of bias, promising but still unproven interventions include widening alarm parameters, instituting alarm delays, and using disposable electrocardiographic wires or frequently changed electrocardiographic electrodes.
CONCLUSIONS
Physiologic monitor alarms are commonly nonactionable, and evidence supporting the concept of alarm fatigue is emerging. Several interventions have the potential to reduce alarms safely, but more rigorously designed studies with attention to possible unintended consequences are needed.
Topics: Clinical Alarms; Electrocardiography; Hospitals; Humans; Monitoring, Physiologic; Nursing Staff, Hospital; Patient Safety; Time Factors
PubMed: 26663904
DOI: 10.1002/jhm.2520 -
Journal of Clinical Nursing Sep 2017To identify the effectiveness of education interventions provided for nurses for clinical alarm response and management. (Review)
Review
AIMS AND OBJECTIVES
To identify the effectiveness of education interventions provided for nurses for clinical alarm response and management.
BACKGROUND
Some education has been undertaken to improve clinical alarm response, but the evidence for evaluating effectiveness for nurse education interventions is limited.
DESIGN
Systematic review.
METHODS
A systematic review of experimental studies published in English from 2005-2015 was conducted in four computerised databases (MEDLINE, EMBASE, CINAHL and Scopus). After identification, screening and appraisal using Joanna Briggs Institute instruments, quality research papers were selected, data extraction and analysis followed.
RESULTS
Five studies met the inclusion criteria for alarm response and no articles were concerned with clinical alarm education for management. All had different types and methods of interventions and statistical pooling was not possible. Response accuracy, response time and perceptions were consistent when different interventions were adopted. A positive effect was identified when learning about general alarms, single alarms, sequential alarms and medium-level alarms for learning as the primary task. Nurses who were musically trained had a faster and more accurate alarm response. Simulation interventions had a positive effect, but the effect of education provided in the care unit was greater. Overall, clinical alarm awareness was improved through education activities.
CONCLUSIONS
Nurses are the main users of healthcare alarms and work in complex environments with high numbers of alarms, including nuisance alarms and other factors. Alarm-related adverse events are common. The findings of a small number of experimental studies with diverse evidence included consideration of various factors when formulating education strategies. The factors which influence effectiveness of nurse education are nurse demographics, nurse participants with musical training, workload and characteristics of alarms. Education interventions based in clinical practice settings increase education effectiveness, although simulation can be effective. No study shows any type of intervention results in sustained improvement.
RELEVANCE TO CLINICAL PRACTICE
There are workload implications in education and the matching of load, number and type of alarms with nurse demographics which should be evaluated. There also needs to be a connection between education and the clinical setting to contribute to clinical alarm awareness for undergraduate nurses and practicing nurses. Education solely supported by employers is insufficient. Patient safety and long-term effects must be further explored.
Topics: Clinical Alarms; Humans; Monitoring, Physiologic; Nursing Staff, Hospital; Patient Safety; Time Factors
PubMed: 27685951
DOI: 10.1111/jocn.13605 -
International Journal of Nursing Studies May 2021Mobilisation alarms are a falls prevention strategy used in hospitals to alert staff when an at risk patient is attempting to mobilise. Mobilisation alarms have an...
Mobilisation alarm triggers, response times and utilisation before and after the introduction of policy for alarm reduction or elimination: A descriptive and comparative analysis.
BACKGROUND
Mobilisation alarms are a falls prevention strategy used in hospitals to alert staff when an at risk patient is attempting to mobilise. Mobilisation alarms have an estimated annual cost of $AUD58MIL in Australia. There is growing evidence from randomised controlled trials indicating mobilisation alarms are unlikely to prevent falls.
AIM
The primary aim of this study was to describe the rate of mobilisation alarm false triggers and staff response time across different health services. The secondary aim was to compare pre to post mobilisation alarm utilisation following the introduction of policy to reduce or eliminate mobilisation alarms.
METHODS
This descriptive and comparative study was conducted through Monash Partners Falls Alliance across six health services in Melbourne, Australia. This study described true and false alarm triggers and trigger response times across three health services and usual care mobilisation alarm utilisation across six health services; and then compared alarm utilisation across two health services following the introduction of policy to reduce (<2.5%) or eliminate (0.0%) mobilisation alarms in the acute and rehabilitation settings.
RESULTS
The most frequent observation was a false alarm (n = 74, 52%), followed by a true alarm (n = 67, 47%) and no alarm (n = 3, 2%). Time to respond to the true and false alarms was an average of 37 seconds (SD 92) and this included 61 occasions of 0 seconds as a member of staff was present when the alarm triggered. If the 61 occasions of staff being present when the alarm triggered were removed, the average time to respond was 65 seconds (SD114). Usual care mobilisation alarm utilisation in acute was 7% (n = 171/2,338) and in rehabilitation was 11% (n = 286/2,623). Introducing policy for reduced and eliminated mobilisation alarm conditions was successful with a reduced utilisation rate of 1.8% (n = 11/609) and an eliminated utilisation rate of 0.0% (n = 0/521).
