Srinivasa Ekta, Mankoo Jaspreet, Kerr Charles
Clinical Resource Nurse for Acute Care, VA Boston Healthcare System, West Roxbury, MA, USA, Curry College Capstone Project, Curry College, Milton, MA, USA.
Clinical Engineer, VA Boston Healthcare System, West Roxbury, MA, USA.
Worldviews Evid Based Nurs. 2017 Aug;14(4):265-273. doi: 10.1111/wvn.12200. Epub 2017 Apr 22.
It is estimated that between 80% and 99% of alarms in the clinical areas are in actionable alarms (Gross, Dahl, & Nielson). Alarm management is one of the Joint Commission's National Patient Safety Goals (2014) because sentinel events have directly been linked to the devices generating these alarms.
At an acute care facility in Boston, a multidisciplinary team consisting of Nursing, Biomedical Engineers, Patient Safety and Providers was formed to conduct a pilot study on the state of telemetry alarms on a surgical floor.
An evidence-based approach was taken utilizing Philips Real-time data exporter alarms tracking software to capture all telemetry alarms during a 43-day time span. Likewise, noise meters were placed near telemetry alarm speakers to track decibel levels within the aforementioned timeframe for 21 days. Analysis of the data showed that clinically insignificant Premature Ventricular Contractions (PVC) alarms accounted for more than 40% of all alarms in the unit within the time span, while also contributing to an average noise level of 58.49 dB. In response to the data, the interdisciplinary team approved to permanently default the settings for PAIR PVC, MULTIFORM PVC, and RUN PVC alarms to off.
The results showed a 54% decrease in the rate of alarms per bed per day, and an average noise reduction of 2.3 dB between the two selected noise measurement areas.
Organizing a multidisciplinary team provides an effective framework toward analyzing and addressing cardiac telemetry alarm fatigue. Looking at quantitative datasets for clinical care areas through various lenses helps identify opportunities for improvement in regards to highlighting alarms that are not actionable. Pilot changes to alarm parameters can be tested for their environmental impact in the care area.
据估计，临床区域80%至99%的警报属于可操作警报（格罗斯、达尔和尼尔森）。警报管理是联合委员会国家患者安全目标（2014年）之一，因为哨点事件与产生这些警报的设备直接相关。
在波士顿的一家急症护理机构，由护理人员、生物医学工程师、患者安全人员和医疗服务提供者组成的多学科团队成立，对手术楼层遥测警报的状况进行试点研究。
采用基于证据的方法，利用飞利浦实时数据导出器警报跟踪软件在43天的时间跨度内捕获所有遥测警报。同样，在遥测警报扬声器附近放置噪音计，在上述21天的时间范围内跟踪分贝水平。数据分析表明，在该时间段内，临床上无意义的室性早搏（PVC）警报占该科室所有警报的40%以上，同时平均噪音水平为58.49分贝。针对这些数据，跨学科团队批准将成对PVC、多形PVC和连发PVC警报的设置永久默认关闭。
结果显示，每张病床每天的警报率下降了54%，两个选定噪音测量区域之间的平均噪音降低了2.3分贝。
组建多学科团队为分析和解决心脏遥测警报疲劳提供了一个有效的框架。通过各种视角查看临床护理区域的定量数据集，有助于识别在突出不可操作警报方面的改进机会。可以测试警报参数的试点更改对护理区域环境的影响。
