Clinical Alarms Research Articles

Staff perspectives on the influence of patient characteristics on alarm management in the intensive care unit: a cross-sectional survey study

BackgroundHigh rates of clinical alarms in the intensive care unit can result in alarm fatigue among staff. Individualization of alarm thresholds is regarded as one measure to reduce non-actionable alarms. The aim of this study was to investigate staff’s perceptions of alarm threshold individualization according to patient characteristics and disease status.MethodsThis is a cross-sectional survey study (February-July 2020). Intensive care nurses and physicians were sampled by convenience. Data was collected using an online questionnaire.ResultsStaff view the individualization of alarm thresholds in the monitoring of vital signs as important. The extent to which alarm thresholds are adapted from the normal range varies depending on the vital sign monitored, the reason for clinical deterioration, and the professional group asked. Vital signs used for hemodynamic monitoring (heart rate and blood pressure) were most subject to alarm individualizations. Staff are ambivalent regarding the integration of novel technological features into alarm management.ConclusionsAll relevant stakeholders, including clinicians, hospital management, and industry, must collaborate to establish a “standard for individualization,” moving away from ad hoc alarm management to an intelligent, data-driven alarm management. Making alarms meaningful and trustworthy again has the potential to mitigate alarm fatigue – a major cause of stress in clinical staff and considerable hazard to patient safety.Trial registrationThe study was registered at ClinicalTrials.gov (NCT03514173) on 02/05/2018.

Intensive care unit nurses' perceptions and practices regarding clinical alarms: A descriptive study.

To describe the frequencies of physiologic monitor clinical alarms and to investigate nurses' perceptions and practices regarding clinical alarms in ICUs. A descriptive study. A 24-h continuous nonparticipant observation study was conducted in ICU. Observers observed and recorded the occurrence time, detail information when electrocardiogram monitor alarms triggered. And a cross-sectional study was conducted among ICU nurses by convenience sampling, using the general information questionnaire and the Chinese version of clinical alarms survey questionnaire for medical devices. Data analysis was performed using SPSS 23. A total of 13,829 physiologic monitor clinical alarms were recorded in 14-day observation and 1191 ICU nurses responded to the survey. Most nurses agreed or strongly agreed the sensitivity to alarms and responded quickly (81.28%), smart alarm systems (74.56%), alarm notification systems (72.04%) and set up alarm administrators (59.45%) were useful to improve alarm management, while frequent nuisance alarms disrupted patients care (62.47%) and reduced nurses' trust in alarms (49.03%), environmental noise interfered with nurses' recognition of the alarms (49.12%) and not everyone received education of alarm systems (64.65%). Physiological monitor alarms occur frequently in ICU, and it is necessary to formulate or further optimize alarm management measures. It is recommended to use smart medical devices and alarm notification systems, formulate and implement standardized alarm management policies and norms, and strengthen alarm management education and training, so as to improve the nursing quality and patient safety. The patients in the observation study included all patients admitted to the ICU during the observation period. The nurses in the survey study were conveniently selected through an online survey.

Determining Factors of Alarm Fatigue among Nurses in Intensive Care Units-A Polish Pilot Study.

With the development of medical technology, clinical alarms from various medical devices, which are rapidly increasing, are becoming a new problem in intensive care units. The aim of this study was to evaluate alarm fatigue in Polish nurses employed in Intensive Care Units and identify the factors associated with alarm fatigue. A cross-sectional study. The study used the nurses' alarm fatigue questionnaire by Torabizadeh. The study covered 400 Intensive Care Unit nurses. The data were collected from February to June 2021. The overall mean score of alarm fatigue was 25.8 ± 5.8. Participation in training programs related to the use of monitoring devices available in the ward, both regularly (ß = -0.21) and once (ß = -0.17), negatively correlated with nurses' alarm fatigue. On the other hand, alarm fatigue was positively associated with 12 h shifts [vs. 8 h shifts and 24 h shifts] (ß = 0.11) and employment in Intensive Cardiac Surveillance Units-including Cardiac Surgery [vs. other Intensive Care Units] (ß = 0.10). Monitoring device alarms constitute a significant burden on Polish Intensive Care Unit nurses, in particular those who do not take part in training on the operation of monitoring devices available in their ward. It is necessary to improve Intensive Care Unit personnel's awareness of the consequences of overburdening and alarm fatigue, as well as to identify fatigue-related factors.

