Alsaad Ali A, Alman Carly R, Thompson Kristine M, Park Shin H, Monteau Rebecca E, Maniaci Michael J
Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
Department of Nursing, Mayo Clinic, Jacksonville, Florida, USA.
Postgrad Med J. 2017 Jul;93(1101):430-435. doi: 10.1136/postgradmedj-2016-134764. Epub 2017 Apr 28.
Alarm fatigue (AF) is a distressing factor for staff and patients in the hospital. Using cardiac telemetry (CT) without clinical indications can create unnecessary alarms, and increase AF and cost of healthcare. We sought to reduce AF and cost associated with CT monitoring.
After implementing a new protocol for CT placement, data were collected on telemetry orders, alarms and bed cost for 13 weeks from 1 January 2015 through 31 March 2015. We also retrospectively collected data on the same variables for the 13 weeks prior to the intervention. A survey was administered to nurses to assess past and present perceptions of AF. Interventions included protocol creation and education for participants.
At baseline, 77% of patients were monitored with CT. A total of 145 (31%) order discrepancies were discovered during data collection, of which 72% had no indication for CT, so CT was discontinued. The other 28% had indications, so orders were placed. A total of 8336 alarms were recorded during 4 weeks of data collection, of which 333 (4%) were classified as true actionable alarms. Postintervention data showed 67% CT assignment with 10% reduction in CT usage, with no increase in mortality (p<0.001 and >0.05, respectively). A 42% cost reduction was achieved after adjusting the patient status. Nurses reported 27% perceived reduction in AF. One-year follow-up revealed that 69% of patients were being monitored by CT, and the rate of order discrepancies due to lack of indication was 9%.
All hospital units may benefit from the protocols created during this study. If applied appropriately, these protocols can lead to reduced AF and cost per episode of care.
警报疲劳（AF）是医院工作人员和患者面临的一个困扰因素。在没有临床指征的情况下使用心脏遥测（CT）会产生不必要的警报，增加警报疲劳并提高医疗成本。我们试图降低与CT监测相关的警报疲劳和成本。
在实施一项关于CT放置的新方案后，收集了2015年1月1日至2015年3月31日这13周内遥测医嘱、警报和床位费用的数据。我们还回顾性收集了干预前13周相同变量的数据。对护士进行了一项调查，以评估他们过去和现在对警报疲劳的看法。干预措施包括制定方案并对参与者进行教育。
在基线时，77%的患者接受CT监测。在数据收集期间共发现145例（31%）医嘱差异，其中72%没有CT监测指征，因此停止了CT监测。另外28%有指征，所以下达了医嘱。在4周的数据收集期间共记录了8336次警报，其中333次（4%）被归类为真正可采取行动的警报。干预后的数据显示，CT监测的分配率为67%，CT使用量减少了10%，死亡率没有增加（分别为p<0.001和>0.05）。调整患者状态后成本降低了42%。护士报告称，感觉警报疲劳降低了27%。一年的随访显示，69%的患者正在接受CT监测，因缺乏指征导致的医嘱差异率为9%。
所有医院科室都可能从本研究中制定的方案中受益。如果适当应用，这些方案可导致警报疲劳降低和每次护理费用降低。
