Decreasing inconsistent alarms notifications: a pragmatic clinical trial in a post-anesthesia care unit
Diminuindo notificações de alarmes inconsistentes: um ensaio clínico pragmático em uma unidade de recuperação pós-anestésica
Saullo Queiroz Silveira, Rafael Sousa Fava Nersessian, Arthur de Campos Vieira Abib, Leonardo Barbosa Santos, Fernando Nardy Bellicieri, Karen Kato Botelho, Helidea de Oliveira Lima, Renata Mazzoni de Queiroz, Gabriel Silva dos Anjos, Hermann dos Santos Fernandes, Glenio B. Mizubuti, Joaquim Edson Vieira, Leopoldo Muniz da Silva
Abstract
Background
Alarms alert healthcare professionals of deviations from normal/physiologic status. However, alarm fatigue may occur when their high pitch and diversity overwhelm clinicians, possibly leading to alarms being disabled, paused, and/or ignored. We aimed to determine whether a staff educational program on customizing alarm settings of bedside monitors may decrease inconsistent alarms in the Post-Anesthesia Care Unit (PACU).
Methods
This is a prospective, analytic, quantitative, pragmatic, open-label, single-arm study. The outcome was evaluated on PACU admission before (P1) and after (P2) the implementation of the educational program. The heart rate, blood pressure, and oxygen saturation alarms were selected for clinical consistency.
Results
A total of 260 patients were included and 344 clinical alarms collected, with 270 (78.4%) before (P1), and 74 (21.6%) after (P2) the intervention. Among the 270 alarms in P1, 45.2% were inconsistent (i.e., false alarms), compared to 9.4% of the 74 in P2. Patients with consistent alarms occurred in 30% in the P1 and 27% in the P2 (p = 0.08). Patients with inconsistent alarms occurred in 25.4% in the P1 and in 3.8% in the P2. Ignored consistent alarms were reduced from 21.5% to 2.6% (p = 0.004) in the P2 group. The educational program was a protective factor for the inconsistent clinical alarm (OR = 0.11 [95% CI 0.04–0.3]; p < 0.001) after adjustments for age, gender, and ASA physical status.
Conclusion
Customizing alarm settings on PACU admission proved to be a protective factor against inconsistent alarm notifications of multiparametric monitors.
Keywords
Resumo
Introdução
Os alarmes alertam os profissionais de saúde sobre desvios do estado normal/fisiológico. No entanto, a fadiga dos alarmes pode ocorrer quando o seu tom agudo e diversidade sobrecarregam os médicos, possivelmente levando à desativação, pausa e/ou ignoração dos alarmes. Nosso objetivo foi determinar se um programa educacional da equipe sobre a personalização das configurações de alarme dos monitores de cabeceira pode diminuir os alarmes inconsistentes na Sala de Recuperação Pós-Anestesia (SRPA).
Métodos
Este é um estudo prospectivo, analítico, quantitativo, pragmático, aberto e de braço único. O desfecho foi avaliado na admissão na SRPA antes (P1) e após (P2) a implementação do programa educativo. Os alarmes de frequência cardíaca, pressão arterial e saturação de oxigênio foram selecionados para consistência clínica.
Resultados
Foram incluídos 260 pacientes e coletados 344 alarmes clínicos, sendo 270 (78,4%) antes (P1) e 74 (21,6%) após (P2) a intervenção. Entre os 270 alarmes em P1, 45,2% eram inconsistentes (ou seja, alarmes falsos), em comparação com 9,4% dos 74 em P2. Pacientes com alarmes consistentes ocorreram em 30% no P1 e 27% no P2 (p = 0,08). Pacientes com alarmes inconsistentes ocorreram em 25,4% no P1 e em 3,8% no P2. Os alarmes consistentes ignorados foram reduzidos de 21,5% para 2,6% (p = 0,004) no grupo P2. O programa educativo foi fator de proteção para alarme clínico inconsistente (OR = 0,11 [IC 95% 0,04–0,3]; p < 0,001) após ajustes para idade, sexo e estado físico ASA.
Conclusão
A personalização das configurações de alarme na admissão na SRPA mostrou-se um fator de proteção contra notificações de alarme inconsistentes dos monitores multiparamétricos.
Palavras-chave
References
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