An Open-Source, Interoperable Architecture for Generating Real-Time Surgical Team Cognitive Alerts from Heart-Rate Variability Monitoring.

Clinical alarm and decision support systems that lack clinical context may create non-actionable nuisance alarms that are not clinically relevant and can cause distractions during the most difficult moments of a surgery. We present a novel, interoperable, real-time system for adding contextual awareness to clinical systems by monitoring the heart-rate variability (HRV) of clinical team members. We designed an architecture for real-time capture, analysis, and presentation of HRV data from multiple clinicians and implemented this architecture as an application and device interfaces on the open-source OpenICE interoperability platform. In this work, we extend OpenICE with new capabilities to support the needs of the context-aware OR including a modularized data pipeline for simultaneously processing real-time electrocardiographic (ECG) waveforms from multiple clinicians to create estimates of their individual cognitive load. The system is built with standardized interfaces that allow for free interchange of software and hardware components including sensor devices, ECG filtering and beat detection algorithms, HRV metric calculations, and individual and team alerts based on changes in metrics. By integrating contextual cues and team member state into a unified process model, we believe future clinical applications will be able to emulate some of these behaviors to provide context-aware information to improve the safety and quality of surgical interventions.

Implementing a Unit-Based Alarm Management Bundle for Critical Care Nurses

Clinical alarms are designed to signal an unsatisfactory patient physiological state and alert staff members to malfunctioning medical equipment. Alarm desensitization and fatigue can occur when clinicians are exposed to an overwhelming number of clinical alarms, particularly nonactionable alarms. Alarm fatigue and alarm management competency related to use of Philips monitoring systems were noted to be problematic among nurses working in the 27-bed surgical intensive care unit of a teaching hospital in northeastern Florida. A quality improvement project was conducted to reduce alarm fatigue and improve nursing competency in managing alarms. The CEASE (Communication, Electrodes, Appropriateness, Setup, and Education) evidence-based alarm management bundle was implemented on the unit, and a representative from the alarm manufacturer conducted in-service training sessions. A clinical alarms survey developed by the Healthcare Technology Foundation was distributed both before and after the intervention to 115 nurses working in the unit. Descriptive and inferential statistics were used to assess for differences between the preintervention and postintervention periods. Nurse participants demonstrated improved alarm management competency, resulting in significant improvements in their perceptions of alarm functionality, settings, response time, and policy adherence. There was a statistically significant decrease in self-reported alarm fatigue, and the CEASE bundle was found to influence nursing practice. The Joint Commission's 2022 goal of improving clinical alarm safety remains a top priority nationwide. Implementation of the CEASE alarm management bundle was effective in reducing surgical intensive care unit nurses' alarm fatigue and improving their alarm management practices.

Clinical Alarms in a Gynaecological Surgical Unit: A Retrospective Data Analysis

Alarm fatigue refers to the desensitisation of medical staff to patient monitor clinical alarms, which may lead to slower response time or total ignorance of alarms and thereby affects patient safety. The reasons behind alarm fatigue are complex; the main contributing factors include the high number of alarms and the poor positive predictive value of alarms. The study was performed in the Surgery and Anaesthesia Unit of the Women's Hospital, Helsinki, by collecting data from patient monitoring device clinical alarms and patient characteristics from surgical operations. We descriptively analysed the data and statistically analysed the differences in alarm types between weekdays and weekends, using chi-squared, for a total of eight monitors with 562 patients. The most common operational procedure was caesarean section, of which 149 were performed (15.7%). Statistically significant differences existed in alarm types and procedures between weekdays and weekends. The number of alarms produced was 11.7 per patient. In total, 4698 (71.5%) alarms were technical and 1873 (28.5%) were physiological. The most common physiological alarm type was low pulse oximetry, with a total of 437 (23.3%). Of all the alarms, the number of alarms either acknowledged or silenced was 1234 (18.8%). A notable phenomenon in the study unit was alarm fatigue. Greater customisation of patient monitors for different settings is needed to reduce the number of alarms that do not have clinical significance.

Capturing the attentional response to clinical auditory alarms: An ERP study on priority pulses.

