A Brief Questionnaire for Measuring Alarm Fatigue in Nurses and Physicians in Intensive Care Units

Abstract

Background. When exposed to hundreds of medical device alarms per day, intensive care unit (ICU) staff can develop “alarm fatigue” (i.e., desensitisation to alarms). However, no standardised way of quantifying alarm fatigue exists. Objective. We aimed to develop a brief questionnaire for measuring alarm fatigue in nurses and physicians. Methods. After developing a list of initial items based on a literature review, we conducted 15 cognitive interviews with the target group (13 nurses and two physicians) to ensure that the items are face valid and comprehensible. We then asked 32 experts on alarm fatigue to judge whether the items are suited for measuring alarm fatigue. The resulting 27 items were sent to nurses and physicians from 15 ICUs of a large German hospital. We used exploratory factor analysis to further reduce the number of items and to identify scales. Results. A total of 585 submissions from 707 participants could be analysed (of which 14% were physicians and 64% were nurses). The simple structure of a two-factor model was achieved within three rounds. The final questionnaire (called Charité Alarm Fatigue Questionnaire; CAFQa) consists of nine items along two scales (i.e., the “alarm stress scale” and the “alarm coping scale”). Conclusion. CAFQa is a brief questionnaire that allows clinical alarm researchers to quantify the alarm fatigue of nurses and physicians. It should not take more than five minutes to administer.

Evaluating the Construct Validity of the Charité Alarm Fatigue Questionnaire using Confirmatory Factor Analysis

“…The t indices RMSEA, CFI, and TLI have been shown to overestimate model t when using the ULS estimator [33,34], potentially leading researchers to accept a bad-tting model. Yet, in our case, other t indicesindicate a good model t. As in our previous work [10], the assumption that participants can accurately re ect and express their own alarm fatigue in percent is likely awed (otherwise it would not be necessary to develop a questionnaire in the rst place). However, we believe that it is a valuable method for assessing convergent validity when no other instrument is available.…”

“…Our results from two independent studies underpin the construct validity of the Charité Alarm Fatigue Questionnaire. All items consistently loaded onto the factors as we proposed in a previous publication [10]. When conducting research or quality improvement projects in ICUs, clinical alarm researchers and clinicians can rely on this instrument to measure, compare and benchmark the alarm fatigue of nurses and physicians.…”

“…Overall, these results support the hypothesized factor structure. The questionnaire seems to measure the construct of alarm fatigue as proposed in our previous work [10].…”

“…The questionnaire used in both studies was identical and consisted of all nine items from the CAFQa [10] and ve general questions about the alarm situation in participants' ICUs. These general questions were not part of the analysis for this report.…”

“…Therefore, we recently developed the Charité Alarm Fatigue Questionnaire (CAFQa), which is a 9-item questionnaire that measures alarm fatigue in nurses and physicians [10]. Using exploratory factor analysis, we identi ed two correlated factors: one revolving around the psychophysiological effects of alarms (e.g., headaches and feelings of distraction), and one revolving around ICU staff's alarm management strategies (e.g., customization of alarm limits).…”