Authors (including presenting author) :
Lam SY (1), Yeung SC(1), Lee KP(1), Yiu SC(1), Lee PYV(1), Yiu KH(1), Choo KL(1)
Affiliation :
(1) Medicine, North District Hospital
Introduction :
Analyzing electrocardiograms (ECG) is the daily routine for cardiac nurses to provide continuous assessment to patients hospitalized in Cardiac Care Unit (CCU). Alarms are default and should be customized in cardiac monitors to achieve individualized patient monitoring. Appropriate alarm setting allows nurses to identify abnormalities, timely inform doctors and administer treatment for their patients.
In contrast, study pointed out that more than 80% of the alarms do not require any clinical management (Pelter et al., 2020). Research revealed that nurses are exposed to more than a thousand of physiological monitor alarms every shift (Hueske-Kraus & Ruskin, 2015). Excessive false and irrelevant alarms lead to alarm fatigue and eventually undermine patient safety (Ruppel et al., 2018).
Objectives :
1. Reduce alarm fatigue of nurses, thus enhance patient safety;
2. Identify the numbers and characteristics of inactionable alarms;
3. Investigate the nursing practice of alarm monitoring;
4. Examine the situations of alarm fatigue of nurses;
5. Eliminate unnecessary ECG artifacts by specific nursing interventions; and
6. Minimize the amount of inactionable alarms.
Methodology :
The study was a quasi-experimental pretest and posttest design. It conducted at the CCU of North District Hospital (NDH). By using convenience sampling, the target population was all hospitalised patients except mentally incompetent, uncooperative and dialect speakers under cardiac monitoring. The study takes a total of 6 weeks consisting of the pre-intervention and intervention part which is further divided into two phases (I & II).
A retrospective review and 2-week prospective studies were first conducted to scrutinize the numbers and characteristics of inactionable alarms. A comprehensive alarm report was generated from Mindray telemetry central monitoring system. A baseline statistic was formulated to classify and calculate inactionable alarms. Besides, the nursing practice of alarm monitoring and situations of alarm fatigue amongst nurses were investigated using a designated questionnaire.
A pretest-posttest quantitative design was adopted to investigate whether standardized skin preparation and customization of telemetry alarm settings in phase I and II are effective to eliminate unnecessary alarms in a total of 4-week time. The study design and proposed intervention gained approval from cardiac consultants and nursing managers.
Result & Outcome :
Phrase I intervention resulted in 30% reduction in nuisance alarms caused by contact error of electrodes. Besides, inactionable alarm related to artifacts and lead off declined by 15.1% and 32% respectively. From the above result, it echoed our literature review that simple and cost effective change in practice assured a promising outcome.
Phrase II intervention resulted in 82.2% alarms decreased by eliminating redundant alarm setting and adjusting parameter settings.
Combining the effect of the above interventions, there are a 60.9% nuisance alarm reduction in total.
Apart from the reduction in numbers of alarms, the proposed interventions proven to alleviated alarm fatigue among frontline nursing colleagues. 80% of our colleagues expressed that after implemented the interventions, the frequency of inactionable alarms were remarkably reduced thus, increase their alertness towards clinically significant alarms. Colleagues also expressed that there was a reduction in patient complaining about the noise generated by nuisance alarm.
Furthermore, the proposed intervention also strengthened the communication between physicians and nurses, thus further enhanced team dynamics.
Recommendation
It is recommended that the program should be translated into our daily practice, and explore more intervention to further reduce inactionable alarm to enhance patient safety and outcome.