CONCLUSION
Half of mobilisation alarm triggers are false and when alarms trigger without staff present, staff take about a minute to respond. While usual care has one in fourteen patients in acute and one in nine patients in rehabilitation using a mobilisation alarm, it is possible to introduce policy which will change practice to reduce or eliminate the use of mobilisation alarms, providing evidence of feasibility for future disinvestment effectiveness studies that it is feasible to disinvest in the alarms.
Topics: Australia; Clinical Alarms; Humans; Monitoring, Physiologic; Policy; Reaction Time
PubMed: 33647843
DOI: 10.1016/j.ijnurstu.2020.103769 -
Journal of Animal Science and Technology Nov 2022Horse breeders suffer massive economic losses due to dystocia, abortion, and stillbirths. In Thoroughbred mares, breeders often miss the foaling process because...
Horse breeders suffer massive economic losses due to dystocia, abortion, and stillbirths. In Thoroughbred mares, breeders often miss the foaling process because approximately 86% of the foaling events occur from 19:00 to 7:00; consequently, breeders cannot assist mares experiencing dystocia. To solve this problem, various foaling alarm systems have been developed. However, there is a need to develop a new system to overcome the shortcomings of the existing devices and improve their accuracy. To this end, the present study aimed to (1) develop a novel foaling alarm system and (2) compare its accuracy with that of the existing Foalert™ system. Specifically, eighteen Thoroughbred mares (11.9 ± 4.0 years old) were included. An accelerometer was used to analyze specific foaling behaviors. Behavioral data were transmitted to a data server every second. Depending on the acceleration value, behaviors were automatically classified by the server as categorized behaviors 1 (behaviors without change in body rotation), 2 (behaviors with sudden change in body rotation, such as rolling over), and 3 (behaviors with long-term change in body rotation, such as lying down laterally). The system was designed to alarm when the duration of categorized behaviors 2 and 3 was 12.9% and that of categorized behavior 3 was 1% during 10 min. The system measured the duration of each categorized behavior every 10 min and transmitted an alarm to the breeders when foaling was detected. To confirm its accuracy, the foaling detection time of the novel system was compared with that of Foalert™. The novel foaling alarm system and Foalert™ alarmed foaling onset respectively 32.6 ± 17.9 and 8.6 ± 1.0 min prior to foal discharge, and the foaling detection rate of both systems was 94.4%. Therefore, the novel foaling alarm system equipped with an accelerometer can precisely detect and alert foaling onset.
PubMed: 36811996
DOI: 10.5187/jast.2022.e75 -
Critical Care Nursing Clinics of North... Sep 2023Pediatric intensive care unit nurses can be exposed to hundreds of alarms per patient they care for each shift. The exposure to so many alarms can cause nurses to be... (Review)
Review
Pediatric intensive care unit nurses can be exposed to hundreds of alarms per patient they care for each shift. The exposure to so many alarms can cause nurses to be desensitized to future alarms and thus increase the time to respond to alarms. This is one of the largest patient safety concerns within health care today. Steps should be taken to mitigate the number of alarms nurses experience so that they can properly respond to actionable alarms.
Topics: Child; Humans; Clinical Alarms; Monitoring, Physiologic; Intensive Care Units, Pediatric; Patient Safety; Intensive Care Units
PubMed: 37532388
DOI: 10.1016/j.cnc.2023.05.003 -
Australian Critical Care : Official... Mar 2024Excessive number of alarms and false and nonactionable alarms may lead to alarm fatigue. Alarm fatigue could easily contribute to burnout. Burnout may reduce nurses'...
BACKGROUND
Excessive number of alarms and false and nonactionable alarms may lead to alarm fatigue. Alarm fatigue could easily contribute to burnout. Burnout may reduce nurses' sensitivity to alarms, thus affecting patients' safety due to insufficient response to the alarms. However, no study has examined nurses' alarm fatigue in Ghana.
OBJECTIVES
The objective of this study was to investigate the level of alarm fatigue and its associated factors, as well as determine its relationship with burnout among nurses working in the critical care units of hospitals in Ghana.
METHODS
The cross-sectional study was conducted in critical care units of five hospitals in Ghana from November 2021 to January 2022. A total of 364 nurses were recruited and completed the questionnaire. Alarm fatigue was assessed by the alarm fatigue questionnaire, which was originally developed in Chinese and was translated into English using a standard protocol. Burnout was assessed using the Maslach Burnout Inventory.
RESULTS
The overall alarm fatigue score was 76.43 ± 27.80 out of 124. Longer years working at the critical care unit (B = -2.50, 95% confidence interval [CI]: -4.62, -0.37) and having policies related to alarm management (B = -10.77, 95% CI: -3.50, -18.04) were associated with a decreased risk of alarm fatigue, while working in neonatal intensive care unit (B = 16.35, 95% CI: 2.48, 30.21) and postanesthesia care unit (B = 15.16; 95% CI: 0.32, 30.01), and having anxiety and stress (B = 8.15, 95% CI: 1.30, 15.00) were associated with an increased risk of alarm fatigue. In addition, alarm fatigue was positively associated with emotional exhaustion (r = 0.52, P < 0.001) and depersonalisation (r = 0.43, P < 0.001) but not personal accomplishment (r = -0.09, P = 0.100).
