5结论与展望
5.1研究结论
本研究通过对杭州某三曱医院的ICU床边监护仪报警数据进行调查分析,总结以上结果和讨论,可以得出以下几个主要结论。
5.1.1误报警和无意义报警大量存在于ICU,应釆取一些国际通用的报警管理方法降低误报警率,如贴电极片之前的皮肤准备。其中心律失常报警误报警率最高,需进行进一步质量改进项目。
5.1.2报警倦急现象存在,除了要对新员工进行心电监护仪性能和报警制度的培训,还要对工作年限较长的护士进行持续在职教育5.1.3床边护士对报警的反应速度慢,应在现有的报警制度中对此作出明确的规定,以提高护士对报警的反应速度。
5.2研究不足和展望
床边监护仪报警对于患者来讲,具有十分重要的意义。对其的:研究还需进一步的深化。因为本研究受到地点、时间、样本等客观条件的限制,所以对床边监护仪报警的研究还存在一些需要改进的地方,同时,也是未来研究的方向。
5.2.1本次研究的样本釆集于浙江省某三级甲等医院ICU,研究的结论可能只限于特定地区和医院的情况,今后可对不同级别和地区医院采集样本。
5.2.2本次研究只釆集某个时间段的样本,从时间跨度来讲,没有对不同月份或季度进行调查。
5.2.3在样本的采集中,对于某些影响因素,存在样本数不够对称的情况,因此,在统计推断时,会对数据统计结果的代表性产生一定影响。
参考文献:
[1]Varpio L, Kuziemsky C,MacDonald C,et al. The helpful or hindering effects of in-hospital patient monitor alarms on nurses: a qualitative analysis [J]. ComputInform Nurs
[2]Cvach M. Monitor alarm fatigue: an integrative review[J].Biomed InstrumTechnol,2012,46(4):268-277.
[3]No authors listed. Joint commission releases sentinel event alert on alarm hazards[J].Health Devices,2013,42(6):200.
[4]Keller JP Jr. Clinical alarm hazards: a “top ten” health technology safety concern[J]. J Electrocardiol.
[5]张文燕。2013年十大医疗技术危害[J].中国医院院长,2013,2:26-29.
[6]Kerr JH, Hayes B. An “alarming” situation in the intensive therapy unit[J].Intensive Care Med, 1983,9(3):103-104.
[7]Borowski M,Grges M, Fried R,et al . Medical device alarms [J]. Biomed Tech(Berl),2011,56(2):73-83.
[8]American College of Clinical Engineering (ACCE) Healthcare TechnologyFoundation. Impact of clinical alarms on patient safety: a report from theAmerican College of Clinical Engineering Healthcare Technology Foundation[J].J Clin Eng,2007,3:22-33.
[9]Kerr J,Hayes B.An alarming situation in the intensive therapy unit [J].Intensivecare medicine, 1983,9:103-104.
[10]Cropp AJ,Woods LA, Raney D,et al .Name that tone. The proliferation of alarmsin the intensive care unit[J]Chest Journal, 1994,105: 1217-1220.
[11]Atzema C,Schull MJ, Borgundvaag B,et al. Alarmed: adverse events in low-riskpatients with chest pain receiving continuous electrocardiographic monitoring inthe emergency department: a pilot study [J]. J Emerg Med, 2006,24:62-67.
[12]Bliss J,Fallon CK,Nica N. The role of alarm signal duration as a cure for alarmvalidity[J]. Appl Ergonom,2007,38(2): 191-199.
[13]Biton Y,Meyer J,Shinar D,et aL Nurses' reactions to alarms in a neonatalintensive care unit[J]. J Cognitive Technol Work,2004,6:239-246.
[14]Cvach M. The Johns Hopkins Hospital Quality Improvement Alarm Data.2011 ?
[15]Graham KC,Cvach M. Monitor alarm fatigue: standardizing use of physiologicalmonitors and decreasing nuisance alarms[J].Am J Crit Care,
[16]Chambrin MC,Ravaux P,Calvelo-Aros D,et al. Multicentric study of monitoringalarms in the adult intensive care unit (ICU): a descriptive analysis[J].IntensiveCare Med,1999,25(12):1360-1366.
[17]Gross B,Dahl D,Nielsen L. Physiologic monitoring alarm load 衡 medical/surgical floors of a community hospital[J]. Biomed Instrum Technol,2011,(suppl):29-36.
[18]Morris R,Montano S .Response times to visual and auditory alarms duringanaesthesia [J]. Anaesthesia and intensive care,1996,24: 682-684.
[19]Meredith C,Edworthy J. Sources of confusion in intensive 细rapy unit Alarms,Hximan factors in alarm design,1995:207-219.
[20]Sabar R, Zmora E.Nurses' response to alarms from monitoring systems in NICU[J]. Pediatric Research, 1997,41:174-174.
[21]Momtahan K,Hetu R,Tansley B.Audibility and dentification of auditory alarms inthe operating room and intensive care unit[J] Ergonomics, 1993,36:1159-1176.
[22]Meredith C,Edworthy J.Are there too many alarms in the intensive care unit? Anoverview of the problems[J] Journal of Advanced Nursing,1995,21:15-20.
