Evaluating the Alarm Fatigue and its Associated Factors among Clinicians in Critical Care Units



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Submitted Dec 6, 2020
Published Dec 27, 2020
10.24018/clinicmed.2020.1.1.8

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The Alarm Fatigue (AF) occurs when clinicians are exposed to a large number of false alarms which can cause alarm desensitization. AF is a well-recognized patient safety concern in intensive care settings. This study aims to evaluate the alarm fatigue in clinicians along with its associated factors in critical care settings using a valid and reliable instrument. During 2020, a cross-sectional study was conducted among clinicians working in Critical care units in Lebanon and enrolled 337 participants via self-administered electronic questionnaire. The survey included questions on socio-demographic characteristics, health status, staff recognition of alarms and alarm management, and Alarm Fatigue questionnaire. The translation and cultural adaptation of the Alarm Fatigue questionnaire in Arabic followed a standardized protocol.  The mean age of participants was 30.79 (SD=7.26; median=29) years, 61.4% were women. 77.2% were nursing staff and 22.8% were physicians. 78.8% worked in private hospitals.  41.3% of staff were from neonatal and pediatric intensive care units. 58.8% of clinicians find that more than 50% of alarms were irrelevant, and 69.4% deactivate and silence the alarm when annoyed. The Alarm Fatigue questionnaire has good reliability and validity. The Cronbach alpha was 0.69 which establishes good reliability for group comparison. AF in physicians (OR=2.25; 95%CI=-0.01-4.50, p=0.05) and Registered Nurses (OR=2.64; 95%CI=-0.52-4.75, p=0.02) was higher than in nurses and head nurses; AF was more frequent in ICUs units (OR=2.1; 95%CI=0.05-4.18, p=0.04) compared to other critical care units.  The AF was higher for the clinicians that deactivate and silence the alarm when annoyed compared to other subgroup (OR=4.14, 95%CI=2.75–5.53, p<0.001).  The AF was 3.14 times frequent for the staff who reported stress (p<0.001). Non-actionable alarms occurred frequently and associated to alarm fatigue.  Physicians score slightly higher alarm fatigue than nurses. The Arabic Alarm Fatigue questionnaire has a good psychometric properties and suitable to evaluate the AF in Lebanon.  Multidisciplinary approaches can be established to minimize the incidence of AF using a valid and reliable instrument.

Keywords: Alarm Fatigue questionnaire clinicians clinical alarms critical care units

