YOĞUN BAKIM HEMŞİRELERİNDE ALARM YORGUNLUĞU VE YÖNETİMİ
Yıl 2019,
Cilt: 23 Sayı: 1, 43 - 49, 06.05.2019
Fatma Dursun Ergezen
,
Emine Kol
Öz
Yoğun bakım ünitelerinde hasta izlemi, tedavi ve ilaç yönetimi için alarm sistemleri ile çalışan çok sayıda cihaz kullanılmaktadır. Alarm sistemleri, hastanın klinik durumuyla ya da cihazla ilgili önceden belirlenmiş “normal” durumlardan sapmalara karar vererek hemşire ve hekimi uyarmaktadır. Yoğun bakımlarda kullanılan her bir cihazın farklı alarm sistemleri ile çalışması, alarm sayısını ve çeşitliliğini artırmaktadır. Hemşireler her biri farklı alarm limitine, kategorisine ve uyarım tipine sahip cihazları yönetmek ve alarmlara müdahale etmek zorundadır. Bu makalede yoğun bakım hemşireliğinde önemli bir sorun olan alarm yorgunluğu tartışılmıştır.
Kaynakça
- 1. Kiekkas P, Karga M, Poulopoulou M, Karpouhtsi I, Papadoulas V, Koutsojannis C. Use of technological equipment in critical care units: nurses’ perceptions in Greece. J Clin Nurs 2006;15(2):178-187.
- 2. Alastalo M, Salminen L, Lakanmaa RL, Leino-Kilpi H. Seeing beyond monitors—Critical care nurses’ multiple skills in patient observation: Descriptive qualitative study. Intensive Crit Care Nurs 2017;42:80-87.
- 3. Imhoff M, Kuhls S. Alarm algorithms in critical care monitoring. Anesth Analg 2006;102(5):1525-1537.
- 4. Emergency Care Research Institute. Top 10 Health Technology Hazards for 2014. Health Devices 2013;42(11):1-13. Erişim Tarihi: 17.09.2018 https://www.ecri.org/Resources/Whitepapers_and_reports/2014_Top_10_Hazards_Executive_Brief.pdf
- 5. Emergency Care Research Institute. Top 10 Health Technology Hazards for 2012. Health Devices 2011;40(11):1-16. Erişim Tarihi: 17.09.2018 http://www.marylandpatientsafety.org/html/education/2012/handouts/documents/Top%2010%20Technology%20Hazards%20for%202012%20Article.pdf
- 6. Cvach M. Monitor alarm fatigue: an integrative review. Biomed Instrum Technol 2012;46(4):268-277.
- 7. Emergency Care Research Institute. Top 10 Health Technology Hazards for 2013. Health Devices 2012;41(11),1-23. Erişim Tarihi: 17.09.2018 https://www.ecri.org/Resources/Whitepapers_and_reports/2013_Health_Devices_Top_10_Hazards.pdf
- 8. Varpio L, Kuziemsky C, Macdonald C, King WJ. The helpful or hindering effects of in-hospital patient monitor alarms on nurses: a qualitative analysis. Comput Inform Nurs 2012;30(4):210-217.
- 9. Honan L, Funk M, Maynard M, Fahs D, Clark JT, David Y. Nurses’ perspectives on clinical alarms. Am J Crit Care 2015;24(5):387-395.
- 10. Graham KC, Cvach M. Monitor alarm fatigue: standardizing use of physiological monitors and decreasing nuisance alarms. Am J Crit Care 2010;19(1):28-34.
- 11. Sendelbach S, Funk M. Alarm fatigue: a patient safety concern. AACN Adv Crit Care 2013;24(4):378-386.
- 12. Ruskin KJ, Hueske-Kraus D. Alarm fatigue: impacts on patient safety. Curr Opin Anaesthesiol 2015;28(6):685-690.
