Sowan Azizeh K, Staggers Nancy, Berndt Andrea, Austin Tommye, Reed Charles C, Malshe Ashwin, Kilger Max, Fonseca Elma, Vera Ana, Chen Qian
School of Nursing University of Texas Health at San Antonio San Antonio, TX United States.
School of Nursing and Department of Biomedical Informatics University of Utah Salt Lake City, UT United States.
JMIR Nurs. 2021 Feb 3;4(1):e20584. doi: 10.2196/20584. eCollection 2021 Jan-Mar.
Clinical alarm system safety is a national patient safety goal in the United States. Physiologic monitors are associated with the highest number of device alarms and alarm-related deaths. However, research involving nurses' use of physiologic monitors is rare. Hence, the identification of critical usability issues for monitors, especially those related to patient safety, is a nursing imperative.
This study examined nurses' usability of physiologic monitors in intensive care units with respect to the effectiveness and efficiency of monitor use.
In total, 30 nurses from 4 adult intensive care units completed 40 tasks in a simulation environment. The tasks were common monitoring tasks that were crucial for appropriate monitoring and safe alarm management across four categories of competencies: admitting, transferring, and discharging patients using the monitors (7 tasks); managing measurements and monitor settings (23 tasks); performing electrocardiogram (ECG) analysis (7 tasks); and troubleshooting alarm conditions (3 tasks). The nurse-monitor interaction was video-recorded. The principal investigator and two expert intensive care units nurse educators identified, classified, and validated task success (effectiveness) and the time of task completion (efficiency).
Among the 40 tasks, only 2 (5%) were successfully completed by all the nurses. At least 1-27 (3%-90%) nurses abandoned or did not correctly perform 38 tasks. The task with the shortest completion time was "take monitor out of standby" (mean 0:02, SD 0:01 min:s), whereas the task "record a 25 mm/s ECG strip of any of the ECG leads" had the longest completion time (mean 1:14, SD 0:32 min:s). The total time to complete 37 navigation-related tasks ranged from a minimum of 3 min 57 s to a maximum of 32 min 42 s. Regression analysis showed that it took 6 s per click or step to successfully complete a task. To understand the nurses' thought processes during monitor navigation, the authors analyzed the paths of the 2 tasks with the lowest successful completion rates, where only 13% (4/30) of the nurses correctly completed these 2 tasks. Although 30% (9/30) of the nurses accessed the correct screen first for task 1 and task 2, they could not find their way easily from there to successfully complete the 2 tasks.
Usability testing of physiologic monitors revealed major ineffectiveness and inefficiencies in the current nurse-monitor interactions. The results indicate the potential for safety and productivity issues in completing routine tasks. Training on monitor use should include critical monitoring functions that are necessary for safe, effective, efficient, and appropriate monitoring to include knowledge of the shortest navigation path. It is imperative that vendors' future monitor designs mimic clinicians' thought processes for successful, safe, and efficient monitor navigation.
临床警报系统安全是美国的一项全国性患者安全目标。生理监测仪产生的设备警报及与警报相关的死亡案例数量最多。然而，关于护士使用生理监测仪的研究却很少。因此，识别监测仪的关键可用性问题，尤其是与患者安全相关的问题，是护理工作的当务之急。
本研究考察了重症监护病房护士使用生理监测仪的有效性和效率方面的可用性。
来自4个成人重症监护病房的30名护士在模拟环境中完成了40项任务。这些任务是常见的监测任务，对于四大类能力的适当监测和安全警报管理至关重要：使用监测仪收治、转运和出院患者（7项任务）；管理测量和监测仪设置（23项任务）；进行心电图（ECG）分析（7项任务）；以及排除警报状况故障（3项任务）。对护士与监测仪的互动进行了视频记录。首席研究员和两名重症监护病房专家护士教育工作者确定、分类并验证了任务的成功完成情况（有效性）和任务完成时间（效率）。
在这40项任务中，所有护士仅成功完成了2项（5%）。至少有1至27名（3% - 90%）护士放弃或未正确执行38项任务。完成时间最短的任务是“将监测仪从待机状态中取出”（平均0:02，标准差0:01分:秒），而“记录任何一条心电图导联的25毫米/秒心电图条带”任务的完成时间最长（平均1:14，标准差0:32分:秒）。完成37项与导航相关任务的总时间最短为3分57秒，最长为32分42秒。回归分析表明，成功完成一项任务每次点击或操作需要6秒。为了解护士在监测仪导航过程中的思维过程，作者分析了成功率最低的2项任务的操作路径，只有13%（4/30）的护士正确完成了这2项任务。尽管30%（9/30）的护士在任务1和任务2中首先访问了正确的屏幕，但他们无法从那里轻松找到完成这2项任务的方法。
生理监测仪的可用性测试揭示了当前护士与监测仪互动中存在的重大无效性和低效性。结果表明在完成日常任务时存在安全和生产效率问题的可能性。监测仪使用培训应包括安全、有效、高效和适当监测所需的关键监测功能，包括最短导航路径的知识。供应商未来的监测仪设计必须模仿临床医生成功、安全和高效进行监测仪导航的思维过程。
