JMIR Publications

ABSTRACT

Background:

The high number of unnecessary alarms in intensive care settings threatens patient safety and leads to alarm fatigue among staff. To develop and implement effective and sustainable solutions for alarm management in intensive care units (ICU), an understanding of staff interactions with the patient monitoring system and current alarm management practices is essential.

Objective:

This study aims to investigate the interaction of nurses and physicians with the patient monitoring systems’ alarms, their perceptions of alarm management and the potentials to the use of an intelligent alarm management system.

Methods:

This explorative qualitative study with an ethnographic, multi-methods approach was conducted in an ICU of a German university hospital. Using triangulation in data collection, 102 hours of field observations, 12 semi-structured interviews with ICU staff members and the results of a participatory task were analyzed. The data analysis followed an inductive, Grounded Theory approach.

Results:

Nurses and physicians reported that they interacted with the continuous vital sign monitoring system for the majority of their work time and tasks. There were no established standards for alarm management; instead, nurses and physicians stated to address alarms through ad-hoc reactions, a practice viewed as problematic by them. Staffs’ perceptions of intelligent alarm management varied and the importance of understandable and traceable suggestions was highlighted to increase trust and cognitive ease.

Conclusions:

ICU staffs’ interactions with the omnipresent patient monitoring system and its alarms are essential parts of ICU workflows and clinical decision making. Alarm management standards and workflows are deficient, and our observations, as well as staff feedback, suggest that changes are warranted. Solutions for alarm management should be designed and implemented with users, workflows and real-world data at the core.