Abstract
To measure the magnitude of the effect of an individualized parameterization protocol for hemodynamic alarms in patients with acute myocardial infarction. Pragmatic clinical trial, open label and single arm, whose intervention was performed through a protocol validated and tested in 32 patients using multiparametric monitors. The heart rate, blood pressure, respiratory rate, oxygen saturation and ST segment-monitoring were measured and classified for clinical consistency one hour before and after the intervention, for 64 hours. The protocol obtained Content Validity Index of 0.92. Of the 460 registered alarms, 261 were considered inconsistent before the intervention and 47 after it. The Relative Risk of inconsistent alarms after the protocol was 0.32 (95% CI 0.23-0.43, p <0.0001). The protocol proved to be a protective factor to the appearance of inconsistent clinical alarms of multiparametric monitors.
Highlights
Clinical alarms of multiparametric vital signs monitors must alert caregivers that something is not right and direct them to prompt action
The majority were characterized as Killip I 23 (71.8%), Thrombolysis in Myocardial Infarction (TIMI) risk Graph 1 –Distribution of the clinical alarms that went off before and after the between 0 and 2 14 (4.8%) and Grace Risk < or = 108 17 (53.2%), intervention by hemodynamic parameter. – Rio de Janeiro, RJ, Brazil, 2017 which mostly represents patients with low-risk acute myocardial infarction (AMI)
Individualized parameterization of alarms is recommended by Association of Critical Care Nurses(14) (AACN), which published a“Practical Alert”on the management of clinical alarms in 2013 as a way to combat the phenomenon of alarm fatigue[4]
Summary
Clinical alarms of multiparametric vital signs monitors must alert caregivers that something is not right and direct them to prompt action. Due to the severity of the disease, patients with AMI must be observed in beds with multiparametric monitors for the early detection of hemodynamic instabilities and life-threatening arrhythmias[2]. In this case, responding to clinical alarms of ventricular fibrillation (VF), for example, prevents death or an unfavorable neurological outcome, inversely proportional to the time of its care[3]. Inconsistent clinical alarms are those that do not present reliable clinical data about the patient and may occur from 80% to 99% of the time in hospital units. Current data on the consistency of clinical alarms indicate a frequency of only 5% to 13% of monitor alarms that required some immediate action by the team[5]
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