title: Nurses' Perceptions and Practices Toward Clinical Alarms in a Transplant Cardiac Intensive Care Unit: Exploring Key Issues Leading to Alarm Fatigue.
abstract: BACKGROUND
  Intensive care units (ICUs) are complex work environments where false alarms occur more frequently than on non-critical care units. The Joint Commission National Patient Safety Goal .06.01.01 targeted improving the safety of clinical alarm systems and required health care facilities to establish alarm systems safety as a hospital priority by July 2014. An important initial step toward this requirement is identifying ICU nurses' perceptions and common clinical practices toward clinical alarms, where little information is available.
  
  
  OBJECTIVE
  Our aim was to determine perceptions and practices of transplant/cardiac ICU (TCICU) nurses toward clinical alarms and benchmark the results against the 2011 Healthcare Technology Foundation's (HTF) Clinical Alarms Committee Survey.
  
  
  METHODS
  A quality improvement project was conducted on a 20-bed TCICU with 39 full- and part-time nurses. Nurses were surveyed about their perceptions and attitudes toward and practices on clinical alarms using an adapted HTF clinical alarms survey. Results were compared to the 2011 HTF data. Correlations among variables were examined.
  
  
  RESULTS
  All TCICU nurses provided usable responses (N=39, 100%). Almost all nurses (95%-98%) believed that false alarms are frequent, disrupt care, and reduce trust in alarm systems, causing nurses to inappropriately disable them. Unlike the 2011 HTF clinical alarms survey results, a significantly higher percentage of our TCICU nurses believed that existing devices are complex, questioned the ability and adequacy of the new monitoring systems to solve alarm management issues, pointed to the lack of prompt response to alarms, and indicated the lack of clinical policy on alarm management (P<.01). Major themes in the narrative data focused on nurses' frustration related to the excessive number of alarms and poor usability of the cardiac monitors. A lack of standardized approaches exists in changing patients' electrodes and individualizing parameters. Around 60% of nurses indicated they received insufficient training on bedside and central cardiac monitors. A correlation also showed the need for training on cardiac monitors, specifically for older nurses (P=.01).
  
  
  CONCLUSIONS
  False and non-actionable alarms continue to desensitize TCICU nurses, perhaps resulting in missing fatal alarms. Nurses' attitudes and practices related to clinical alarms are key elements for designing contextually sensitive quality initiatives to fight alarm fatigue. Alarm management in ICUs is a multidimensional complex process involving usability of monitoring devices, and unit, clinicians, training, and policy-related factors. This indicates the need for a multi-method approach to decrease alarm fatigue and improve alarm systems safety.
authors.affiliation: University of Texas Health Science Center at San Antonio, School of Nursing, Department of Health Restoration and Care Systems Management, San Antonio, TX, United States. sowan@uthscsa.edu.
authors.forename: Azizeh Khaled
authors.identifier: http://orcid.org/0000-0001-7719-2037
authors.initials: AK
authors.lastname: Sowan
authors.forename: Albert Fajardo
authors.identifier: http://orcid.org/0000-0001-9012-4303
authors.initials: AF
authors.lastname: Tarriela
authors.forename: Tiffany Michelle
authors.identifier: http://orcid.org/0000-0002-9099-6133
authors.initials: TM
authors.lastname: Gomez
authors.forename: Charles Calhoun
authors.identifier: http://orcid.org/0000-0001-6037-538X
authors.initials: CC
authors.lastname: Reed
authors.forename: Kami Marie
authors.identifier: http://orcid.org/0000-0002-1329-9190
authors.initials: KM
authors.lastname: Rapp
keywords: alarm fatigue; clinical alarms; critical care; nursing; physiologic monitors; survey