- 13. Tsien CL, Fackler JC. Poor prognosis for existing monitors in the intensive care unit. Crit Care Med 1997;25(4):614-619.
- 14. The Joint Commission. Preventing ventilator-related deaths and injuries. 2002;25:1-3. Erişim Tarihi: 17.09.2018 https://www.jointcommission.org/sentinel_event_alert_issue_25_preventing_ventilator-related_deaths_and_injuries/
- 15. The Joint Commission. Sentinel Event Alert. 2013;50. Erişim Tarihi: 17.09.2018 https://www.jointcommission.org/assets/1/18/SEA_50_alarms_4_5_13_FINAL1.PDF
16. Lacker C. Physiologic alarm management. Pennsylvania Patient Safety Advisory 2011;8(3):105-8.
- 17. O' Carroll TM. Survey of alarms in an intensive therapy unit. Anaesthesia 1986;41(7):742-744.
- 18. Chambrin MC, Ravaux P, Calvelo-Aros D, Jaborska A, Chopin C, Boniface B. Multicentric study of monitoring alarms in the adult intensive care unit (ICU): a descriptive analysis. Intensive Care Med 1999;25(12):1360-1366.
- 19. Siebig S, Kuhls S, Imhoff M, Langgartner J, Reng M, Schölmerich J, ... & Wrede CE. Collection of annotated data in a clinical validation study for alarm algorithms in intensive care—a methodologic framework. J Crit Care 2010;25(1):128-135.
- 20. Gazarian PK. Nurses’ response to frequency and types of electrocardiography alarms in a non-critical care setting: a descriptive study. Int J Nurs Stud 2014;51(2):190-197.
- 21. van Pul C, vd Mortel HPME, vd Bogaart JJL, Mohns T, Andriessen P. Safe patient monitoring is challenging but still feasible in a neonatal intensive care unit with single family rooms. Acta Paediatr 2015;104(6):e247-e254.
- 22. Görges M, Markewitz BA, Westenskow DR. Improving alarm performance in the medical intensive care unit using delays and clinical context. Anesth Analg 2009;108(5):1546-1552.
- 23. Bridi AC, Silva RCLD, Farias CCPD, Franco AS, Santos VDLQD. Reaction time of a health care team to monitoring alarms in the intensive care unit: implications for the safety of seriously ill patients. Rev Bras Ter Intensiva 2014;26(1):28-35.
- 24. Akansel N, Kaymakçı Ş. Effects of intensive care unit noise on patients: a study on coronary artery bypass graft surgery patients. J Clin Nurs 2008;17(12):1581-1590.
- 25. Johansson L, Bergbom I, Waye KP, Ryherd E, Lindahl B. The sound environment in an ICU patient room—a content analysis of sound levels and patient experiences. Intensive Crit Care Nurs 2012;28(5):269-279.
- 26. Kol E, İlaslan E, İnce S. Yogun Bakım Ünitelerinde Gürültü Kaynakları ve Gürültü Düzeyleri. Türk Yoğun Bakım Derneği Dergisi 2015;13(3):122.
- 27. Hu RF, Hegadoren KM, Wang XY, Jiang XY. An investigation of light and sound levels on intensive care units in China. Aust Crit Care 2016;29(2):62-67.
- 28. Whalen DA, Covelle PM, Piepenbrink JC, Villanova KL, Cuneo CL, Awtry EH. Novel approach to cardiac alarm management on telemetry units. J Cardiovasc Nurs 2014;29(5):E13-E22.
- 29. Welch J. An evidence-based approach to reduce nuisance alarms and alarm fatigue. Biomed Instrum Technol 2011;45(s1):46-52.
- 30. Sendelbach S, Wahl S, Anthony A, Shotts P. Stop the noise: a quality improvement project to decrease electrocardiographic nuisance alarms. Crit Care Nurse 2015;35(4):15-22.
- 31. Lukasewicz CL, Mattox EA. Understanding clinical alarm safety. Crit Care Nurse 2015;35(4):45-57.
