Are auditory warnings in the intensive care unit properly adjusted?

Abstract

The purpose of this study was to determine whether auditory warnings in the intensive care unit (ICU) were properly adjusted. An intervention study (before- and-after assessment) was conducted in a 12-bed medical-surgical ICU of an acute-care teaching hospital in Barcelona, Spain. A total of 100 patients with stable haemodynamic and respiratory parameters were included. In the first 3-month phase of the study, minimum and maximum alarm parameters of breathing rate, expired volume/min, airway pressure, SaO(2), arterial blood pressure and heart rate were recorded. In the second 12-month phase of the study, the same alarm parameters were recorded every 4 hours in the patient's medical record. In the third 3-month phase of the study, alarm readings were recorded again as in the first phase. The change throughout coefficient of variation (CV) and the 95% confidence interval (CI) for each alarm were calculated. Following the intervention, there was a statistically significant improvement in alarm readings for expired volume, heart rate and systolic blood pressure, so that alarms had been more properly adjusted to the patient's real value. Nursing staff should be aware that auditory warnings in ICU stable patients are frequently set very far from suitable values. Recording of alarm parameters in the patient's medical record as a routine daily activity was an effective intervention for improving adjustment of auditory warnings.

Reaction time of a health care team to monitoring alarms in the intensive care unit: implications for the safety of seriously ill patients

“…Other studies present results similar to the current data, identifying disabled alarms, alarms with low volumes, and alarms without parameters appropriate to the patients, resulting in incidents. (6,28) According to the authors, when a patient is monitored with alarms that are disabled, have a low volume, or lack the proper parameterization for the alert, depending on his/her clinical condition, a false sense of safety is created. (17,27) Nonetheless, regarding the audibility of alarms, the team should consider the flow of people in the environment, the physical layout of the unit, the background noise, and the patients profile when they adjust the alarm volumes, thereby preventing relevant alarms going unnoticed or loud noises causing discomfort - factors related to alarm fatigue.…”

Fewer but better auditory alarms will improve patient safety

“…14 15 Even setting alarm limits more diligently can improve alarm systems significantly. 16 There certainly exists a view that, unless alarms are made to be intelligent and are properly set, then it would be better to get rid of them. 17 Design of alarm sounds Imagine being entrusted with the task of developing the worst alarm signal in the world.…”

Apparatlarm inom intensivvarden

“…Tre studier visade hur viktigt det var att föra larmprotokoll över larmgränsinställningar för att förbättra patientsäkerheten, så att adekvata kliniska åtgärder kunde sättas in samt att antalet falsklarm kunde minskas. I studierna framkom det hur viktigt det var att IVAsjuksköterskan var alert och använde sunt förnuft, då det var viktigt att inte blint lita på tekniken då det exempelvis kunde uppstå teknikfel (8,9,13). I två studier redovisades det införande och genomförande av riktlinjer för att dämpa ljudnivåerna på IVA (7,8).…”

“…Det framkom att larm som miljöfaktor kunde påverka intensivvårdspatientens säkerhet och IVA-sjuksköterskans handlingsberedskap. Apparatlarm kunde utlösa falsklarm som inte krävde aktiva åtgärder (7)(8)(9)(10)(11)(12)(13)(14). Det är väsentligt att känna till flera felkällor för att kunna garantera patientens säkerhet.…”