Resuscitation Team Roles and Responsibilities: In-Hospital Cardiopulmonary Arrest Teams.

Patients who experience an in-hospital cardiopulmonary arrest event often have poor outcomes. Those outcomes are influenced by institutional factors, including the effectiveness of the responding team. Two main types of response teams may exist for in-hospital settings: basic life support trained staff providing initial interventions, and advanced cardiac life support teams. The interface between these two responses, and differences in discipline, experience, and skill mix, adds complexity to team dynamics. In-hospital cardiopulmonary arrest teams benefit from addressing these and other factors, which may lead to lack of clarity in role and responsibility identification and ultimately team performance.

Mechanical Ventilation Alarms and Alarm Fatigue.

Mechanical ventilation alarms and alerts, both audible and visual, provide the clinician with vital information about the patient's physiologic condition and the status of the machine's function. Not all alarms generated by the mechanical ventilator provide actionable information. Over time, clinicians can become desensitized to audible alarms due to alarm fatigue and may potentially ignore an actionable situation that results in patient harm. Alarm fatigue has been recognized by multiple agencies as a major patient-safety issue. To date, mechanical ventilator alarm settings do not have standardized nomenclature. The aim of this review was to examine and report on the literature that pertains to mechanical ventilation alarms and alarm fatigue and to propose recommendations for future research that may lead to safer mechanical ventilation alarm practices.

Testing physiologic monitor alarm customization software to reduce alarm rates and improve nurses' experience of alarms in a medical intensive care unit.

BACKGROUND: Clinicians in intensive care units experience alarm fatigue related to frequent false and non-actionable alarms produced by physiologic monitors. To reduce non-actionable alarms, alarm settings may need to be customized for individual patients; however, nurses may not customize alarms because of competing demands and alarm fatigue. OBJECTIVE: To examine the effectiveness and acceptance of physiologic monitor software to support customization of alarms. METHODS: This pre/post intervention study was conducted in a 56-bed medical intensive care unit. IntelliVue® Alarm Advisor customization support software for alarm limit violations was installed on all monitors and education on its use provided. For 2 months before and after implementation of the software, data were collected on patient characteristics from the electronic health record, alarm counts and duration from the monitoring system, and nurses' experience of alarms from a survey. RESULTS: Medium-priority heart rate, respiratory rate, and arterial pressure alarms were significantly reduced after software implementation (9.3%, 11.8%, and 15.9% reduction respectively; p<0.001 for all). The duration of these alarms was also significantly shorter (7.8%, 13.3%, and 9.3% reduction respectively; p<0.05 for all). The number and duration of SpO2 alarms did not decrease (p>0.05 for both). Patients post-intervention had worse Glasgow Coma Scale scores (p = 0.014), but otherwise were comparable to those pre-intervention. Nurses reported less time spent on non-actionable alarms post-intervention than pre-intervention (p = 0.026). Also lower post-intervention were the proportions of nurses who reported that alarms disturbed their workflow (p = 0.027) and who encountered a situation where an important alarm was ignored (p = 0.043). The majority (>50%) agreed that the software supported setting appropriate alarm limits and was easy to use. CONCLUSION: Alarm customization software was associated with a reduction in alarms. Use of software to support nurses' recognition of trends in patients' alarms and facilitate changes to alarm settings may add value to alarm reduction initiatives.