Determinants of Alarm Fatigue among Nurses Working in Thika Level 5 Hospital, Kenya
Published: 2024-06-20
Page: 139-156
Issue: 2024 - Volume 7 [Issue 1]
Emmanuel Keya
*
Department of Health Sciences, School of Nursing, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya.
Nilufa Jivraj
Department of Health Sciences, School of Nursing, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya.
George Njoroge
Department of Health Sciences, School of Nursing, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya.
*Author to whom correspondence should be addressed.
Abstract
Introduction: One of the main sources of health technology risks is clinical alarms, such as those for cardiac monitors and mechanical ventilation. Alarm Fatigue is the cause of these risks. Alarm weariness is the psychological result of too many alarms going off in a medical setting, which makes Nurses miss real alarms that are clinically meaningful, hence the objectives of this study was to assess the level of alarm fatigue among Nurses working and assess Alarm Management strategies utilized by Nurses working at Thika Level 5 Hospital, Kiambu Kenya.
Methodology: The study design that was employed in this study is descriptive cross-sectional design. Structured self-administrated questionnaires were used to collect data. The researcher used census sampling where the entire population Registered Nurses working in the renal, theatre, casualty and emergency and critical care department. The data was analyzed using SPSS version 25.0. The findings were presented in tables, graphs and figures. The analysis comprised of descriptive statistics, frequencies, mean, and standard deviations. Inferential statistics included chi-square test for independence (X2).
Results: The study participants consisted of 56 Nurses and the response rate in this study was 82.1%. The majority of respondents were female, constituting 76.1% of the respondents. The age group of 31-40 years comprises the majority of respondents, accounting for 78.3% of the total. The overwhelming majority of respondents rated mechanical ventilators as having the highest alarm frequency (95.7%) followed by 58.7% of the respondents monitors as the main source of alarms. 73.9% of participants identified mechanical ventilator alarms as the most challenging to troubleshoot or operate. Nearly half of the respondents (47.8%) indicated that they are likely to trust clinical alarms to some extent.
Discussion: Majority of nurses (95.7%) encountered clinical alarms during their work shifts. Mechanical ventilators and cardiac monitors were rated as having the highest alarm frequency, while patient call systems and electrical beds were perceived to have the lowest alarm frequency.
Recommendations: Offering training on alarm management, optimizing staffing levels, and streamlining equipment interfaces to mitigate alarm fatigue and enhance patient care quality.
Keywords: Clinical alarm, alarm fatigue, nurses and alarm, critical care and alarms
How to Cite
References
The joint commission, sound the alarm: Managing physiologic monitoring systems. Jt Comm Perspect Patient Saf. 2018; 11(12):6-11.
Cheung WK, Chau LS, Mak ILL. Prevalence of alarms in intensive care units, and its relationship with nursing. Journal of Perioperative and Critical Intensive Care Nursing; 2016.
Luna AA, Silva RCLD, Barbosa MTS. The influence of nursing activities score on clinical alarms service. Scelo; 2020. Available:https://doi.org/10.1590/0034-7167-2018-0963
Lewandowska K, Weisbrot M, Cieloszyk A, Mędrzycka-Dąbrowska W, Krupa S, Ozga D. International Journal of Public Health; 2020. Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7697990/
Yue L, Plummer V, Cross W. The effectiveness of nurse education and training for clinical alarm response and management: A systematic review. Journal of Clinical Nursing. 2018;17-18:2511-2526. DOI: 10.1111/jocn.13605
West, Abbott and Probst. Alarm fatigue: A concept analysis. 2019;18(2):1-1.
Walsh-Irwin C, Jurgens C. Proper skin preparation and electrode placement decreases alarms on a telemetry unit, Dimensions Critical Care Nursing. 2015;34 (3):134-139.
Sue Sendelbach RP, CCNS Marjorie Funk RP. Alarm fatigue; A patient safety concern. AACN Advanced Critical Care. 2013;24 (4):378-386.
Storm J, Chen HC. The relationships among alarm fatigue, compassion fatigue, burnout and compassion satisfaction in critical care and step-down nurses; 2020. Available:https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.15555
Sowan AK, Gomez, Michelle T, Tarriela AF, Reed C. Calhoun and Michael B. JMIR Publications; Advancing Digital Health and Open Science; 2016. Available:https://humanfactors.jmir.org/2016/1/e1/
WSAASP, Sendelbach S. Stop the noise: A quality improvement project to decrease electrocardiographic nuisance alarms. Critical Care Nurse. 2015;35(4):15-22.
Cvach M, Biggs M, Rothwell K, CHC. Daily electrode change and effect on cardiac monitor alarms: An evidence-based practice approach. J Nurs Care Qual. 2013;28(3):265–271.
