Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California.
Department of Anesthesiology, Kaiser Permanente San Jose Medical Center, San Jose, California.
Respir Care. 2020 Apr;65(4):482-491. doi: 10.4187/respcare.07187. Epub 2020 Jan 28.
The prevalence of nuisance (technical) alarms is the leading cause of alarm fatigue resulting in decreased awareness and a reduction in effective care. The Joint Commission identified in their National Patient Safety goals alarm fatigue as a major safety issue. The introduction of noninvasive respiratory volume monitoring (RVM) has implications for effective perioperative respiratory status management. We evaluated this within the Kaiser Permanente health system.
This observational study was conducted at 4 hospitals in the Kaiser Permanente system. Standard data from RVM, pulse oximetry, and capnography were collected postoperatively in the post-anesthesia care unit (PACU) and/or on the general hospital floor. Device-specific alarm types, rates, and respective actions were recorded and analyzed by non-study staff.
RVM was applied to 247 subjects (143 females, body mass index 32.3 ± 8.7 kg/m, age 60.9 ± 13.9 y) providing 2,321 h. RVM alarms occurred 605 times (0.25 alarms/h); 64% were actionable and addressed, 17% were not addressed, 13% were self-resolved, and only 6% were nuisance. In a subgroup, RVM completed all 127 h of monitoring, whereas oximetry with capnography only completed 51 h with 12.9 alarms/h (73% nuisance). The overall RVM alarm rate was significantly lower than with either pulse oximeters or capnography monitors. We saw a nearly 1,000-fold reduction in nuisance alarms compared to capnography and a 20-50-fold reduction in nuisance alarms compared to pulse oximetry.
Our study indicates that alarm fatigue due to nuisance alarms continues to be a clinical challenge in perioperative settings. Among the 3 common technologies for respiratory function monitoring, RVM had the lowest rate of overall technical alarms and the highest rate of compliance. Furthermore, with early interventions, none of the subjects monitored with RVM suffered any negative outcomes.
令人烦恼（技术性）警报的出现率是导致警报疲劳的主要原因，从而降低了医护人员的警觉性并减少了有效的护理。联合委员会在其国家患者安全目标中确定了警报疲劳是一个主要的安全问题。非侵入性呼吸容量监测（RVM）的引入对围手术期呼吸状态的有效管理具有重要意义。我们在 Kaiser Permanente 医疗系统中对此进行了评估。
这项观察性研究在 Kaiser Permanente 系统的 4 家医院进行。术后在麻醉后护理单元（PACU）和/或综合医院病房中收集 RVM、脉搏血氧饱和度和呼气末二氧化碳监测的标准数据。由非研究人员记录和分析设备特定的报警类型、发生率和相应的动作。
RVM 应用于 247 名受试者（143 名女性，体重指数 32.3 ± 8.7 kg/m2，年龄 60.9 ± 13.9 岁），监测时间为 2321 小时。RVM 报警发生 605 次（0.25 次/小时）；其中 64%是可采取行动的，并得到解决，17%未得到解决，13%自行解决，只有 6%是令人烦恼的。在一个亚组中，RVM 完成了所有 127 小时的监测，而脉搏血氧饱和度和呼气末二氧化碳监测仅完成了 51 小时，报警率为 12.9 次/小时（73%是令人烦恼的）。总体而言，RVM 的报警率明显低于脉搏血氧饱和度和呼气末二氧化碳监测仪。与呼气末二氧化碳监测仪相比，我们发现令人烦恼的报警几乎减少了 1000 倍，与脉搏血氧饱和度监测仪相比，令人烦恼的报警减少了 20-50 倍。
我们的研究表明，在围手术期环境中，由于令人烦恼的警报导致的警报疲劳仍然是一个临床挑战。在 3 种常用的呼吸功能监测技术中，RVM 的总技术报警率最低，合规率最高。此外，通过早期干预，使用 RVM 监测的受试者均未出现任何不良后果。
