Allan Sharon H, Doyle Peter A, Sapirstein Adam, Cvach Maria
Jt Comm J Qual Patient Saf. 2017 Feb;43(2):62-70. doi: 10.1016/j.jcjq.2016.11.004. Epub 2016 Nov 14.
Alarm fatigue in the ICU setting has been well documented in the literature. The ICU's high-intensity environment requires staff's vigilant attention, and distraction from false and non-actionable alarms pulls staff away from important tasks, creates dissatisfaction, and is a potential patient safety risk if alarms are missed or ignored. This project was intended to improve patient safety by optimizing alarm systems in a cardiovascular surgical intensive care unit (CVSICU). Specific aims were to examine nurses' attitudes toward clinical alarm signals, assess nurses' ability to discriminate audible alarm signals, and implement a bundled set of best practices for monitor alarm reduction without undermining patient safety.
CVSICU nurses completed an alarm perception survey and participated in alarm discriminability testing. Nurse survey data and baseline monitor alarm data were used to select targeted alarm reduction interventions, which were progressively phased in. Monitor alarm data and cardiorespiratory event data were trended over one year.
Five of the most frequent CVSICU monitor alarm types-pulse oximetry, heart rate, systolic and diastolic blood pressure, pulse oximetry sensor, and ventricular tachycardia > 2-were targeted. After implementation, there was a 61% reduction in average alarms per monitored bed and a downward trend in cardiorespiratory events.
To reduce alarm fatigue it is important to decrease alarm burden through targeted interventions. Methods to reduce non-actionable alarms include adding short delays to allow alarm self-correction, adjusting default alarm threshold limits, providing alarm notification through a secondary device, and teaching staff to optimize alarm settings for individual patients.
重症监护病房（ICU）环境中的警报疲劳在文献中已有充分记载。ICU高强度的环境要求工作人员时刻保持警惕，而虚假且无需采取行动的警报会分散他们的注意力，使他们无法专注于重要任务，引发不满情绪，并且如果警报被遗漏或忽视，还会对患者安全构成潜在风险。本项目旨在通过优化心血管外科重症监护病房（CVSICU）的警报系统来提高患者安全。具体目标是检查护士对临床警报信号的态度，评估护士辨别可听警报信号的能力，并实施一套捆绑式的最佳实践以减少监护仪警报，同时不损害患者安全。
CVSICU的护士完成了一项警报认知调查，并参与了警报辨别能力测试。护士的调查数据和基线监护仪警报数据被用于选择有针对性的警报减少干预措施，并逐步实施。监护仪警报数据和心肺事件数据在一年时间内进行了趋势分析。
针对CVSICU中最常见的五种监护仪警报类型——脉搏血氧饱和度、心率、收缩压和舒张压、脉搏血氧饱和度传感器以及室性心动过速>2进行了干预。实施后，每张监测病床的平均警报减少了61%，心肺事件呈下降趋势。
为了减少警报疲劳，通过有针对性的干预措施减轻警报负担很重要。减少无需采取行动的警报的方法包括增加短暂延迟以实现警报自我纠正、调整默认警报阈值限制、通过辅助设备提供警报通知，以及教导工作人员为个体患者优化警报设置。