Sendelbach S, Funk M. Alarm fatigue: A patient safety concern. Lippincot Nursing Center. 2015;378 - 386.
Seiferta M, Tola DH, Thompson J, McGugan L, Smallheer B. Effect of bundle set interventions on physiologic alarms and alarm fatigue in an intensive care unit: A quality improvement project. Intensive and Critical Care Nursing. 2021; 67:103098. Available:https://www.sciencedirect.com/science/article/pii/S0964339721000872?casa_token=2WzSsyZ3wtoAAAAA:o4dyxqVBBP1ySjXYhSNfOjD9wavCkUu5cyPsKk7zUcwbWHuZ0aWh3vo8bwLVC_zY-PgnAeUw-mE
Schmid F, Goepfert M, Reuter D. Patient monitoring alarms in the ICU and in the operating room. Journal of critical Care. 2018;216.
Rossum MCV, Vlaskamp LB, Posthuma LM, Visscher MJ, Breteler MJM, Hermens HJ, Kalkman CJ, Preckel B. Journal of Clinical Monitoring and Computing; 2021. Available:https://link.springer.com/article/10.1007/s10877-021-00666-4
Ramlaul A, Chironda G. Alarms in the ICU: A study investigating how ICU nurses respond to clinical alarms for patient safety in a selected hospital in KwaZulu-Natal Province, South Africa. South African Journal Of Critical Care Nursing. 2021;57-53.
Poole S, Shah N. Addressing vital sign alarm fatigue using personalized alarm thresholds. Bio Computing. 2018;472-483.
Pelter MM, Drew BJ. Patient Safety Network; 2015. Available:https://psnet.ahrq.gov/web-mm/harm-alarm-fatigue
Zhao Y, Wan M, Liu H, Ma M. The current situation and influencing factors of the alarm fatigue of nurses’ medical equipment in the intensive care unit based on intelligent medical care. Journal of Healthcare Engineering, p. Article ID 9994303 Available:https://doi.org/10.1155/2021/9994303, 2021
Pelter MM, Mortara D, Badilini F. Computer assisted patient monitoring: Associated patient, clinical and ECG characteristics and strategy to minimize false alarms. The Application of Computer Techniques to ECG Interpretation). 2021;2(4):459-471. Available:https://doi.org/10.3390/hearts2040036
Mahmoud HWS. Assessment Knowledge of Nurses about clinical alarms in critical setting in ELRebat University Hospital; 2017. Available:http://repository.ush.sd:8080/xmlui/handle/123456789/791
Luo B, Mc Loone M, Rasooly IR, Craig S, Muthu N, Won J, Ruppel H, Bonafide CP. Protocol for a New Method to Measure Physiologic Monitor Alarm Responsiveness. Biomedical Instrumentation and Technologies. 2020;54(6):389–396. Available:https://doi.org/10.2345/0899-8205-54.6.389
Lukasewicz C, Andersson Mattox E. Patient safety. Understanding clinical alarm safety. American Journal of critical Care Nursing. 2015;35(4):45-57.
Lukasewicz C, Mattox E. Understanding clinical alarm safety. Critical Care Nurses. 2015;35(4):45-57.
Lee SJ, Yun Mi L, Seo EJ, Son YJ. Impact of hospital nurses’ perception on clinical alarms and patient safety culture on alarm management practice. International Journal of public health and environmental Research. 2021;18(8):4018.
Available:https://doi.org/10.3390/ijerph18084018
Cvach M, Doyle P, Wong SY, Letnaunchyn K, Dell D, Mamaril M. Decreasing Pediatric PACU noise level and alarm fatigue: a quality improvement initiative to improve safety and satisfaction. Journal of Peri Anesthesia Nursing. 2020;357-364.
Casey S, Avalos G, Dowling M. Critical care nurses’ knowledge of alarm fatigue and practices towards alarms: A multicentre study. Intensive Crit. Care Nurs. Intensive Care Nursing. 2018;48:36–41.
Busch-Vishniac I. Death by alarm: An error model of hospital alarms. The Journal of the Acoustical Society of America. 2016;139:2201.
Bourgi H, Sabbah H, Al'Jamil A, Sabbah I. Evaluating the alarm fatigue and its associated factors among clinicians in critical care units. Indian Journal of Clinical Medicine. 2020;1(1):9.
Walsh BK, Waugh JB. Alarm strategies and surveillance for mechanical ventilation. Journal of Respiratory Care. 2020;65(6): 820-831. Available:https://doi.org/10.4187/respcare.07546
Keller J. Clinical alarm hazards: A top ten health technology safety concern. Journal of Electrocardiology. 2012;45:588–591. DOI: 10.1016/j.jelectrocard.2012.08.050
I. Joint Commision. Hospital Inter National Patient Safety Goals; Goal 6 - Reduce the harm associated with clinical alarm systems. The Joint Commision, Pennsylvania; Washington DC; 2020.