Clinical auditory alarms are often found in hospital wards and operating rooms. In these environments, regular daily tasks can result in having a multitude of concurrent sounds (from staff and patients, building systems, carts, cleaning devices, and importantly, patient monitoring devices) which easily amount to a prevalent cacophony. The negative impact of this soundscape on staff and patients' health and well-being, as well as in their performance, demand for accordingly designed sound alarms. The recently updated IEC60601-1-8 standard, in guidance for medical equipment auditory alarms, proposed a set of pointers to distinctly convey medium or high levels of priority (urgency). However, conveying priority without compromising other features, such as ease of learnability and detectability, is an ongoing challenge. Electroencephalography, a non-invasive technique for measuring the brain response to a given stimulus, suggests that certain Event-Related Potentials (ERPs) components such as the Mismatch Negativity (MMN) and P3a may be the key to uncovering how sounds are processed at the pre-attentional level and how they may capture our attention. In this study, the brain dynamics in response to the priority pulses of the updated IEC60601-1-8 standard was studied via ERPs (MMN and P3a), for a soundscape characterised by the repetition of a sound (generic SpO2 "beep"), usually present in operating and recovery rooms. Additional behavioural experiments assessed the behavioural response to these priority pulses. Results showed that the Medium Priority pulse elicits a larger MMN and P3a peak amplitude when compared to the High Priority pulse. This suggests that, at least for the applied soundscape, the Medium Priority pulse is more easily detected and attended at the neural level. Behavioural data supports this indication, showing significantly shorter reaction times for the Medium Priority pulse. The results pose the possibility that priority pointers of the updated IEC60601-1-8 standard may not be successfully conveying their intended priority levels, which may not only be due to design properties but also to the soundscape in which these clinical alarms are deployed. This study highlights the need for intervention in both hospital soundscapes and auditory alarm design settings.

Assessment of Alarm Fatigue Risk Among Oncology Nurses in Jordan.

Using technology in the clinical setting where clinical alarms frequently occur, resulting in many false alarms, which is called alarm fatigue, alarm fatigue may increase nurses' distraction, and that might negatively affect patient safety. This study aimed to assess alarm fatigue among oncology nurses in Jordan. A descriptive cross-sectional design was used in a non-profit specialized cancer center. A self-reported questionnaire was answered by nurses who participated in the study. A total of 222 questionnaires were analyzed with a more than 95% response rate. More than half of the sample (60.4%) were females. The participants were young nurses with a mean age of 25.18 ± 3.33 years. The total mean score of alarm fatigue was 31.62 ± 7.14 on a scale ranging from zero to 52. Post-hoc analysis showed that the palliative unit (25.73 ± 7.22) and emergency room (28.73 ± 6.62) had low scores of total mean alarm fatigue than remaining area of practice, such as the ICU (33.92 ± 6.99); p-value: .004. Alarm fatigue is a global issue affecting many practice areas. An educational program is recommended for nurses to learn how to deal with alarm fatigue. In order to effectively manage alarms, nurses' education and individual training are crucial.

Identifying Noise Sources & Alarm Hazards in ICUs – Occurrences. Tools to Minimize

ICU of a hospital is considered to be one of the most stressful and psychologically taxing working places because of the congregation of critically ill and severely injured patients. Patients with any life-threatening illnesses are admitted to the intensive care unit. The objective of ICUs is to assist such patients duly recover by providing them advanced treatment with the skillful application of advanced techniques. ICU is also a place where sophisticated equipment and machinery necessary to supervise and care for a seriously ill patient are strung together to meet the treatment needs of patients without the possibility of neglecting them. Part of the ICU architecture is medical device alarms. Clinical devices and other appliances sound hundreds of alarms per patient per day, creating a dissonance that can overwhelm, distract, and desensitize health care workers as well as patients. The hazards related to excessive noise and clinical alarms were conceived as a project when it was observed that the stress level of patients and care givers increased due to the noise coming out of these alarm systems. A study undertaken in one of the multispecialty Hospitals in Bhubaneswar to find out the possible sources of stress revealed that noise from alarms and other sources were proving to be a source of a hindrance for effective communication and contributing to patients’ stress. The results of our study indicate that behavioral modification alone is not adequate to control excessive noise. There is a need for further research involving the supportive involvement by clinicians, nurses, and paramedic and support staffs, along with effective medical device alarm management, and continuous process improvement methods and training.

