McGrath Susan P, Perreard Irina M, McGovern Krystal M, Blike George T
Surveillance Analytics Core, Department of Anesthesiology and Analytics Institute, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, United States.
Surveillance Analytics Core, Department of Anesthesiology and Analytics Institute, Dartmouth-Hitchcock Medical Center, United States.
Resusc Plus. 2022 Aug 20;11:100295. doi: 10.1016/j.resplu.2022.100295. eCollection 2022 Sep.
The aim of this study is to investigate the impact of alarm configuration tactics in general care settings.
Retrospective analysis of over 150,000 hours of medical/surgical unit continuous SpO2 and pulse rate data were used to estimate alarm rates and impact on individual nurses.
Application of an SpO2 threshold of 80% vs 88% produced an 88% reduction in alarms. Addition of a 15 second annunciation delay reduced alarms by an additional 71% with an SpO2 threshold of 80%. Pulse rate alarms were reduced by 93% moving from a pulse rate high threshold of 120-140 bpm, and 95% by lowering the pulse rate low threshold from 60 to 50 bpm. A 15 second annunciation delay at thresholds of 140 bpm and 50 bpm resulted in additional reductions of 80% and 81%, respectively. Combined alarm frequency across all parameters for every 24 hours of actual monitored time yielded a rate of 4.2 alarms for the surveillance configuration, 83.0 alarms for critical care monitoring, and 320.6 alarms for condition monitoring. Total exposure time for an individual nurse during a single shift ranged from 3.6 min with surveillance monitoring, to 1.2 hours for critical care monitoring, and 5.3 hours for condition monitoring.
Continuous monitoring can eliminate unwitnessed/unmonitored arrests associated with significant increased mortality in the general care setting. The "alarm problem" associated with these systems is manageable using alarm settings that signify severely abnormal physiology to alert responsible clinicians of urgent situations.
本研究旨在调查普通护理环境中警报配置策略的影响。
对超过15万小时的内科/外科病房连续SpO₂和脉搏率数据进行回顾性分析，以估计警报率及其对个体护士的影响。
将SpO₂阈值设为80%而非88%，可使警报减少88%。增加15秒的发声延迟，在SpO₂阈值为80%时，警报可再减少71%。将脉搏率高阈值从120 - 140次/分钟调整后，脉搏率警报减少了93%，将脉搏率低阈值从60次/分钟降至50次/分钟，警报减少了95%。在140次/分钟和50次/分钟的阈值处设置15秒的发声延迟，分别使警报进一步减少80%和81%。每24小时实际监测时间内，所有参数的综合警报频率在监测配置下为4.2次警报，重症监护监测为83.0次警报，病情监测为320.6次警报。单个护士在一个班次中的总暴露时间，监测监测为3.6分钟，重症监护监测为1.2小时，病情监测为5.3小时。
持续监测可消除普通护理环境中与死亡率显著增加相关的未被目睹/未受监测的心脏骤停情况。与这些系统相关的“警报问题”可通过设置警报来管理，这些警报表示严重异常的生理状况，以提醒负责的临床医生注意紧急情况。