[23]Sylvia Siebig MD,Silvia Kuhls PhD,Michael Imhoff MD,et al. Collection ofannotated data in a clinical validation study for alarm algorithms in intensivecare-a methodologic framework[J]. Journal of Critical care,2010, 25:128-135.
[24]Tsien CL,Fackler JC.Poor prognosis for existing monitors in the intensive careunit[J].Critical Care Med, 1997,25:614-619.
[25]O'CARROLL T.Survey of alarms in an intensive therapy unit[J], Anaesthesia,1986,41:742-744.
[26]Patel SI,Souter MJ. Equipment-related electrocardiographic artifacts: causes,characteristics, consequences, and correction[J]. Anesthesiology, 2008,108(1):138-148.
[27]Tsien CL,Fackler JC.Poor prognosis for existing monitors in the intensive careunit[J].Critical care medicine, 1997,25:614-619.
[28]Bell L.Alarm fatigue linked to patient's death. Interview by Laura Wallis[J]. TheAmerican journal of nursing,2010,110:16-16.
[29]No authors listed. Joint commission releases sentinel event alert on alarmhazards [J]. Health Devices, 2013,42(6):200.
[30]kivirta AM,Koski E, Kari A,et al.The median filter as a preprocessor for a patientmonitor limit alarm system in intensive care [J] Computer methods and programs inbiomedicine, 1991,34:39-144.
[31]Borowski M,Siebig S,Wrede C, et al.Reducing false alarms of intensive careonline-monitoring systems: an evaluation of two signal extraction algorithms [J]Computational and mathematical methods in medicine,2011.
[32]Aboukhalil A, Nielsen L,Saeed M,et al.Reducing false alarm rates for criticalarrhythmias using the arterial blood pressure waveform [J] Joumal of biomedicalinformatics,2008, 41:442-451.
[33]Clifford G,Aboukhalil A, Sun J,et al.Using the blood pressure waveform toreduce critical false ECG alarms,Computers in Cardiology, 2006:829-832.
[34]Li Q,Clifford GD.Suppress false arrhythmia alarms of icu monitors using heartrate estimation based on combined arterial blood pressure and ecganalysis,Bioinformatics and Biomedical Engineering, 2008. ICBBE 2008. The2nd International Conference on, 2008:2185-2187.
[35]Deshmane AV.False arrhythmia alarm suppression using ECG, ABP, anphotoplethysmogram,Massachusetts Institute of Technology, 2009.
[36]Zong W, Moody G,Mark R.Reduction of false arterial blood pressure alarmsusing signal quality assessement and relationships between the electrocardiogramand arterial blood pressure[J]Medical and Biological Engineering and Computing,2004,42:698-706.
[37]LiQ,Mark RG, Clifford GD.Robust heart rate estimation from multipleasynchronous noisy sources using signal quality indices and a Kalmanfilter[J]Physiological measurement,2008,29:15.
[38]No authors listed.Alarm management performance improvement plan:astep-by-step guid [J], American Association of Critical-Care,
[39]Chambrin MC,Ravaux P,Calvelo-Aros D,et al. Multicentric study of monitoringalarms in the adult intensive care unit (ICU): a descriptive analysis[J].IntensiveCare Med,1999,25(12):1360-1366.
[40]PT Trzepalz,RW Baker,J Greenhouse.A symptom rating scale for delirium [J],Psychiatry Research, 1988,23(1):89-97
[41]Kelly Creighton Graham,Maria Cvach.Monitor alarm fatigue: standardizing use ofphysiological monitors and decreasing nuisance alarms [J] .American Journal OfCritical Care,2010,19(l): 28-34.
[42]Gilles clermont,MDCM,MSC.Arterial catheterization techniques for invasivenionitoring.
[43]Patel SI, Souter MJ. Equipment-related electrocardiographic artifacts: causes,characteristics, consequences,and correction [J]. Anesthesiology,2008,108(1):138-148.
[44]Drew BJ,Funk M. Practice standards for ECG monitoring in hospital settings:executive summary and guide for implementation^]. Crit Care Nurs Clin NorthAm,2006,18(2):157-168.
[45]Medina V,Clochesy JM,Ornery A. Comparison of electrode site preparationtechniques[J]. Heart Lung,1989, 18(5):456-460.
[46]Clochesy JM,Cifani L, Howe K. Electrode site preparation techniques: afollow-up study [J]. Heart Lung,1991,20(1):27-30.
[47]Cvach MM,Biggs M,Rothwell KJ,et al. Daily electrode change and effect oncardiac monitor alarms: an evidence-based practice approach [J] J Nurs CareQual,2012,28(3):265-271.
[48]No authors listed. The hazards of alarm overload. Keeping excessive physiologicmonitoring alarms from impeding care[J]. Health Devices,2007,36(3):73-83.
[49]Welch J. An evidence-based approach to reduce nuisance alarms and alaim fatigue[J]. Biomed Instrum Technol, 201 l,(suppl):46-52.
[50]吴静。ICU噪音污染与护理管理[J].中外医学研究,2011,9(26) : 71
[51]Bitan Y,Meyer J, Shinar D, et al.Nursers'reactions to alarms in a neonatalintensive care unit[J]. Cognition, Technology & Work, 2004,6; 239-246.
[52]周姓良,胡靖青,刘娟。护理干预对降低心电监护仪误报警率的效果观察[J].现代临床护理2012,11 (2) :16-18