基于循证的举措以减少烧伤重症监护病房的报警疲劳。
An Evidence-Based Initiative to Reduce Alarm Fatigue in a Burn Intensive Care Unit.
机构信息
Rayna Gorisek was a clinical nurse IV in the North Carolina Jaycee Burn Center at the University of North Carolina Medical Center, Chapel Hill, North Carolina, at the time this article was written. She is the clinical nurse leader in the surgical intensive care unit at the Durham VA Medical Center, Durham, North Carolina.
Celeste Mayer was the patient safety officer at the University of North Carolina Medical Center at the time this article was written. She is now retired.
出版信息
Crit Care Nurse. 2021 Aug 1;41(4):29-37. doi: 10.4037/ccn2021166.
BACKGROUND
Alarm fatigue occurs when nurses are exposed to multiple alarms of mixed significance and become desensitized to alarms to the point that a critical alarm may receive no response or a delayed response. In burn intensive care units, reducing the risk of alarm fatigue is uniquely challenging because of the critically ill patient population and the nature of burn skin injuries. Nurses and the interdisciplinary team can become fatigued and desensitized to alarms, decreasing response rates for necessary interventions.
OBJECTIVE
To decrease the risk of alarm fatigue by using an initiative designed to reduce nonactionable and false alarms in a burn intensive care unit.
METHODS
Baseline data (alarm count per patient-day by alarm type) were collected for 1 month before education and implementation of evidence-based interventions. Data were collected every 6 months for 2 years.
INTERVENTIONS
A series of interventions included raising awareness of the risks associated with alarm fatigue, customizing alarm parameters and default settings, providing education on electrode placement and daily electrode changes, using physical reminders, and consistently sharing alarm data. The education, delivered in modules, aligned with the evidence-based interventions.
RESULTS
Preintervention baseline data were compared to postintervention data at 6, 12, 18, and 24 months. The results showed a significantly sustained reduction (P < .001) in total alarm rate over time.
CONCLUSION
A quality improvement initiative based on evidence-based practice can contribute to a sustainable reduction in nonactionable and false alarms, ultimately improving patient safety.
背景
当护士暴露在多种意义混杂的警报中，并且对警报变得麻木，以至于一个关键警报可能得不到响应或响应延迟时，就会发生警报疲劳。在烧伤重症监护病房，由于危重病患者人群和烧伤皮肤损伤的性质，降低警报疲劳的风险具有独特的挑战性。护士和跨学科团队可能会对警报感到疲劳和麻木，从而降低对必要干预措施的反应率。
目的
通过采用一项旨在减少烧伤重症监护病房非操作性和虚假警报的计划来降低警报疲劳的风险。
方法
在进行基于证据的干预措施的教育和实施之前，收集了 1 个月的基线数据（按警报类型计算的每位患者每天的警报数）。在接下来的 2 年内，每 6 个月收集一次数据。
干预措施
一系列干预措施包括提高对警报疲劳相关风险的认识、定制警报参数和默认设置、提供电极放置和日常电极更换方面的教育、使用物理提醒以及始终如一地共享警报数据。教育内容以模块形式提供，与基于证据的干预措施一致。
结果
将干预前的基线数据与干预后的 6、12、18 和 24 个月的数据进行比较。结果表明，随着时间的推移，总警报率显著持续下降（P<0.001）。
结论
基于循证实践的质量改进计划可以有助于非操作性和虚假警报的持续减少，最终提高患者安全性。
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