References

  1. R. Joshi, H. v. d. Mortel, L. Feijs, P. Andriessen and C. v. Pul, "The heuristics of nurse responsiveness to critical patient monitor and ventilator alarms in a private room neonatal," PLoS ONE, vol. 12, no. 10, p. e0184567, 2017.
     Google Scholar
  2. M. Salous, J. Alkhawaldeh, S. Kewan, H. Aburashideh, D. B. Hani and A. Alzayyat, "Nurses' Attitudes Related To Alarm Fatigue in Critical Care Units: A Systematic Review," IOSR Journal of Nursing and Health Science, vol. 6, no. 2, pp. 62-66, 2017.
     Google Scholar
  3. S. Ashrafi, S. N. Mehri and B. Nehrir, "Designing an Alarm Fatigue Assessment Questionnaire: Evaluation of the Validity and Reliability of an Instrument," Journal of Critical Care Nursing, vol. 10, 2017.
     Google Scholar
  4. K. J. Ruskin and James P Bliss, "Alarm Fatigue and Patient Safety," TheAnesthesia Patient Safety Foundation Newsletter (APSF Newsletter). , vol. 34, no. 1, p. 1–28, 2019.
     Google Scholar
  5. T. A. Bach, L.-M. Berglund and E. Turk, "Managing alarm systems for quality and safety in the hospital setting," BMJ Open Quality, vol. 7:e000202. , 2018.
     Google Scholar
  6. A. K. Sowan, A. G. Verab, E. I. Fonsecab, C. C. Reed, A. F. Tarriela and A. E. Berndt, "Nurse Competence on Physiologic Monitors Use: Toward Eliminating Alarm Fatigue in Intensive Care Units," The Open Medical Informatics Journal, vol. 11, pp. 1-11, 2017.
     Google Scholar
  7. B. J. Drew, P. Harris, J. K. Ze`gre-Hemsey, T. Mammone, D. Schindler, R. Salas-Boni, Y. Bai, A. Tinoco, Q. Ding and X. Hu., "Insights into the Problem of Alarm Fatigue with Physiologic Monitor Devices: A Comprehensive Observational Study of Consecutive Intensive Care Unit Patients," PLoS ONE 9(10): e110274., 2014.
     Google Scholar
  8. J. L. D. a. J. D. Young, "An investigation of sound levels on intensive care units with reference to the WHO guidelines," Critical Care 2013,, vol. 17:R187, 2013.
     Google Scholar
  9. K. S. Simons, E. Verweij, P. M. C. Lemmens, S. Jelfs, M. Park, P. E. Spronk, J. P. C. Sonneveld, H.-M. Feijen, M. S. v. d. Steen, A. G. Kohlrausch, M. v. d. Boogaard and C. P. C. d. Jager, "Noise in the intensive care unit and its influence on sleep quality: a multicenter observational study in Dutch intensive care units," Critical Care volume 22, Article number: 250 (2018) C, vol. 22, 2018.
     Google Scholar
  10. A. C. Bridi, T. Q. Louro and R. C. L. d. Silva, "Clinical Alarms in intensive care: implications of alarm fatigue for the safety of patients," Rev. Latino-Am. Enfermagem, vol. 22, no. 6, pp. 1034-40, 2014.
     Google Scholar
  11. R. J. Pugh, "The impact of noise in the intensive care unit," critical & emergenc y care, 2007.
     Google Scholar
  12. H. Mokarami, V. Gharibi, H. O. Kalteh, M. F. Kujerdi and R. Kazemi, "Multiple environmental and psychosocial work risk factors and sleep disturbances," e.Proofing, 2020.
     Google Scholar
  13. H. Ruppel, L. D. Vaux, D. Cooper, S. Kunz, B. Duller and M. Funk, "Testing physiologic monitor alarm customization software to reduce alarm rates and improve nurses’ experience of alarms in a medical intensive care unit," PLoS ONE, vol. 13, no. 10, p. 1e0205901. , 2018.
     Google Scholar
  14. O. M. Cho, H. Kim, Y. W. Lee and I. Cho, "Clinical Alarms in Intensive Care Units: Perceived Obstacles of Alarm Management and Alarm Fatigue in Nurses," Healthc Inform Res. (Healthcare Informatics Research), vol. 22, no. 1, pp. 46-53, 2016.
     Google Scholar
  15. S. Sendelbach and M. Funk, "Alarm Fatigue A Patient Safety Concern," AACN Advanced Critical Care, vol. 24, no. 4, pp. 378 - 386, 2013.
     Google Scholar
  16. C. Torabizadeh, A. Yousefinya, F. Zand, M. Rakhshan and M. Fararooei, "A nurses’ alarm fatigue questionnaire: development and psychometric properties," Journal of Clinical Monitoring and Computing (J Clin Monit Comput), 2016.