Jamsa JO, HUutela K, Tapper AM, Lehtonen L. Clinical alarms and alarm fatigue in a University Hospital Emergency Department; A retrospective Analysis. Journal of Emergency Anaesthsiology; 2021.
Horkan MA. Alarm fatigue and patient safety. Nephrol Nurs J. 2014;41 (1):83-85.
Schmidt B. Alarm Fatigue Hazards: The Sirens Are Calling; 2020.
Available:https://www.psqh.com/analysis/alarm-fatigue-hazards-the-sirens-are-calling/
Graham K, Cvach M. Monitor alarm fatigue: Standardizing use of physiological monitors and decreasing nuisance alarms. Am J Crit Care. 2010;28–34.
Gorisek R, Mayer C, Hicks B, Barnes J. An evidence-based initiative to reduce alarm fatigue in a burn intensive care unit. Journal of Critical Care Nursing. 2021;29-37.
Funk M, Clark JT, Bauld TJOJC, CP. Attitudes and practices related to clinical alarms. American Journal of critical care Nursing. 2014;23(3):9-e18.
Foley L, Anderson CJ, Schutz M. Re-Sounding Alarms: Designing Ergonomic Auditory Interfaces by Embracing Musical Insights; 2020. Available:https://doi.org/10.3390/healthcare8040389
Despins LA. Factors influencing when intensive care unit nurses go to the bedside to investigate patient related alarms; A descriptive qualitative study. Intensive and critical care Nursing 2017; 2017.
Christensen M, Dodds A, Sauer J, Watts N. Alarm setting for the critically ill patient: A descriptive pilot survey of nurses’ perceptions of current practice in an Australian Regional Critical Care Unit. Intensive Critical Care Nursing. 2014;30: 204–210.
Cho OM, Kim H, Young Whee Lee. Clinical Alarms in Intensive Care Units: Perceived Obstacles of Alarm Management and Alarm Fatigue in Nurses; 2016. Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756058/#:~:text=Four%20of%20the%209%20types,rang%20per%20patient%20per%20hour
Welch J. Alarm fatigue hazards: The sirens are calling. Journal of Anaesthesia. 2021;307:1591.
Rodger J, Baker K. Data for: Assessing Causes of Alarm Fatigue in Long-Term Acute Care and Its Impact on Identifying Clinical Changes in Patient Conditions; 2020.
Available:https://data.mendeley.com/datasets/dr5hvdydbv/1
Goepfert MS, Reuter DA. Patient monitoring alarms in the ICU and in the operating room. Biomed central (BMC) article. 2018;216:17.
Bliss JP, Gilson RD, Deaton JE. Human probability matching behaviour in response to alarms of varying reliability. Journal of Clinical Ergonomics. 2017;38 (11):1995.
Bi J, Yin X, Li H, Gao R, Zhang Q, Zhong T, Zan T, Guan B, Li Z. Effects of monitor alarm management training on nurses’ alarm fatigue: A randomised controlled trial. Journal of Clinical Nursing. 2020;29 (21-22):4203-4216.
Baker' K, Rodger J. Assessing causes of alarm fatigue in long-term acute care and its impact on identifying clinical changes in patient conditions. Informatics in Medicine Unlocked. 2020; (18).
Asadi N, Salmani F, Asgari N, Salmani M. Alarm fatigue and moral distress in ICU nurses in COVID-19 pandemic. British Medical Journal. 2022;125.
ACCE Foundation TH. Journal of Clinical Engineering: Clinical Alarms Task Force Impact of Clinical Alarms on Patient Safety. 2017;32(1):22-33.
Etikan I, Musa SA, Alkassim RS. Comparison convinience sampling and purposive sampling; census. American Journal of Theoritical and Applied Statistics. 2016;1-4.
T. The Joint Commission. Medical Device Alarm Safety in Hospitals. The Joint Commission; 2013.
Meng’anyi LW, Omondi LA, Muiva MN. Assessment of nurses interventions in the Management of Clinical Alarms in the critical care unit, Kenyatta National Hospital, a cross sectional study. Biomed Central Nursing. 2017;16:41.
Lewandowska K, Weisbrot M, Cieloszyk A, Krupa S, Ozga D. Impact of alarm fatigue on the work of nurses in an intensive care environment—a systematic review. International Journal of Environmetal Research and Public Health. 2020;22-34.
Sowan AK, Vera AG, Fonseca EI, Reed CC, Tarriela AF, Berndt AE. Nurse competence on physiologic monitors use: Toward eliminating alarm fatigue in intensive care units. The Open Medical Informatics Journal; PMCID: PMC5420192. 2017; 1- 11.