PP300 [Quality and Safety » Data Management (EHR, documentation)]: REDUCING PATIENT HARM WITH CORRECT APPLICATION OF CLINICAL ALARM SYSTEMS WITHIN THE PICU AND CICU

1Department of Pediatrics, Sidra Medicine Hospital, Doha, Qatar; Weill Cornell Medicine - Qatar, Doha, Qatar 2Department of Pediatrics, Sidra Medicine Hospital, Doha, Qatar

Evaluating Alarm Classifiers with High-confidence Data Programming

Classification of clinical alarms is at the heart of prioritization, suppression, integration, postponement, and other methods of mitigating alarm fatigue. Since these methods directly affect clinical care, alarm classifiers, such as intelligent suppression systems, need to be evaluated in terms of their sensitivity and specificity, which is typically calculated on a labeled dataset of alarms. Unfortunately, the collection and particularly labeling of such datasets requires substantial effort and time, thus deterring hospitals from investigating mitigations of alarm fatigue. This article develops a lightweight method for evaluating alarm classifiers without perfect alarm labels. The method relies on probabilistic labels obtained from data programming—a labeling paradigm based on combining noisy and cheap-to-obtain labeling heuristics. Based on these labels, the method produces confidence bounds for the sensitivity/specificity values from a hypothetical evaluation with manual labeling. Our experiments on five alarm datasets collected at Children’s Hospital of Philadelphia show that the proposed method provides accurate bounds on the classifier’s sensitivity/specificity, appropriately reflecting the uncertainty from noisy labeling and limited sample sizes.

Promoting digital health equity through remote patient monitoring: A feasibility study.

441 Background: Remote patient monitoring (RPM) is a form of telemedicine involving collection and transmission of health data from patients to providers using non-invasive digital technology. RPM may offer earlier recognition of clinical deterioration to help reduce acute care use and improve healthcare outcomes. Studies of digital interventions in oncology have demonstrated reduction in symptom distress and unplanned hospitalizations but lack focus on minority patients. Studies of telehealth aiming to address disparities have not focused on patients with cancer. In this pilot study, we evaluated the feasibility of RPM among patients with cancer at a large urban medical center serving a racially and socioeconomically diverse population. Methods: We partnered with Current Health to provide an FDA-approved RPM wearable device, which included a secure HIPAA-compliant platform, to collect heart rate, temperature, respiration, oxygen saturation, and blood pressure. The kit included broadband access and a tablet to provide telehealth services. Oncology coordinators determined clinical inclusion and exclusion criteria of RPM initiation for patients. A centralized team of Nurse Practitioners (NPs) monitored alarms. Clinical alarms indicated abnormal vital signs; technical alarms indicated no data transmission for a 12-hour period. We measured feasibility by recruitment and retention, and used descriptive statistics to describe the study population, time enrolled on RPM, and alarms. Results: To date, we enrolled 39 patients on the RPM platform over a 14-month period with a weekly census of 10 patients undergoing RPM monitoring. Of the 39 patients, 19 (49%) were white, 10 (26%) Black, and 5 (13%) Asian; 3 (8%) patients identified as Hispanic. Nine (23%) patients had either primary or secondary Medicaid insurance. The average age was 57.9 years. The majority of patients (95%) had hematologic malignancies, all of whom were enrolled on hospital discharge. The mean length of time per patient enrolled with the device was 21.7 days. Over 14 months, there were 607 technical and 118 clinical alarms with an average of 2 clinical alarms per week addressed by NPs by phone, indicating low clinician burden. Conclusions: This pilot study demonstrated the feasibility of RPM in patients with cancer at home. Future studies should focus on equity-driven implementation of RPM in patients with cancer, as well as patient-reported and healthcare utilization outcomes to identify best practices in telemedicine implementation. RPM has promise to deliver high quality and equitable cancer care.

A Scoping Review of Integrated Medical Devices and Clinical Decision Support in the Acute Care Setting.

