Phillips JoAnne, Sowan Azizeh, Ruppel Halley, Magness Rochelle
Author Affiliations: Director of Clinical Practice (Dr Phillips), Virtua Health System, Marlton, New Jersey; School of Nursing (Dr Sowan), The University of Texas Health at San Antonio; Staff Scientist and Postdoctoral Fellow (Dr Ruppel), Division of Research, Kaiser Permanente Oakland California and Hoag Memorial Hospital Presbyterian, Newport Beach, California (Mrs Magness). Halley Ruppel received funding from The Permanente Medical Group (TPMG) Delivery Science Fellowship Program. Halley Ruppel was supported by NIH K12HD052163.
Clin Nurse Spec. 2020 Mar/Apr;34(2):50-62. doi: 10.1097/NUR.0000000000000507.
Clinical alarm systems safety is a national healthcare concern in the United States. Physiologic monitors are the medical devices associated with the highest number of false and clinically insignificant alarms, producing alarm fatigue and a challenge to meet the national clinical alarm systems safety goal. Modern physiologic monitors are high-tech complex devices with multimeasurement modalities and high sensitivity for alarms. This complexity hinders safe operation of the monitors by nurses and appropriate management of associated alarms. Nurses need to integrate cognitive knowledge, psychomotor skills, and critical thinking to safely operate the monitors and support clinical decisions. Limited resources are available to support clinical education for nurses on physiologic monitor use and alarm management. This toolkit presents an educational framework for physiologic monitor use and alarm safety guided by adult learning principles. The components of the program are (1) knowledge, skills, and attitude of physiologic monitor use; (2) scenario-based learning model to support the knowledge, skills, and attitude necessary for safe monitor use; and (3) a framework for evaluating the educational program. Education should be ongoing and customized per facility to ensure safe use of complex technology and to decrease alarm fatigue, the leading cause of alarm-related sentinel events.
临床警报系统安全是美国全国医疗保健领域所关注的问题。生理监测仪是与数量最多的误报及临床无意义警报相关的医疗设备，会导致警报疲劳，对实现国家临床警报系统安全目标构成挑战。现代生理监测仪是高科技复杂设备，具备多种测量模式且对警报高度敏感。这种复杂性妨碍了护士对监测仪的安全操作以及对相关警报的妥善管理。护士需要综合运用认知知识、操作技能和批判性思维，以安全操作监测仪并辅助临床决策。用于支持护士进行生理监测仪使用及警报管理临床教育的资源有限。本工具包提出了一个以成人学习原则为指导的生理监测仪使用及警报安全的教育框架。该项目的组成部分包括：（1）生理监测仪使用的知识、技能和态度；（2）基于场景的学习模式，以支持安全使用监测仪所需的知识、技能和态度；（3）一个评估教育项目的框架。教育应该持续进行，并根据每个机构的情况进行定制，以确保复杂技术的安全使用，并减少警报疲劳，而警报疲劳是与警报相关的警讯事件的主要原因。
