This study is a descriptive survey study to investigate alarm situations in the intensive care units and nurses’ attitudes, fatigue, and medical equipment management aspects of their management of the medical equipment alarm and management in the intensive care units. This study targeted the intensive care units of H University Hospital located in Gangwon Province from October 2 to October 31, 2017. This study was carried out through a direct observation and a questionnaire survey. The questionnaire survey targeted 48 nurses working in the intensive care units of H Hospital located in Gangwon Province. This study divided 24 hours (a day) into the unit of an hour and conducted two times of direct observation per unit hour for 48 hours targeting the medical equipment applied to 40 beds in the two intensive care units concerning the following: kinds of medical equipment’s alarm in the intensive care units, the number of alarm from the medical equipment, the equipment-generated alarm, the types of the medical equipment, the alarm setting state of the physiological monitors and ventilators, nurses’ alarm control, and alarm level. Regarding the
nurses’ perception, fatigue, and alarm management aspects on alarm and management in the intensive care units, the 48 nurses were instructed to fill the questionnaire out in the two intensive care units, after the direct observation was finished. Actual numbers, percentage, mean, and standard deviation of the collected data were calculated using SPSS Win 21.0, and the data were analyzed using t-tests and Pearson’s correlation coefficient. The results of this study are as follows: 1. 3.8 (±2.8) units of medical equipment on average were used for each serious patient. There were four types of equipment that generated alarm: physiological monitors, ventilators, continuous renal replacement therapy, and infusion pump. 2. As a result of investigating the alarm from the medical equipment in the intensive care units, 184 cases of alarm sounded during 48 hours of the investigation, which indicated that 3.8 cases of alarm sounded per hour. Among them, false alarm was 110 cases (59.8%). 3. As for the management of alarm, two-minute alarm sound removal took up most at 38.0% (70 cases), and no response was second most at 32.6% (60 cases). When valid alarm sounded, no response took most at 43.2% as nurses’ alarm management. Of the valid alarm, premature ventricular contraction (PVC) took up 53.8% of the observed alarm. 4. As for nurses’ general characteristics, mean age was 30±7.0, mean working experience in the intensive care units was 5.2±5.6 years. The ratio of the nurses, who received training on how to manage medical equipment’s alarm (solving method and scope setting method) within recent two years, was 43.8%, and the ratio of the nurses experiencing safety accidents related with alarm was 66.7%. 5. As a result of measuring the nurses’ fatigue from alarm in the intensive care units, its score was 29.1 points (±4.0) out of 40 points in full mark, and they felt more than medium level of fatigue from the alarm. 6. The most important problem regarded by the nurses as the problem associated with alarm management was “Frequent false alarm, which leads to reduced attention or response to alarm,” and the second most important problem was “the lack of personnel.” 7. The item for which management of alarm was conducted most was “Use an infusion pump for only drug, of which accurate dosage infusion is required.” The item showing the lowest performance was “Clean the skin on which electrode was attached using alcohol. 8. The alarm management showed significant correlations with clinical career (p=.020) and whether the nurses have an experience on patient’s safety accidents (p=.021).
In conclusion, the nurses in the intensive care units felt more than medium level fatigue on the alarm, and they had lots of stress. Out of the alarm, false alarm frequently occurred, and such false alarm is regarded as causing the decline of nurses’ attention and handling of the alarm. For proper alarm management, the development of a standard protocol at hospital level is required, and fatigue from alarm should be reduced, and alarm management should be enhanced through steady training. The lack of personnel to manage alarm in Korea was an important problem unlike foreign countries. For this reason, an intervention is judged
necessary so that new nurses can properly cope with alarm through adequate training and education. Through sufficient employment of nurses in the intensive care units in Korea, alarm management needs to be managed well. The concepts of false alarm or fatigue from alarm is unfamiliar in Korea, and the tools measuring fatigue from alarm were all different. Therefore, there was a limitation in that the study results could not be compared with domestic previous studies in diverse ways. Therefore it is necessary to compare and analyze domestic research results on alarm fatigue by revising related instructions so that unified tools to measure alarm fatigue are developed and consistent standard and principles are applied in the research
process of alarm in the future.