Seamless data integration between point-of-care medical devices and the electronic health record (EHR) can be central to clinical decision support systems (CDSS). The objective of this scoping review is to (1) examine the existing evidence related to integrated medical devices, primarily medication pump devices, and associated clinical decision support (CDS) in acute care settings and (2) to identify how acute care clinicians may use device CDS in clinical decision-making. The rationale for this review is that integrated devices are ubiquitous in the acute care setting, and they generate data that may help to contribute to the situational awareness of the clinical team necessary to provide individualized patient care. This scoping review was conducted using the Joanna Briggs Institute Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extensions for Scoping Review guidelines. PubMed, CINAHL, IEEE Xplore, and Scopus databases were searched for scholarly, peer-reviewed journals indexed between January 1, 2010 and December 31, 2020. A priori inclusion criteria were established. Of the 1,924 articles screened, 18 were ultimately included for synthesis, and primarily included articles on devices such as intravenous medication pumps and vital signs machines. Clinical alarm burden was mentioned in most of the articles, and despite not including the term "medication" there were many articles about smart pumps being integrated with the EHR. The Revised Technology, Nursing & Patient Safety Conceptual Model provided the organizational framework. Ten articles described patient assessment, monitoring, or surveillance use. Three articles described patient protection from harm. Four articles described direct care use scenarios, all of which described insulin administration. One article described a hybrid situation of patient communication and monitoring. Most of the articles described devices and decision support primarily used by registered nurses (RNs). The articles in this review discussed devices and the associated CDSS that are used by clinicians, primarily RNs, in the daily provision of care for patients. Integrated device data provide insight into user-device interactions and help to illustrate health care processes, especially the activities when providing direct care to patients in an acute care setting. While there are CDSS designed to support the clinician while working with devices, RNs and providers may disregard this guidance, and defer to their own expertise. Additionally, if clinicians perceive CDSS as intrusive, they are at risk for alarm and alert fatigue if CDSS are not tailored to sync with the workflow of the end-user. Areas for future research include refining inclusion criteria to examine the evidence for devices and their CDS that are most likely used by other groups' health care professionals (i.e., doctors and therapists), using integrated device metadata and deep learning analytics to identify patterns in care delivery, and decision support tools for patients using their own personal data.

Debonding-On-Demand Polymeric Wound Patches for Minimal Adhesion and Clinical Communication.

Herein, a multifunctional bilayer wound patch is developed by integrating a debonding‐on‐demand polymeric tissue adhesive (DDPTA) with an ionic conducting elastomer (ICE). As a skin adhesive layer, the DDPTA is soft and adherent at skin temperature but hard and non‐tacky when cooled, so it provides unique temperature‐triggered quick adhesion and non‐forced detachment from the skin. During use, the dense surface of the DDPTA prevents blood infiltration and reduces unnecessary blood loss with gentle pressing. Moreover, its hydrophobic matrix helps to repel blood and prevents the formation of clots, thus precluding wound tearing during its removal. This unique feature enables the DDPTA to avoid the severe deficiencies of hydrophilic adhesives, providing a reliable solution for a wide range of secondary wound injuries. The DDPTA is versatile in that it can be covered with ICE to configure a DDPTA@ICE patch for initiating non‐verbal communication systems by the fingers, leading toward sign language recognition and a remote clinical alarm system. This multifunctional wound patch with debonding‐on‐demand can promote a new style of tissue sealant for convenient clinical communication.

Remote care and triage of obstetric patients with COVID-19 in the community: operational considerations

BackgroundDuring the SARS-CoV-2 (COVID-19) pandemic, routine antenatal care was disrupted, and pregnant women positive for COVID-19 were at increased risk of caesarean section, intensive care admission or neonatal unit admission for their baby. Virtual care and telehealth can reduce barriers to care and improve maternity outcomes, and adoption has been encouraged by health authorities in the United Kingdom.MethodsNorfolk and Norwich University Hospitals Trust deployed a flexible maternity virtual ward (MVW) service using the Current Health platform to care for pregnant women during the pandemic. Patients were monitored either intermittently with finger pulse oximetry or continuously with a wearable device. We outline the MVW technology, intervention and staffing model, triage criteria and patient feedback, as an example of an operational model for other institutions.ResultsBetween October 2021 and February 2022, 429 patients were referred, of which 228 were admitted to the MVW. Total bed-days was 1,182, mean length of stay was 6 days (SD 2.3, range 1–14 days). Fifteen (6.6%) required hospital admission and one (0.4%) critical care. There were no deaths. Feedback alluded to feelings of increased safety, comfort, and ease with the technology.ConclusionsThe MVW offered a safety net to pregnant women positive for COVID-19. It provided reassurance for staff, while relieving pressures on infrastructure. When setting up similar services in future, attention should be given to identifying clinical champions, triage criteria, technology and alarm selection, and establishing flexible escalation pathways that can adapt to changing patterns of disease.

