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

##plugins.themes.bootstrap3.article.main##

  •   Hadia Bourji

  •   Hala Sabbah

  •   Ahmad Al’Jamil

  •   Rania Khamis

  •   Sanaa Sabbah

  •   Nabil Droubi

  •   Ibtissam M. Sabbah

Abstract

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

R. J. Pugh, "The impact of noise in the intensive care unit," critical & emergenc y care, 2007.

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.

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.

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.

S. Sendelbach and M. Funk, "Alarm Fatigue A Patient Safety Concern," AACN Advanced Critical Care, vol. 24, no. 4, pp. 378 - 386, 2013.

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.

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.

K. J. Ruskina and D. Hueske-Kraus, "Alarm fatigue: impacts on patient safety," Curr Opin Anesthesiol, vol. 28, p. 685–690, 2015.

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.

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.

O. o. N. i. Lebanon, "Statistics issued by the Order," Order of Nurses in Lebanon, Beirut, 2019.

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.

J. E. J. Ware, SF-36 health survey manuel and interpretation guide, Second printing ed., Boston: . , MA: The Health Institute, New England Center, 1997).

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.

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.

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.

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.

A. Meli and S. Coppola, "The Night in the ICU," ICU Management & Practice 2 - 2020, vol. 2, pp. 125-127, 2020.

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].

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.

K. R. Johnson, J. I. Hagadorn and David W. Sink, "Alarm Safety and Alarm Fatigue," Clin Perinatol, vol. 44, p. 713–728, 2017.

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.

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.

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.

##plugins.themes.bootstrap3.article.details##

How to Cite
Bourji, H., Sabbah, H., Al’Jamil, A., Khamis, R., Sabbah, S., Droubi, N., & Sabbah, I. M. (2020). Evaluating the Alarm Fatigue and its Associated Factors among Clinicians in Critical Care Units. European Journal of Clinical Medicine, 1(1). https://doi.org/10.24018/clinicmed.2020.1.1.8

Most read articles by the same author(s)