The effect of intelligent management interventions in intensive care units to reduce false alarms: An integrative review.

Objective: In intensive care units (ICU), frequent false alarms from medical equipment can cause alarm fatigue among nurses, which might lead to delayed or missed responses and increased risk of adverse patient events. This review was conducted to evaluate the effectiveness of intelligent management interventions to reduce false alarms in ICU. Method: Following the framework of Whitmore and Knafl, the reviewers systematically searched six databases: PubMed, EMBASE, CINAHL, OVID, Cochrane Library, and Scopus, and studies included intelligent management of clinical alarms published in the English or Chinese language from the inception of each database to December 2022 were retrieved. The researchers used the PICOS framework to formulate the search strategy, developed keywords, screened literature, and assessed the studies' quality using the Joanna Briggs Institute-Meta-Analysis of Statistics, Assessment, and Review Instrument (JBI-MAStARI). The review was preregistered on PROSPERO (CRD42023411552). Results: Seven studies met the inclusion criteria. The results showed that different interventions for intelligent management of alarms were beneficial in reducing the number of false alarms, the duration of alarms, the response time to important alarms for nurses, and the alarm fatigue levels among nurses. Positive results were found in practice after the application of the novel alarm management approaches. Conclusion: Intelligent management intervention may be an effective way to reduce false alarms. The application of systems or tools for the intelligent management of clinical alarms is urgent in hospitals. To ensure more effective patient monitoring and less distress for nurses, more alarm management approaches combined with artificial intelligence will be needed in the future to enable accurate identification of critical alarms, ensure nurses are responding accurately to alarms, and make a real difference to alarm-ridden healthcare environments.

Nurses' engagement in antimicrobial stewardship and its influencing factors: A cross-sectional study.

Objective: This study aimed to investigate the level and influencing factors of nurses' antimicrobial stewardship (AMS) engagement in China based on the capability, opportunity, motivation, and behavior (COM-B) theory, providing valuable insights for developing effective strategies to improve nursing quality in AMS. Methods: This cross-sectional study was conducted in 17 tertiary hospitals in Hunan, China, from November 2021 to January 2022. A total of 4,514 nurses were selected. The Nurse AMS Engagement Questionnaire (NAEQ), developed using the COM-B theory, was used for evaluation. The questionnaire included capability (14 items), opportunity (7 items), motivation (6 items), and behavior (12 items) four dimensions, 39 items. Results: The total NAEQ score was 155.08 ± 27.12, indicating a moderate level. The score of the capability, opportunity, motivation, and behavior dimensions were 52.33 ± 13.48, 28.64 ± 5.76, 24.57 ± 4.57 and 49.53 ± 8.83, respectively. Significant differences in nurses' AMS engagement were based on professional titles, whether working as a part-time infection control nurse, whether knowing the AMS teams and the defined daily doses of antibiotics, department type, the deployment of clinical pharmacists, and frequency of antimicrobial training and physician-nurse joint rounds (P < 0.05). Nurses with junior titles had higher scores on the NAEQ than nurses with intermediate titles (P < 0.05). Nurses who worked as part-time infection control nurses, knew the AMS team, and the defined daily doses of antibiotics had higher NAEQ scores than those who didn't (P < 0.01). Nurses working in the ICU and infectious disease department had lower NAEQ scores than those in other departments, such as the ear, nose, and throat (ENT) department (P < 0.01). Nurses who had clinical pharmacists deployed in their department had higher NAEQ scores than those without or unclear deployment (P < 0.01). Furthermore, nurses who received more frequent antimicrobial training and participated in physician-nurse joint rounds had higher NAEQ scores (P < 0.01). Conclusion: Multiple strategies, including enhanced education and training and improved multidisciplinary communication and collaboration, are expected to improve nurse AMS engagement. It is important to give more attention to nurses with intermediate professional titles, less experience, and those working in specific departments.

Biomarkers Associated with Drugs for the Treatment of Lupus Nephritis.

The constant updating of lupus drug treatment guidelines has led to a question. How can the efficacy of treatment be more effectively monitored? Systemic lupus erythematosus (SLE) is a complex autoimmune disease that often presents clinically with multi-organ involvement, and approximately 30% of patients with SLE develop lupus nephritis (LN). Therefore, it is important to better track disease progression and drug efficacy. Now, kidney biopsy is still the gold standard for diagnosing and guiding the treatment of LN, but it is invasive and expensive. If simple, non-invasive and effective biomarkers can be found, drug intervention and prognosis can be better monitored and targeted. In this review, we focus on LN and explore biomarkers related to LN therapeutics, providing clinicians with more possibilities to track the therapeutic effect of drugs, improve treatment options and assess patient outcomes.

The effect of educational interventions in managing nurses' alarm fatigue: An integrative review.

BACKGROUND: Alarm fatigue is becoming more widely acknowledged as a serious safety concern in modern clinical practice. Nurses are not always proficient in the alarms' functions and capabilities, and they do not undertake training regularly. Educating nurses on alarms maintains their knowledge and abilities in complex clinical settings. Some education has been undertaken to improve clinical alarm response, but the evidence for evaluating the effectiveness of nurse education interventions is limited. OBJECTIVE: To evaluate the effects of educational interventions for reducing alarm fatigue in nurses, including the reduction of excessive, false and non-actionable alarms, which are major factors causing alarm fatigue in nurses. DATA SOURCES: PUBMED, EMBASE, CINAHL, SCOPUS and OVID databases were systematically searched from 2016 to 2021. DESIGN: Integrative Review. REVIEW METHODS: An integrative review of literature was performed using the PRISMA checklist. Critical appraisal was done using Joanna Briggs Institute level of evidence. RESULTS: Thirteen studies met the inclusion criteria. The results of most studies showed that educational intervention was beneficial for reducing the total number of alarms and false alarms. Furthermore, nurses' perceptions and knowledge improved, but the reduction in nurses' alarm fatigue is uncertain. A positive effect in alarm management practices was identified after the educational intervention. CONCLUSION: Educational intervention may be the way to manage nurses' alarm fatigue. The use of medical devices in hospitals is increasing exponentially, and for this reason, alarms are inevitable. The introduction of effective and continuous education and training programs for nurses concerning clinical alarm management as well as raising nurses' awareness of the occurrence of alarm fatigue is vital.