减少不一致的报警通知：麻醉后护理单元中的实用临床试验。
Decreasing inconsistent alarms notifications: a pragmatic clinical trial in a post-anesthesia care unit.
机构信息
Hospital São Luiz Unidade Itaim, Rede D'Or - Equipe de Anestesia CMA, Departamento de Anestesiologia, São Paulo, SP, Brazil.
Hospital São Luiz Unidade Itaim, Rede D'Or - Equipe de Anestesia CMA, Departamento de Anestesiologia, São Paulo, SP, Brazil; Rede D'Or, Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil.
出版信息
Braz J Anesthesiol. 2024 May-Jun;74(3):744456. doi: 10.1016/j.bjane.2023.07.013. Epub 2023 Aug 9.
BACKGROUND
Alarms alert healthcare professionals of deviations from normal/physiologic status. However, alarm fatigue may occur when their high pitch and diversity overwhelm clinicians, possibly leading to alarms being disabled, paused, and/or ignored. We aimed to determine whether a staff educational program on customizing alarm settings of bedside monitors may decrease inconsistent alarms in the Post-Anesthesia Care Unit (PACU).
METHODS
This is a prospective, analytic, quantitative, pragmatic, open-label, single-arm study. The outcome was evaluated on PACU admission before (P1) and after (P2) the implementation of the educational program. The heart rate, blood pressure, and oxygen saturation alarms were selected for clinical consistency.
RESULTS
A total of 260 patients were included and 344 clinical alarms collected, with 270 (78.4%) before (P1), and 74 (21.6%) after (P2) the intervention. Among the 270 alarms in P1, 45.2% were inconsistent (i.e., false alarms), compared to 9.4% of the 74 in P2. Patients with consistent alarms occurred in 30% in the P1 and 27% in the P2 (p = 0.08). Patients with inconsistent alarms occurred in 25.4% in the P1 and in 3.8% in the P2. Ignored consistent alarms were reduced from 21.5% to 2.6% (p = 0.004) in the P2 group. The educational program was a protective factor for the inconsistent clinical alarm (OR = 0.11 [95% CI 0.04-0.3]; p < 0.001) after adjustments for age, gender, and ASA physical status.
CONCLUSION
Customizing alarm settings on PACU admission proved to be a protective factor against inconsistent alarm notifications of multiparametric monitors.
背景
报警可提醒医护人员关注偏离正常/生理状态的情况。然而，报警声过高且种类繁多可能会使医护人员不堪重负，从而导致报警被禁用、暂停和/或忽略，这就是所谓的“报警疲劳”。我们旨在确定对床边监护仪报警设置进行定制化的员工教育计划是否可以减少麻醉后恢复室（PACU）中不一致的报警。
方法
这是一项前瞻性、分析性、定量、实用、开放标签、单臂研究。在实施教育计划前后（P1 和 P2）对 PACU 入院时进行评估。选择心率、血压和血氧饱和度报警来评估临床一致性。
结果
共纳入 260 例患者，共采集 344 例临床报警，其中 270 例（78.4%）发生在干预前（P1），74 例（21.6%）发生在干预后（P2）。在 P1 中的 270 个报警中，45.2%为不一致（即假报警），而 P2 中的 74 个报警中仅 9.4%为不一致。P1 中一致报警的患者占 30%，P2 中占 27%（p = 0.08）。P1 中不一致报警的患者占 25.4%，P2 中占 3.8%。P2 组中忽略的一致报警从 21.5%减少至 2.6%（p = 0.004）。经过对年龄、性别和 ASA 体格状况的调整，教育计划是不一致临床报警的保护因素（OR = 0.11 [95%CI 0.04-0.3]；p < 0.001）。
结论
在 PACU 入院时对报警设置进行定制化证明是一种保护因素，可以减少多参数监护仪的不一致报警通知。
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