Decreasing inconsistent alarms notifications: a pragmatic clinical trial in a post-anesthesia care unit

IF 1.7 4区医学 Q2 ANESTHESIOLOGY Brazilian Journal of Anesthesiology Pub Date : 2024-05-01 DOI:10.1016/j.bjane.2023.07.013

Saullo Queiroz Silveira , Rafael Sousa Fava Nersessian , Arthur de Campos Vieira Abib , Leonardo Barbosa Santos , Fernando Nardy Bellicieri , Karen Kato Botelho , Helidea de Oliveira Lima , Renata Mazzoni de Queiroz , Gabriel Silva dos Anjos , Hermann dos Santos Fernandes , Glenio B. Mizubuti , Joaquim Edson Vieira , Leopoldo Muniz da Silva

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Abstract

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.

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减少不一致的警报通知：麻醉后护理病房的实用临床试验。

背景：警报提醒医护人员注意正常/生理状态的偏差。然而，当警报的高音和多样性使临床医生不知所措时，可能会出现警报疲劳，从而导致警报被禁用、暂停和/或忽略。我们的目的是确定一项关于定制床旁监护仪报警设置的员工教育计划是否能减少麻醉后护理病房（PACU）中不一致的报警：这是一项前瞻性、分析性、定量、实用、开放标签、单臂研究。在实施教育计划之前（P1）和之后（P2），对 PACU 入院时的结果进行评估。根据临床一致性选择了心率、血压和血氧饱和度警报：共纳入 260 名患者，收集到 344 个临床警报，其中干预前（P1）270 个（78.4%），干预后（P2）74 个（21.6%）。在 P1 的 270 次警报中，45.2% 的警报不一致（即误报），而在 P2 的 74 次警报中，9.4% 的警报不一致。警报一致的患者在 P1 中占 30%，在 P2 中占 27%（P = 0.08）。发出不一致警报的患者在 P1 中占 25.4%，在 P2 中占 3.8%。在 P2 组中，被忽略的一致性警报从 21.5% 降至 2.6%（p = 0.004）。在对年龄、性别和 ASA 身体状况进行调整后，教育计划是不一致临床警报的保护因素（OR = 0.11 [95% CI 0.04-0.3]; p < 0.001）：结论：事实证明，在 PACU 入院时自定义警报设置是防止多参数监护仪发出不一致警报通知的保护因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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