Challenges of customizing electrocardiography alarms in intensive care units: A mixed methods study

Halley Ruppel; Marjorie Funk; Holly Powell Kennedy; Christopher P. Bonafide; Shu Fen Wung; Robin Whittemore

doi:10.1016/j.hrtlng.2018.06.010

Challenges of customizing electrocardiography alarms in intensive care units: A mixed methods study

Halley Ruppel, Marjorie Funk, Holly Powell Kennedy, Christopher P. Bonafide, Shu Fen Wung, Robin Whittemore

Nursing, College of

Research output: Contribution to journal › Article › peer-review

15 Scopus citations

Abstract

Background: Customizing monitor alarm settings to individual patients can reduce alarm fatigue in intensive care units (ICUs), but has not been widely studied. Objectives: To understand ICU nurses’ approaches to customization of electrocardiographic (ECG) monitor alarms. Methods: A convergent mixed methods study was conducted in 3 ICUs in 1 hospital. Data on the type and frequency of ECG alarm customization were collected from patient monitors (n=298). Nurses’ customization clinical reasoning was explored through semi-structured interviews (n=27). Results: Of the 298 patients, 58.7% had ≥1 alarm(s) customized. Heart rate limits, irregular heart rate, and atrial fibrillation were the most commonly customized alarms. Interviews revealed that customization practices varied widely and were influenced by factors including clinical expertise, lack of customization education, and negative experiences. Conclusion: Alarm customization is nuanced and requires adequate support to develop safe and effective practices. The challenges identified can inform development of strategies to improve alarm customization.

Original language	English (US)
Pages (from-to)	502-508
Number of pages	7
Journal	Heart and Lung
Volume	47
Issue number	5
DOIs	https://doi.org/10.1016/j.hrtlng.2018.06.010
State	Published - Sep 1 2018

Keywords

Alarm Customization
Clinical Alarms
Critical Care Nursing
Electrocardiography
Intensive Care Units
Physiologic Monitor Alarms

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine
Critical Care and Intensive Care Medicine
Cardiology and Cardiovascular Medicine

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Cite this

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title = "Challenges of customizing electrocardiography alarms in intensive care units: A mixed methods study",

abstract = "Background: Customizing monitor alarm settings to individual patients can reduce alarm fatigue in intensive care units (ICUs), but has not been widely studied. Objectives: To understand ICU nurses{\textquoteright} approaches to customization of electrocardiographic (ECG) monitor alarms. Methods: A convergent mixed methods study was conducted in 3 ICUs in 1 hospital. Data on the type and frequency of ECG alarm customization were collected from patient monitors (n=298). Nurses{\textquoteright} customization clinical reasoning was explored through semi-structured interviews (n=27). Results: Of the 298 patients, 58.7% had ≥1 alarm(s) customized. Heart rate limits, irregular heart rate, and atrial fibrillation were the most commonly customized alarms. Interviews revealed that customization practices varied widely and were influenced by factors including clinical expertise, lack of customization education, and negative experiences. Conclusion: Alarm customization is nuanced and requires adequate support to develop safe and effective practices. The challenges identified can inform development of strategies to improve alarm customization.",

keywords = "Alarm Customization, Clinical Alarms, Critical Care Nursing, Electrocardiography, Intensive Care Units, Physiologic Monitor Alarms",

author = "Halley Ruppel and Marjorie Funk and Kennedy, {Holly Powell} and Bonafide, {Christopher P.} and Wung, {Shu Fen} and Robin Whittemore",

note = "Publisher Copyright: {\textcopyright} 2018 Elsevier Inc.",

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language = "English (US)",

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AU - Funk, Marjorie

AU - Kennedy, Holly Powell

AU - Bonafide, Christopher P.

AU - Wung, Shu Fen

AU - Whittemore, Robin

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: Customizing monitor alarm settings to individual patients can reduce alarm fatigue in intensive care units (ICUs), but has not been widely studied. Objectives: To understand ICU nurses’ approaches to customization of electrocardiographic (ECG) monitor alarms. Methods: A convergent mixed methods study was conducted in 3 ICUs in 1 hospital. Data on the type and frequency of ECG alarm customization were collected from patient monitors (n=298). Nurses’ customization clinical reasoning was explored through semi-structured interviews (n=27). Results: Of the 298 patients, 58.7% had ≥1 alarm(s) customized. Heart rate limits, irregular heart rate, and atrial fibrillation were the most commonly customized alarms. Interviews revealed that customization practices varied widely and were influenced by factors including clinical expertise, lack of customization education, and negative experiences. Conclusion: Alarm customization is nuanced and requires adequate support to develop safe and effective practices. The challenges identified can inform development of strategies to improve alarm customization.

AB - Background: Customizing monitor alarm settings to individual patients can reduce alarm fatigue in intensive care units (ICUs), but has not been widely studied. Objectives: To understand ICU nurses’ approaches to customization of electrocardiographic (ECG) monitor alarms. Methods: A convergent mixed methods study was conducted in 3 ICUs in 1 hospital. Data on the type and frequency of ECG alarm customization were collected from patient monitors (n=298). Nurses’ customization clinical reasoning was explored through semi-structured interviews (n=27). Results: Of the 298 patients, 58.7% had ≥1 alarm(s) customized. Heart rate limits, irregular heart rate, and atrial fibrillation were the most commonly customized alarms. Interviews revealed that customization practices varied widely and were influenced by factors including clinical expertise, lack of customization education, and negative experiences. Conclusion: Alarm customization is nuanced and requires adequate support to develop safe and effective practices. The challenges identified can inform development of strategies to improve alarm customization.

KW - Alarm Customization

KW - Clinical Alarms

KW - Critical Care Nursing

KW - Electrocardiography

KW - Intensive Care Units

KW - Physiologic Monitor Alarms

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Challenges of customizing electrocardiography alarms in intensive care units: A mixed methods study

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Keywords

ASJC Scopus subject areas

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