- 32. Lawless ST. Crying wolf: false alarms in a pediatric intensive care unit. Crit Care Med 1994;22(6):981-985.
- 33. Siebig S, Kuhls S, Imhoff M, Gather U, Schölmerich J, Wrede CE. Intensive care unit alarms—how many do we need?. Crit Care Med 2010;38(2):451-456.
- 34. Bonafide CP, Lin R, Zander M, Graham CS, Paine CW, Rock W, ... & Localio AR. Association between exposure to nonactionable physiologic monitor alarms and response time in a children's hospital. J Hosp Med 2015;10(6):345-351.
- 35. Korniewicz DM, Clark T, David Y. A national online survey on the effectiveness of clinical alarms. Am J Crit Care 2008;17(1):36-41.
- 36. Funk M, Clark JT, Bauld TJ, Ott JC, Coss P. Attitudes and practices related to clinical alarms. Am J Crit Care 2014;23(3):e9-e18.
- 37. Christensen M, Dodds A, Sauer J, Watts N. Alarm setting for the critically ill patient: a descriptive pilot survey of nurses’ perceptions of current practice in an Australian regional critical care unit. Intensive Crit Care Nurs 2014;30(4):204-210.
- 38. Berglund B, Lindvall T, Schwela DH. Guidelines for community noise. In Guidelines for Community Noise OMS 1999;1-160.
- 39. Cropp AJ, Woods LA, Raney D, Bredle DL. Name that tone: the proliferation of alarms in the intensive care unit. Chest 1994;105(4):1217-1220.
- 40. Drew BJ, Harris P, Zègre-Hemsey JK, Mammone T, Schindler D, Salas-Boni R, ... & Hu X. Insights into the problem of alarm fatigue with physiologic monitor devices: a comprehensive observational study of consecutive intensive care unit patients. PLoS One 2014;9(10):e110274.
- 41. Sobieraj J, Ortega C, West I, Voepel L, Battle S, Robinson D. Audibility of patient clinical alarms to hospital nursing personnel. Mil Med 2006;171(4):306-310.
- 42. Alasad J. Managing technology in the intensive care unit: the nurses’ experience. Int J Nurs Stud 2002;39(4):407-413.
- 43. Almerud S, Alapack RJ, Fridlund B, Ekebergh M. Caught in an artificial split: A phenomenological study of being a caregiver in the technologically intense environment. Intensive Crit Care Nurs 2008;24(2):130-136.
- 44. Kongsuwan W, Locsin RC. Thai nurses’ experience of caring for persons with life-sustaining technologies in intensive care settings: a phenomenological study. Intensive Crit Care Nurs 2011;27(2):102-110.
- 45. Tunlind A, Granström J, Engström Å. Nursing care in a high-technological environment: experiences of critical care nurses. Intensive Crit Care Nurs 2015;31(2):116-123.
- 46. Despins LA. Factors influencing when intensive care unit nurses go to the bedside to investigate patient related alarms: A descriptive qualitative study. Intensive Crit Care Nurs 2017;43:101-107.
- 47. American Association of Critical Care Nurses. AACN Practice Alert: Alarm Management. 2013. Erişim Tarihi: 17.09.2018 https://www.altru.org/app/files/public/12560/Soltis3.pdf
- 48. Cvach MM, Biggs M, Rothwell KJ, Charles-Hudson C. Daily electrode change and effect on cardiac monitor alarms: an evidence-based practice approach. J Nurs Care Qual 2012;28(3):265-271.
- 49. Rayo MF, Mansfield J, Eiferman D, Mignery T, White S, Moffatt-Bruce SD. Implementing an institution-wide quality improvement policy to ensure appropriate use of continuous cardiac monitoring: a mixed-methods Retros-pective data analysis and direct observation study. BMJ Qual Saf 2015;0:1-8.