Aim\nAlarm fatigue is a well-recognized patient safety concern in intensive care settings.\nDecreased nurse responsiveness and slow response times to alarms are the potentially\ndangerous consequences of alarm fatigue. The aim of this study was to determine the factors\nthat modulate nurse responsiveness to critical patient monitor and ventilator alarms in\nthe context of a private room neonatal intensive care setting.\nMethods\nThe study design comprised of both a questionnaire and video monitoring of nurse-responsiveness\nto critical alarms. The Likert scale questionnaire, comprising of 50 questions\nacross thematic clusters (critical alarms, yellow alarms, perception, design, nursing action,\nand context) was administered to 56 nurses (90% response rate). Nearly 6000 critical\nalarms were recorded from 10 infants in approximately 2400 hours of video monitoring.\nLogistic regression was used to identify patient and alarm-level factors that modulate nurseresponsiveness\nto critical alarms, with a response being defined as a nurse entering the\npatientââ?¬â?¢s room within the 90s of the alarm being generated.\nResults\nBased on the questionnaire, the majority of nurses found critical alarms to be clinically relevant\neven though the alarms did not always mandate clinical action. Based on video observations,\nfor a median of 34% (IQR, 20ââ?¬â??52) of critical alarms, the nurse was already present\nin the room. For the remaining alarms, the response rate within 90s was 26%. The median\nresponse time was 55s (IQR, 37-70s). Desaturation alarms were the most prevalent and\naccounted for more than 50% of all alarms. The odds of responding to bradycardia alarms,\ncompared to desaturation alarms, were 1.47 (95% CI = 1.21ââ?¬â??1.78; 0.001) while that of responding to a ventilator alarm was lower at 0.35 (95% CI = 0.27ââ?¬â??0.46; p 0.001). For\nevery 20s increase in the duration of an alarm, the odds of responding to the alarm (within\n90s) increased to 1.15 (95% CI = 1.1ââ?¬â??1.2; p 0.001). The random effect per infant improved\nthe fit of the model to the data with the response times being slower for infants suffering\nfrom chronic illnesses while being faster for infants who were clinically unstable.\nDiscussion\nEven though nurses respond to only a fraction of all critical alarms, they consider the vast\nmajority of critical and yellow alarms as useful and relevant. When notified of a critical alarm,\nthey seek waveform information and employ heuristics in determining whether or not to\nrespond to the alarm.\nConclusion\nAmongst other factors, the category and duration of critical alarms along with the clinical status\nof the patient determine nurse-responsiveness to alarms.
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