Background: Intensive care units (ICUs) are complex work environments where false alarms occur more frequently than on\nnon-critical care units. The Joint Commission National Patient Safety Goal .06.01.01 targeted improving the safety of clinical\nalarm systems and required health care facilities to establish alarm systems safety as a hospital priority by July 2014. An important\ninitial step toward this requirement is identifying ICU nurses� perceptions and common clinical practices toward clinical alarms,\nwhere little information is available.\nObjective: Our aim was to determine perceptions and practices of transplant/cardiac ICU (TCICU) nurses toward clinical alarms\nand benchmark the results against the 2011 Healthcare Technology Foundation�s (HTF) Clinical Alarms Committee Survey.\nMethods: A quality improvement project was conducted on a 20-bed TCICU with 39 full- and part-time nurses. Nurses were\nsurveyed about their perceptions and attitudes toward and practices on clinical alarms using an adapted HTF clinical alarms\nsurvey. Results were compared to the 2011 HTF data. Correlations among variables were examined.\nResults: All TCICU nurses provided usable responses (N=39, 100%). Almost all nurses (95%-98%) believed that false alarms\nare frequent, disrupt care, and reduce trust in alarm systems, causing nurses to inappropriately disable them. Unlike the 2011\nHTF clinical alarms survey results, a significantly higher percentage of our TCICU nurses believed that existing devices are\ncomplex, questioned the ability and adequacy of the new monitoring systems to solve alarm management issues, pointed to the\nlack of prompt response to alarms, and indicated the lack of clinical policy on alarm management (P<.01). Major themes in the\nnarrative data focused on nurses� frustration related to the excessive number of alarms and poor usability of the cardiac monitors.\nA lack of standardized approaches exists in changing patients� electrodes and individualizing parameters. Around 60% of nurses\nindicated they received insufficient training on bedside and central cardiac monitors. A correlation also showed the need for\ntraining on cardiac monitors, specifically for older nurses (P=.01).\nConclusions: False and non-actionable alarms continue to desensitize TCICU nurses, perhaps resulting in missing fatal alarms.\nNurses� attitudes and practices related to clinical alarms are key elements for designing contextually sensitive quality initiatives\nto fight alarm fatigue. Alarm management in ICUs is a multidimensional complex process involving usability of monitoring\ndevices, and unit, clinicians, training, and policy-related factors. This indicates the need for a multi-method approach to decrease\nalarm fatigue and improve alarm systems safety.
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