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Differences in alarm events between disposable and reusable electrocardiography lead wires
Nancy M Albert1, Terri Murray2, James F Bena2
1Nancy M. Albert is associate chief nursing officer, Office of Research and Innovation, Nursing Institute and clinical nurse specialist, Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Albert is also an adjunct professor at Aalborg University in Aalborg, Denmark and an adjunct associate professor at Case Western Reserve University, Francis Payne Bolton School of Nursing in Cleveland Ohio. Terri Murray is a nurse manager of 2 cardiovascular step-down/telemetry units, James F. Bena is a statistician, Ellen Slifcak is a research nurse, Joel D. Roach is a research coordinator, Jackie Spence was a manager of 2 cardiovascular step-down/telemetry units, and Alicia Burkle is a supervisor in the clinical monitoring unit at Cleveland Clinic. albertn@ccf.org.
Background:
Disposable electrocardiographic lead wires (ECG-LWs) may not be as durable as reusable ones.
Objective:
To examine differences in alarm events between disposable and reusable ECG-LWs.
Method:
Two cardiac telemetry units were randomized to reusable ECG-LWs, and 2 units alternated between disposable and reusable ECG-LWs for 4 months. A remote monitoring team, blinded to ECG-LW type, assessed frequency and type of alarm events by using total counts and rates per 100 patient days. Event rates were compared by using generalized linear mixed-effect models for differences and noninferiority between wire types.
Results:
In 1611 patients and 9385.5 patient days of ECG monitoring, patient characteristics were similar between groups. Rates of alarms for no telemetry, leads fail, or leads off were lower in disposable ECG-LWs (adjusted relative risk [95% CI], 0.71 [0.53-0.96]; noninferiority P < .001; superiority P = .03) and monitoring (artifact) alarms were significantly noninferior (adjusted relative risk [95% CI]: 0.88, [0.62-1.24], P = .02; superiority P = .44). No between-group differences existed in false or true crisis alarms. Disposable ECG-LWs were noninferior to reusable ECG-LWs for all false-alarm events (N [rate per 100 patient days], disposable 2029 [79.1] vs reusable 6673 [97.9]; adjusted relative risk [95% CI]: 0.81 [0.63-1.06], P = .002; superiority P = .12.)
Conclusions:
Disposable ECG-LWs with patented push-button design had superior performance in reducing alarms created by no telemetry, leads fail, or leads off and significant noninferiority in all false-alarm rates compared with reusable ECG-LWs. Fewer ECG alarms may save nurses time, decrease alarm fatigue, and improve patient safety.
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