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Effect of Nursing Interventions on Physiologic Monitor Alarm Rates


Introduction: Physiologic monitors play a vital role in saving patients' lives but expose clinicians to an overwhelming number of alarms, many of which are false. Objective: Our study aims were; a) to determine whether the mean hourly oxygen saturation (SpO2) low-limit alarm rates could be reduced by modifying the default alarm setting and b) to determine whether there would be a reduction in mean hourly technical and critical arrhythmia alarm rates and the mean percentage of false-positive critical arrhythmia alarms following daily skin preparation and the application of high-quality ECG electrodes. Methods: We conducted a prospective randomized clinical trial in two neuroscience intensive care units, collecting data during two assessment periods. Each patient's alarm rate was calculated as the number of unique alarms divided by monitoring time. Critical arrhythmia alarms were determined (true vs. false positive) using a protocol. Means and standard deviations of the hourly alarm rates and the mean percentage of false-positive critical arrhythmia alarms were determined during both assessments. A negative binomial regression was performed to test the main effect of unit, the main effect of assessment, and the unit by assessment interaction. Results: The combined use of a lower SpO2 low-limit threshold and increased alarm delay resulted in a significant unit-by-assessment interaction (p <. 001). During Assessment 2, the experimental unit had a lower mean hourly SpO2 alarm rate while in the control unit, the rate increased. No significant unit-by-assessment interactions were observed for the mean hourly technical alarm rates; during Assessment 2, both units experienced an increase in ECG lead fail alarm rates and although both units had a reduction in mean hourly artifact alarms, it was insignificant. Similarly, no significant unit-by-assessment interaction in the mean hourly critical arrhythmia alarm rate was observed; no reduction in critical arrhythmia alarm rates was found in the experimental unit. Likewise, the intervention did not reduce the mean percentage of false-positive critical arrhythmia alarms. Conclusion: A lower SpO2 alarm limit and increased alarm delay safely reduces non-actionable alarms. However, our novel electrode regimen does not reduce critical arrhythmia and technical alarm rates or false-positive arrhythmia alarms.

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