Monitor Alarms and Nurses Alarm Management in The Intensive Care Unit: An Observational Study

¹Dokuz Eyl�l University, Institute of Health Sciences, and Dr. Suat Seren Chest Diseases And Surgery Education Research Hospital, Health Sciences University, Charge-nurse, Izmir, Turkey
²Nursing Management Department, Dokuz Eylul University, Nursing Faculty, Balcova, Izmir, Turkey

Aim: To determine the monitor alarm parameters and nurse responses in a training and research hospital�s adult surgical intensive care unit.
Method: The research was conducted with an observational-descriptive design in an adult surgical intensive care unit. The monitor parameters of the patients and the nurses� response to alarms constituted the study sample. A total of 1,197 alarm data belonging to 33 patients recorded over one hour of monitoring in the day and night shifts were evaluated. Data were collected between March and June 2019 using the �alarm management observation form� to evaluate alarm parameters and nurses� behaviours towards alarm management. Descriptive statistics were used in the statistical analysis.
Results: Of the collected alarm data, 42% were related to oxygen saturation, 27% partial heart rate, 18% blood pressure, and 13% heart rate. More than one nurse gave multiple responses to 61% of patient alarms. The rate of patients whose own nurse responded to one or more alarms was 30%. Lastly, it was observed that 9% of the patients received no response to the alarms. These responses involved adjusting the pulse device in cases and checking and adjusting the oxygen level in 16%, informing the physician in 15%, checking the patient�s physician order in 11%, applying additional drug therapy in 10%, deep tracheal aspiration in 9%, ECG recording and checking/changing electrodes in 7%, and warming the patient with a thermal blanket in 7%.
Conclusion: The study concluded that the number of alarms was high, and there was a low response rate. However, it was also observed that the patient�s clinical condition determined responding to the alarm. While nurses did not respond to some patients alarms, multiple nurses responded to the alarms of some patients with more than one intervention. It is suggested that managers do a work plan by considering the alarms and workloads of nurses in all processes, including the pandemic, and take measures to reduce alarm fatigue.

Keywords:

Yo�un Bak�m �nitesindeki Monit�r Alarmlar� ve Hem�irelerin Alarm Y�netimi: G�zlemsel �al��ma

¹Dokuz Eyl�l �niversitesi, Sa�l�k Bilimleri Enstit�s� ve SB�. Dr. Suat Seren G��s Hastal�klar� ve Cerrahisi E�itim ve Ara�t�rma Hastanesi, Yo�un Bak�m Hem�iresi, �zmir, T�rkiye
²Dokuz Eyl�l �niversitesi Hem�irelik Fak�ltesi, Hem�irelikte Y�netim Anabilim Dal�, �zmir, T�rkiye

Ama�: Bir e�itim ara�t�rma hastanesinin eri�kin cerrahi yo�un bak�m �nitesinde monit�r alarm parametrelerini ve hem�irelerin verdi�i yan�tlar� belirlemektir.
Y�ntem: Ara�t�rma, eri�kin cerrahi yo�un bak�m �nitesinde g�zlemsel-tan�mlay�c� tasar�mda ger�ekle�tirilmi�tir. Hastalar�n monit�r parametreleri ve hem�irelerin alarmlara verdikleri yan�t ara�t�rman�n �rneklemini olu�turmaktad�r. Ara�t�rmada 33 hastan�n gece ve g�nd�z vardiyas�nda birer saatlik monit�r verisi g�zlemi ile 1197 alarm verisi izlenmi�tir. Veriler, Mart-Haziran 2019 tarihleri aras�nda alarm parametrelerini ve hem�irelerin alarm y�netimine y�nelik davran��lar�n� de�erlendirmek �zere �alarm y�netimi g�zlem formu� ile toplanm��t�r. Analizlerde tan�mlay�c� istatistikler kullan�lm��t�r.
Bulgular: Alarmlar�n %42�si oksijen saturasyonu, %27�si parsiyel nab�z, %18�i kan bas�nc� ve %13�� kalp at�� h�z� alarm�ndan olu�maktad�r. Hem�irelerin 538 alarma yan�t verdikleri g�r�lm��t�r. Hastalar�n %61�inin alarm�na birden fazla hem�ire ile �oklu yan�t verildi�i g�zlenmi�tir. Hastan�n kendi hem�iresinin bir ve �zerinde alarma yan�t verdi�i hasta oran� %30�dur. Ancak, hastalar�n %9�unun alarmlar�na hi� giri�imde bulunulmad�� g�zlenmi�tir. Yan�tlar aras�nda en y�ksek uygulamalar�n %16 oran�nda pulse oksimetre cihaz�n� d�zeltme ile oksijen d�zeyini kontrol etme ve/veya ayarlama �eklinde ger�ekle�ti�i, di�er yan�tlar�n hekime bilgi verme (%15), hekim istemi kontrol� (%11), ek ila� tedavisi (%10), derin trakeal aspirasyon (%9), EKG �ekilmesi ve elektrotlar� kontrol etme/�ekillendirme (%8) ve hastay� termal battaniye ile �s�tma (%7) oldu�u belirlenmi�tir.
Sonu�: Ara�t�rmada, alarm say�s�n�n y�ksek, yan�t verilme oran�n�n d��k oldu�u sonucuna ula��lm��t�r. Ancak alarma yan�t verme eyleminin hastan�n klinik durumuyla belirlendi�i, hem�irelerin baz� hastalar�n alarm�na hi� yan�t vermezken, baz� hastalar�n alarm�na �oklu hem�ire ve giri�im ile yan�t verdikleri g�zlenmi�tir. Y�neticilerin salg�n dahil t�m s�re�lerde hem�irelerin alarm ve i� y�klerini dikkate alarak i� plan� yapmalar�, alarm yorgunlu�unu azalt�c� �nlemler almalar� �nerilebilir.

Anahtar Kelimeler:

G�lnur G�l, �eyda Seren �ntepeler. Monitor Alarms and Nurses Alarm Management in The Intensive Care Unit: An Observational Study. Journal of Health and Nursing Management. 2021; 8(3): 429-438

Corresponding Author: G�lnur G�l, T�rkiye