     Google Scholar
  17. J. Nguyen, K. Davis, G. Guglielmello and S. P. Stawicki, "Combating Alarm Fatigue: The Quest for More Accurate and Safer Clinical Monitoring Equipment," March 12th 2019.
     Google Scholar
  18. K. J. Ruskina and D. Hueske-Kraus, "Alarm fatigue: impacts on patient safety," Curr Opin Anesthesiol, vol. 28, p. 685–690, 2015.
     Google Scholar
  19. A. K. Sowan, A. F. Tarriela, T. M. Gomez, C. C. Reed and K. M. Rapp, "Nurses' Perceptions and Practices Toward Clinical Alarms in a Transplant Cardiac Intensive Care Unit: Exploring Key Issues Leading to Alarm Fatigue," JMIR Hum Factors, vol. 22, no. 1, p. e3, 2015.
     Google Scholar
  20. J. E. Bartlett, J. W. Kotrlik and C. C. Higgins, "Organizational Research: Determining Appropriate Sample Size in Survey Research," Information Technology, Learning, and Performance Journal, vol. 19, no. 1, pp. 43-50, 2001.
     Google Scholar
  21. O. o. N. i. Lebanon, "Statistics issued by the Order," Order of Nurses in Lebanon, Beirut, 2019.
     Google Scholar
  22. I. Sabbah, N. Drouby, S. Sabbah, N. Retel-Rude and M. Mercier, "Quality of life in rural and urban populations in Lebanon using SF 36 Health Survey," Health and Quality of Life Outcomes, vol. 1: 30, 2003.
     Google Scholar
  23. J. E. J. Ware, SF-36 health survey manuel and interpretation guide, Second printing ed., Boston: . , MA: The Health Institute, New England Center, 1997).
     Google Scholar
  24. H. A. Miot, "Assessing normality of data in clinical and experimental trials (editorial)," Jornal Vascular Brasileiro (J Vasc Bras. ), vol. 16, no. 2, pp. 88-91, 2017.
     Google Scholar
  25. A. M. A. F. Sliman, W. W. A. ElAziz and H. E. Mansour, "The effect of alarm fatigue nursing management protocol on critical care nurses' experience.," J Intensive Crit Care Nurs. , vol. 3, no. 4, 2020.
     Google Scholar
  26. J. L. Darbyshire and P. R. Greig, "Sleep Deprivation and Fatigue Management in the Intensive Care Unit," ICU Management & Practice , vol. 2, pp. 137-139, 2020.
     Google Scholar
  27. I. Sabbah, H. Sabbah, S. Sabbah, H. Akoum and N. Droubi, "Burnout among Lebanese nurses: Psychometric properties of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS)," Health, vol. 4, no. 9, pp. 644-652, 2012.
     Google Scholar
  28. A. Meli and S. Coppola, "The Night in the ICU," ICU Management & Practice 2 - 2020, vol. 2, pp. 125-127, 2020.
     Google Scholar
  29. A. A. o. C. C. N. (AACN), "Managing Alarms in Acute Care Across the Life Span," 4 3 2018. [Online]. Available: https://www.aacn.org/clinical-resources/practice-alerts/managing-alarms-in-acute-care-across-the-life-span. [Accessed 7 11 2020].
     Google Scholar
  30. C. Siobhán, A. Gloria and D. Maura, "Critical care nurses’ knowledge of alarm fatigue and practices towards alarms: A multicentre study," Intensive and Critical Care Nursing, vol. 48, pp. 36-41, 2018.
     Google Scholar
  31. K. R. Johnson, J. I. Hagadorn and David W. Sink, "Alarm Safety and Alarm Fatigue," Clin Perinatol, vol. 44, p. 713–728, 2017.
     Google Scholar
  32. E. Özcan and D. Gommers, "Nine Nurse-Recommended Design Strategies to Improve Alarm Management in the ICU: A Qualitative Study," ICU Management & Practice, vol. 2, pp. 129-133, 2020.
     Google Scholar
  33. I. M. Sabbah, T. T. Ibrahim, R. H. Khamis, H. A.-M. Bakhour, S. M. Sabbah, N. S. Droubi and H. M. Sabbah, "The association of leadership styles and nurses well-being: a cross-sectional study in healthcare settings. 2020;36:328. [doi: ]," Pan African Medical Journal., vol. 36, no. 328, 2020.
     Google Scholar
  34. N. M. Simon, G. N. Saxe and Charles R. Marmar, "Mental Health Disorders Related to COVID-19–Related Deaths," JAMA. 2020;324(15), vol. 324, no. 15, pp. 1493-1494, 2020.
     Google Scholar


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