Faculty of Medicine, Neurology Department, Hacettepe University Hospitals, Neurointensive Care Unit, Sıhhiye, 06230, Ankara, Turkey.
Neurology Department, Akdeniz University Hospitals, Antalya, Turkey.
J Clin Monit Comput. 2022 Aug;36(4):995-1001. doi: 10.1007/s10877-021-00724-x. Epub 2021 May 27.
The contemporary practice of monitoring physiologic parameters in the critical care setting is based on alarm systems with high sensitivity but low specificity. A natural consequence of this approach is a massive amount of alarms, which potentially leads to fatigue in the personnel and negatively impacts the quality of care provided. The study objective is to determine the prevalence, types, and determinants of alarms in a neurological critical care unit (NCCU) prototype. During a one-month period corresponding to 272 days of monitoring in 34 patients, nursing staff recorded the type and number of sounding alarms in a university NCCU. Alarms were categorized into three types as type-A alarms that were merely handled by the nursing staff, type-B alarms that were primarily managed by nurses, but the physician was also notified, and type-C alarms that were principally handled by NCCU physicians. There were a total of 9439 alarms, with an average of daily 34.7 alarms per bed, corresponding to one alarm every 41.4 min. Most of the alarms were type-A (57.7%), followed by type-B (39.2%) and type-C (3.1%) alarms. Alarms originated from electrocardiogram (34.6%), pulse oximeter (33.7%), noninvasive blood pressure monitoring (9.8%), respiratory monitoring (9.7%), intravenous fluid pumps (4.5%), ventilator (3.9%), enteral pumps (2.1%) and invasive blood pressure systems (1.7%). A noticeable diurnal variation was observed for type-A pulse oximeter, type-A and -B ECG alarms (increase during morning shifts), and type-A ventilator alarms (decrease during morning shifts). Alarms are highly prevalent in NCCUs and can correspond to an important portion of the workload.
在重症监护环境中监测生理参数的当代实践基于具有高灵敏度但特异性低的报警系统。这种方法的一个自然结果是大量的警报，这可能导致人员疲劳，并对所提供的护理质量产生负面影响。本研究的目的是确定神经重症监护病房（NCCU）原型中的警报的发生率、类型和决定因素。在一个月的时间内，对应于 34 名患者的 272 天监测期间，护理人员记录了大学 NCCU 中报警的类型和数量。报警分为三种类型：A 型报警只是由护理人员处理，B 型报警主要由护士管理，但医生也会收到通知，C 型报警主要由 NCCU 医生处理。共有 9439 个报警，平均每个床位每天 34.7 个报警，相当于每 41.4 分钟一个报警。大多数报警是 A 型（57.7%），其次是 B 型（39.2%）和 C 型（3.1%）报警。报警源自心电图（34.6%）、脉搏血氧仪（33.7%）、非侵入性血压监测（9.8%）、呼吸监测（9.7%）、静脉输液泵（4.5%）、呼吸机（3.9%）、肠内泵（2.1%）和有创血压系统（1.7%）。A 型脉搏血氧仪、A 型和 B 型心电图报警（早晨班次增加）和 A 型呼吸机报警（早晨班次减少）出现明显的昼夜变化。NCCU 中的警报非常普遍，可能占工作量的重要部分。
