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Clinician Perspectives on Specifications for Metrics to Inform Pediatric Alarm Management
Insights
Clinicians need better alarm metrics to manage patient alarms and reduce fatigue. Developing specific alarm data formats and delivery methods can improve alarm management in pediatric care.
Area of Science:
- Clinical Informatics
- Human Factors Engineering
- Patient Safety
Background:
- Effective management of monitor alarms is crucial for reducing clinician alarm fatigue.
- Strategies to improve clinician engagement in active alarm management, particularly in pediatric acute care, require further investigation.
- Alarm summary metrics show potential for enhancing clinician engagement in alarm management.
Purpose of the Study:
- To identify functional specifications for creating, packaging, and delivering alarm metrics to clinicians.
- To lay the groundwork for developing interventions aimed at improving alarm management.
- To explore clinician needs and preferences regarding alarm data.
Main Methods:
- Conducted five focus groups with 13 clinicians (nurses and physicians) from pediatric medical-surgical inpatient units.
- Utilized inductive coding of transcripts to identify themes related to current and future states of alarm management.
- Employed a human factors engineering approach in collaboration with clinician scientists.
Main Results:
- Clinicians currently manage alarm burden information on an ad hoc basis, primarily initiated by nurses.
- In a future state, clinicians desire alarm metrics including trends, benchmarks, and contextual data to aid decision-making.
- Identified specific ways alarm metrics could assist clinicians in managing alarms more effectively.
Conclusions:
- Four key recommendations for enhancing clinician management of patient alarms were developed.
- Formulate alarm metrics by categorizing rates and summarizing trends; package with contextual data.
- Deliver metrics in interprofessional forums with clinician education on alarm fatigue and reduction strategies.
Abstract:
Background: Ongoing management of monitor alarms is important for reducing alarm fatigue among clinicians (e.g., nurses, physicians). Strategies to enhance clinician engagement in active alarm management in pediatric acute care have not been well explored. Access to alarm summary metrics may enhance clinician engagement. Objective: To lay the foundation for intervention development, we sought to identify functional specifications for formulating, packaging, and delivering alarm metrics to clinicians. Methods: Our team of clinician scientists and human factors engineers conducted focus groups with clinicians from medical-surgical inpatient units in a children's hospital. We inductively coded transcripts, developed codes into themes, and grouped themes into "current state" and "future state." Results: We conducted five focus groups with 13 clinicians (eight registered nurses and five doctors of medicine). In the current state, information exchanged among team members about alarm burden is initiated by nurses on an ad hoc basis. For a future state, clinicians identified ways in which alarm metrics could help them manage alarms and described specific information, such as alarm trends, benchmarks, and contextual data, that would support decision-making. Conclusion: We developed four recommendations for future strategies to enhance clinicians' active management of patient alarms: (1) formulate alarm metrics for clinicians by categorizing alarm rates by type and summarizing alarm trends over time, (2) package alarm metrics with contextual patient data to facilitate clinicians' sensemaking, (3) deliver alarm metrics in a forum that facilitates interprofessional discussion, and (4) provide clinician education to establish a shared mental model about alarm fatigue and evidence-based alarm-reduction strategies.
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