Premature ventricular complexes during continuous electrocardiographic monitoring in the intensive care unit: Occurrence rates and associated patient characteristics.

This study examined the occurrence rate of specific types of premature ventricular complex (PVC) alarms and whether patient demographic and/or clinical characteristics were associated with PVC occurrences. Because PVCs can signal myocardial irritability, in-hospital electrocardiographic (ECG) monitors are typically configured to alert nurses when they occur. However, PVC alarms are common and can contribute to alarm fatigue. A better understanding of occurrences of PVCs could help guide alarm management strategies. A secondary quantitative analysis from an alarm study. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was followed. Seven PVC alarm types (vendor-specific) were described, and included isolated, couplet, bigeminy, trigeminy, run PVC (i.e. VT >2), R-on-T and PVCs/min. Negative binomial and hurdle regression analyses were computed to examine the association of patient demographic and clinical characteristics with each PVC type. A total of 797,072 PVC alarms (45,271 monitoring hours) occurred in 446 patients, including six who had disproportionately high PVC alarm counts (40% of the total alarms). Isolated PVCs were the most frequent type (81.13%) while R-on-T were the least common (0.29%). Significant predictors associated with higher alarms rates: older age (isolated PVCs, bigeminy and couplets); male sex and presence of PVCs on the 12-lead ECG (isolated PVCs). Hyperkalaemia at ICU admission was associated with a lower R-on-T type PVCs. Only a few distinct demographic and clinical characteristics were associated with the occurrence rate of PVC alarms. Further research is warranted to examine whether PVCs were associated with adverse outcomes, which could guide alarm management strategies to reduce unnecessary PVC alarms. Targeted alarm strategies, such as turning off certain PVC-type alarms and evaluating alarm trends in the first 24 h of admission in select patients, might add to the current practice of alarm management.

A feasibility study of remote patient monitoring among vulnerable patients with cancer.

e13652 Background: Patients with cancer have high rates of healthcare utilization due to complications of disease and treatment. Early identification of patient illness may help reduce acute care use and improve quality of care. Remote patient monitoring (RPM), a type of telemedicine involving collection and transmission of health data from a patient’s home to clinicians, has promise to alleviate disparities by providing timely access and early intervention, particularly during the COVID-19 pandemic. Studies of digital interventions in oncology have demonstrated reduction in symptom distress and unplanned hospitalizations but lack focus on minority patients whereas studies of telehealth aiming to address disparities have not focused on patients with cancer. In this pilot study, we aimed to evaluate the feasibility of RPM among patients with cancer at a large urban medical center serving a racially and socioeconomically diverse population. Methods: We partnered with a secure HIPAA-compliant platform and FDA-approved RPM device, Current Health, which monitored heart rate, temperature, respiration, oxygen saturation, and blood pressure. The kit included broadband access and a tablet to provide telehealth services. Oncology Clinicians determined clinical inclusion and exclusion criteria of RPM initiation for patients on the bone marrow transplant service and patients with myeloma and lung cancer. A centralized team of Nurse Practitioners (NPs) monitored alarms. Clinical alarms indicated abnormal vital signs; technical alarms indicated no data transmission for a 12-hour period. We measured feasibility by recruitment and retention, and used descriptive statistics to describe the study population, time enrolled on RPM, and alarms. Results: To date, we enrolled 30 patients on the RPM platform over a 10-month period with a weekly census of 9-10 patients undergoing RPM monitoring. Of the 30 patients, 17 (57%) were white, 7 (23%) Black, and 2 (7%) Asian; 2 patients (7%) identified as Hispanic. The average age was 57.4 years. The majority of patients (93%) had hematologic malignancies, all of whom were enrolled on hospital discharge. Of the 2 patients with lung cancer, 1 patient was enrolled from the outpatient setting and 1 following hospital discharge. The mean length of time per patient enrolled with the device was 21.7 days. Over 10 months, there were 393 technical and 62 clinical alarms with an average of 3 clinical alarms per week addressed by NPs by phone, indicating low clinician burden. Conclusions: This pilot study demonstrated the feasibility of RPM monitoring in patients with cancer. Future studies should evaluate patient-reported and healthcare utilization outcomes, as well as barriers to reimbursement. The identification of best practices in telemedicine implementation can accelerate adoption and increase high quality, timely, and equitable cancer care.