CONCLUSION
Critical care nurses in Ghana experienced higher levels of alarm fatigue, which is affected by multiple factors. There is a significant link between nurses' alarm fatigue and burnout. Our findings provide important guidance for future intervention programs to improve critical care nurses' alarm fatigue by introducing policies on alarm management and improving nurses' psychological health, with a special focus on nurses with shorter working years and working in neonatal intensive care unit and postanesthesia care unit.
Topics: Infant, Newborn; Humans; Cross-Sectional Studies; Alert Fatigue, Health Personnel; Clinical Alarms; Burnout, Professional; Critical Care; Intensive Care Units, Neonatal; Nurses; Psychological Tests; Self Report
PubMed: 37580238
DOI: 10.1016/j.aucc.2023.06.010 -
BMJ Open Feb 2015This literature review examined research into the impact of a previous 'all-clear' or non-cancer diagnosis following symptomatic presentation ('false alarm') on symptom... (Review)
Review
OBJECTIVES
This literature review examined research into the impact of a previous 'all-clear' or non-cancer diagnosis following symptomatic presentation ('false alarm') on symptom attribution and delays in help seeking for subsequent possible cancer symptoms.
DESIGN AND SETTING
The comprehensive literature review included original research based on quantitative, qualitative and mixed data collection methods. We used a combination of search strategies, including in-depth searches of electronic databases (PubMed, EMBASE, PsychInfo), searching key authors and articles listed as 'related' in PubMed, and reference lists. We performed a narrative synthesis of key themes shared across studies.
PARTICIPANTS
The review included studies published after 1990 and before February 2014 reporting information on adult patients having experienced a false alarm following symptomatic presentation. We excluded false alarms in the context of screening.
PRIMARY AND SECONDARY OUTCOME MEASURES
We evaluated the effect of a 'false alarm' on symptom attribution and help seeking for new or recurrent possible cancer symptoms.
RESULTS
Overall, 1442 papers were screened and 121 retrieved for full-text evaluation. Among them, 19 reported on false alarms and subsequent symptom attribution or help seeking. They used qualitative (n=14), quantitative (n=3) and mixed methods (n=2). Breast (n=7), gynaecological (n=3), colorectal (n=2), testicular (n=2), and head and neck cancers (n=2) were the most studied. Two broad themes emerged underlying delays in help seeking: (1) over-reassurance from the previous 'all-clear' diagnosis leading to subsequent symptoms being interpreted as benign, and (2) unsupportive healthcare experiences in which symptoms were dismissed, leaving patients concerned about appearing hypochondriacal or uncertain about the appropriate next actions. The evidence suggested that the effect of a false alarm can persist for months and even years.
CONCLUSIONS
In conclusion, over-reassurance and undersupport of patients after a false alarm can undermine help seeking in the case of new or recurrent potential cancer symptoms, highlighting the need for appropriate patient information when investigations rule out cancer.
Topics: Female; Humans; Male; Neoplasm Recurrence, Local; Neoplasms; Patient Acceptance of Health Care; Uncertainty
PubMed: 25652803
DOI: 10.1136/bmjopen-2014-007002 -
Journal of Electrocardiology 2018
Review
Topics: Clinical Alarms; Diagnostic Errors; Equipment Failure; Humans; Patient Safety; Point-of-Care Systems; Sound
PubMed: 30045808
DOI: 10.1016/j.jelectrocard.2018.07.007 -
Scientific Reports Aug 2023When exposed to hundreds of medical device alarms per day, intensive care unit (ICU) staff can develop "alarm fatigue" (i.e., desensitisation to alarms). However, no... (Review)
Review
When exposed to hundreds of medical device alarms per day, intensive care unit (ICU) staff can develop "alarm fatigue" (i.e., desensitisation to alarms). However, no standardised way of quantifying alarm fatigue exists. We aimed to develop a brief questionnaire for measuring alarm fatigue in nurses and physicians. After developing a list of initial items based on a literature review, we conducted 15 cognitive interviews with the target group (13 nurses and two physicians) to ensure that the items are face valid and comprehensible. We then asked 32 experts on alarm fatigue to judge whether the items are suited for measuring alarm fatigue. The resulting 27 items were sent to nurses and physicians from 15 ICUs of a large German hospital. We used exploratory factor analysis to further reduce the number of items and to identify scales. A total of 585 submissions from 707 participants could be analysed (of which 14% were physicians and 64% were nurses). The simple structure of a two-factor model was achieved within three rounds. The final questionnaire (called Charité Alarm Fatigue Questionnaire; CAFQa) consists of nine items along two scales (i.e., the "alarm stress scale" and the "alarm coping scale"). The CAFQa is a brief questionnaire that allows clinical alarm researchers to quantify the alarm fatigue of nurses and physicians. It should not take more than five minutes to administer.
Topics: Humans; Adaptation, Psychological; Clinical Alarms; Intensive Care Units; Physicians; Nurses
PubMed: 37620385
DOI: 10.1038/s41598-023-40290-7