JMIR Publications

ABSTRACT

Background:

Clinical alarm system safety is a national patient safety goal in the U.S. Physiologic monitors are associated with the highest number of device alarms and alarm-related deaths. However, research involving nurses' use of physiologic monitors is rare. Identifying critical usability issues for monitors, especially those related to patient safety, is a nursing imperative.

Objective:

This study examined nurses’ usability of physiologic monitors in intensive care units (ICUs) in terms of effectiveness and efficiency in monitor use.

Methods:

Thirty nurses from 4 adult ICUs completed 40 tasks in a simulation environment. The tasks were common monitoring tasks crucial for appropriate monitoring and safe alarm management across 4 categories of competencies: admitting, transferring and discharging patients into and out of the monitors (7 tasks); managing measurements and monitor settings (23 tasks); performing electrocardiogram analysis (7 tasks); and troubleshooting alarm conditions (3 tasks). Nurse-monitor interaction was video-recorded. The PI and two expert ICU nurse educators identified, classified and validated task success (effectiveness) and time of task completion (efficiency).

Results:

Among the 40 tasks, only 2 (5%) were successfully completed by all nurses. At least 1 (3%) to 27 (90%) nurses abandoned or did not correctly perform 38 tasks. The task with the shortest completion time was “take monitor out of standby” (mean= 0:02 in min:sec, SD= 0:01), while “record a 25mm/sec ECG (or electrocardiogram) strip of any of the ECG leads” had the longest completion time (mean= 1:14 in min:sec, SD= 0:32). The total time to complete 37 navigation-related tasks ranged from a minimum of 3 min and 57 sec and a maximum of 32 min and 42 sec. Based on regression analysis, it took 6 seconds per click or step to successfully complete a task. To understand the nurses’ thought processes during monitor navigation, we analyzed the paths of the two tasks with the lowest successful completion rates where only 13% (4/30) of the nurses completed correctly. Although many nurses accessed the correct screen first (9 or 30% for task 1, and 9 or 30% for task 2), they could not find their way easily from there to successfully complete the two tasks.

Conclusions:

Usability testing of physiologic monitors revealed major ineffectiveness and inefficiencies in current nurse-monitor interaction. Results indicate the potential for safety and productivity issues in completing routine tasks. Training on monitor use should include critical monitoring functions necessary for safer, effective, efficient and appropriate monitoring to include knowing the shortest navigation path. An imperative is that vendors’ future monitor designs mimic clinicians’ thought processes for successful, safe and efficient monitor navigation.