Nurses’ clinical alarm-related behaviors and influencing factors in China†

Abstract Objective To explore the nurses’ behaviors regarding clinical alarms, analyze the related influencing factors, and provide rationales for alarm management. Methods A cross-sectional survey was conducted in China. The self-made questionnaire of nurses’ clinical alarm-related knowledge, attitude, and behavior (NCAKAB) was used. Results The valid response rate was 98.66% (n = 2368). The average nurses’ clinical alarm-related behaviors (NCAB) score was 65.14 ± 7.95 (out of 85). The dimension scores of NCAB from high to low were alarm learning (4.02 ± 0.85, out of 5), alarm response (27.99 ± 3.64, out of 35), alarm setting (19.24 ± 3.88, out of 25), alarm recognition (7.63 ± 1.68, out of 10) and alarm notification (6.25 ± 1.84, out of 10). There were significant differences in alarm behavior scores between nurses of different ages (F = 4.619, P = 0.000), nursing stints (F = 9.564, P = 0.000), professional titles (F = 4.425, P = 0.004), departments (F = 9.166, P = 0.000), and hospital levels (t = 2.705, P = 0.007). The study showed that nurses’ total alarm behavior scores were positively correlated with the total alarm knowledge score (r = 0.267; P < 0.001) and the total alarm attitude score (r = 438; P < 0.001). Conclusions Nurses scored highest in alarm learning, followed by alarm response, alarm setting, alarm recognition, and alarm notification behavior. The factors that influenced alarm behavior included age, title, department, nursing stint, hospital level, professional title, alarm-related training, willingness to participate in alarm-related training, whether or not departments have improved alarm management over the last 3 years, and whether or not departments have formulated norms for alarm management. Nurses with higher scores for clinical alarm knowledge had higher correlating scores for alarm behavior; similarly, nurses with higher scores for clinical alarm attitude had higher scores for alarm-related behavior.

Critical Care Nurses' Perceptions of Clinical Alarm Management on Nursing Practice.

The alarm management of physiological monitoring systems is a key responsibility of critical care nurses. However, the high numbers of false and nonactionable (true but clinically irrelevant) alarms cause distractions to healthcare professionals, interruptions to nursing workflow, and ignoring of crucial tasks. Therefore, understanding how nurses manage large amounts of alarms in their daily work could provide a direction to design interventions to prevent adverse patient care effects. A qualitative design with focus group interviews was conducted with 37 nurses in Taiwan. Content analysis was performed to analyze the interview data, and four main themes were derived: (1) the foundation stone of critical care nursing practice; (2) a trajectory adaptation of alarms management; (3) adverse impacts on the quality of care and patient safety; and (4) a hope for multimodal learning alternatives and wireless technology. Nurses manage alarm parameter settings influenced not only by their knowledge and skills of patient care, but also in accordance with the three dimensions of technology, human, and organization evaluation framework. Customized alarm management training alternatives, patient-centered care values, and application of wireless technology are the suggested approaches to enhance nursing care and minimize the risk of adverse events.

Critical care nurses' perceptions and practices towards clinical alarms.

Muted or controlled alarms resulting from alarm fatigue have become a threat to patient safety and several institutions are aware of this risk. This study aimed to investigate critical care nurses' perceptions of medical device alarms, alarm fatigue, and alarm management practices. This descriptive study investigated 48 nurses working at two intensive care units (ICUs) within a single university hospital, in South Korea. They were asked to complete a self-administered questionnaire about their perception of the ICU medical device alarm, alarm fatigue, and related management practices. The response rate was 100%. Critical care nurses experienced a moderate or higher level of alarm fatigue, scoring 29.1 out of 40. Participants identified the items "Frequent false alarms, which lead to reduced attention or response to alarm when they occur," and "Inadequate staff" as the most important issues for alarm management. The most frequently involved item in alarm management practice was "I only use infusion pumps for drugs that require precise dose." Alarm management practices among the nurses differed significantly according to ICU clinical career and experience of patient safety accidents. This study highlights the need to develop a standardized medical device alarm management protocol that can help identify different alarms correctly and respond to them rapidly and appropriately. It is necessary to reduce alarm fatigue and promote safe and effective alarm management practices among critical care nurses through sufficient education and steady training. Alarm fatigue should also be mitigated by employment of sufficient nursing personnel in ICUs.