The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
Am J Crit Care. 2010 Jan;19(1):28-34; quiz 35. doi: 10.4037/ajcc2010651.
Reliance on physiological monitors to continuously "watch" patients and to alert the nurse when a serious rhythm problem occurs is standard practice on monitored units. Alarms are intended to alert clinicians to deviations from a predetermined "normal" status. However, alarm fatigue may occur when the sheer number of monitor alarms overwhelms clinicians, possibly leading to alarms being disabled, silenced, or ignored.
Excessive numbers of monitor alarms and fear that nurses have become desensitized to these alarms was the impetus for a unit-based quality improvement project.
Small tests of change to improve alarm management were conducted on a medical progressive care unit. The types and frequency of monitor alarms in the unit were assessed. Nurses were trained to individualize patients' alarm parameter limits and levels. Monitor software was modified to promote audibility of critical alarms.
Critical monitor alarms were reduced 43% from baseline data. The reduction of alarms could be attributed to adjustment of monitor alarm defaults, careful assessment and customization of monitor alarm parameter limits and levels, and implementation of an interdisciplinary monitor policy.
Although alarms are important and sometimes life-saving, they can compromise patients' safety if ignored. This unit-based quality improvement initiative was beneficial as a starting point for revamping alarm management throughout the institution.
在监测病房中，依靠生理监测器持续“观察”患者并在出现严重节律问题时向护士发出警报，这是标准做法。警报旨在提醒临床医生注意偏离预定“正常”状态的情况。然而，当监测器警报的数量过多，使临床医生不堪重负时，可能会出现警报疲劳，从而导致警报被禁用、静音或忽略。
过多的监测器警报数量以及护士对这些警报产生麻木感，促使开展了一项基于单元的质量改进项目。
在医疗渐进式护理病房中进行了小型的改进措施测试，以改善警报管理。评估了该病房中监测器警报的类型和频率。对护士进行了培训，以个性化设置患者的警报参数限制和级别。修改了监测器软件，以提高关键警报的可听度。
与基线数据相比，关键监测器警报减少了 43%。警报的减少可归因于调整监测器警报的默认设置、仔细评估和定制监测器警报参数限制和级别，以及实施跨学科的监测器政策。
尽管警报很重要，有时甚至可以拯救生命，但如果被忽视，它们也会危及患者的安全。该基于单元的质量改进倡议作为在整个机构中重新调整警报管理的起点是有益的。
