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Alarm fatigue has the potential to have significant consequences for patient safety, and the critical role of intensive care nurses in alarm management is an important component of this process.
This study aimed to investigate the alarm management practices of intensive care nurses.
This study utilised an observational design.
The study was conducted in the intensive care unit of a university hospital in western Türkiye with 21 nurses. To avoid influencing their behaviour, the primary purpose of the observation was not disclosed to the nurses. Two observers used an observation form to record alarms, nurse interventions and intervention times. Environmental noise levels were also measured and recorded during the observation periods.
Over 118 h of observation, 460 alarms were recorded. Most alarms (80.4%) were generated by monitors, and 36.3% were due to deviations in the patient's clinical status. It was found that 53.3% of alarms were not responded to, and 73.7% were controlled. Environmental noise levels ranged from 41.90 to 83.10 dB.
The control, intervention and response times to alarms by intensive care nurses varied based on the alarm cause and their workload at the time. High environmental noise levels were also observed, which may impact alarm response.
The centralised location of the nurses' station, preparation of treatments at the bedside and proximity to patients contribute positively to alarm management. Recommendations to reduce technical alarms include appropriate device calibration; secure technical connections; and appropriate use of ECG electrodes, sensors and medical supplies. Setting appropriate alarm limits by primary nurses and evaluating ICU noise levels for necessary adjustments are crucial.
The study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklists.
No patient or public contribution.
To identify and characterise the approaches and instruments used in recent literature to measure the prevalence of restrictive care practices in adult mental health inpatient units. Additionally, it sought to summarise the reported psychometric properties, including reliability and validity of these measures.
A systematic review of recent litratures was conducted using Scopus, MEDLINE, CINAHL, PsycINFO, Web of Science and Embase databases to identify studies published from 1 January 2010 to 11 October 2023. A total of 128 studies measuring the use of restrictive care practices were included. Data on measurement methods were extracted from each study and summarised to compare how consistently these practices have been measured across studies and how authors consistently reported the reliability and validity of these measurment approaches. All findings were reported following the PRISMA 2020 checklist.
There were significant variations in how the prevalence of restrictive care practices was measured, and the reliability and validity of these measurements were unclear for most studies. Only 11 studies reported inter/intra-rater reliability. Key variations were observed in data sources utilised, how and by whom the data were collected, the timing and total duration of data collection during patient admission, how and by whom data were extracted from secondary sources, measurement instruments and the reported reliability and validity of measures.
Methodological inconsistencies about the measurements approaches of restricitve care practices would introduduce potential random and/or systematic biases on the reported data which may obscure the the true prevalance these practices. This hinder the ability to acurately assess the effectiveness of reduction strategies and understand the naturally occuring practices. Establishing a standardised set of reliable measures is crucial for enabling valid comparisons for the rates of restricitve car epractice use across settings and countries, which could enhance the ongoing monitoring and reduction of these practices.
The absence of standardised defintions and measurement approaches for restrictive care practices challenges the global effort to reduce their use. Without reliable and common measures, clinicians and researchers often face challenges in documening RCP incidents accurately, compromising efforts to improve care quality and support a recovery-oriented approach. Such measurment errors would mislead decission-maker which would furhter contribute to the inconsistency the the implementation of these practices.
No patient or public contribution.
PROSPERO: CRD:42022335167; https://www.crd.york.ac.uk/prospero/export_details_pdf.php
To compare contextual factors influencing discharge practices in three intensive care units (ICUs).
A prospective observational study.
Data were collected using a discharge process report form (DPRF) between May and September 2023. Descriptive statistics were performed to analyse demographic and clinical data. One-way analysis of variance (ANOVA) was used to test the time interval differences among the three sites.
Overall, 69 patients' discharge processes were observed. Among them, 41 (59%) experienced discharge delay, and 1 in 5 patients experienced after-hours discharge. There were statistically significant differences in mean hours in various time intervals during the discharge processes among the three sites. Patients in Hospital C waited the longest time (mean = 31.9 h) for the ward bed to be ready after the bed was requested and for being eventually discharged after ICU nurses to get them ready for discharge (mean = 26.7 h) compared to Hospital A and Hospital B.
We found that discharge delay and after-hours discharge were common and there were significant differences in mean hours of various time intervals during the discharge processes occurred among the three sites. The influence of contextual factors in different hospitals/ICU needs to be considered to improve the ICU discharge process.
Researchers and clinicians should consider targeted context-specific interventions and strategies to optimise patient discharge process from ICUs.
The study findings will inform the development of tailored interventions to reduce the discharge delay and after-hours discharge and, in turn, improve the quality and safety of patient care and health service efficiency.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
Patients' discharge processes were observed, and consumer representatives were involved in the study design.
There is a growing consensus to reduce the use of restrictive care practices in mental health settings to minimise the physical and psychological complications for patients. However, data regarding restrictive care practice use and factors contributing to variations in the proportion estimates has not previously been synthesised.
This study aimed to synthesise evidence on (1) the pooled proportions of physical restraint, seclusion or chemical restraint in adult mental health inpatients and (2) sources of variability in these proportion estimates.
Studies were identified from Scopus, MEDLINE, PsycINFO, Web of Science, Embase and CINAHL databases following the PRISMA 2020 guidelines. We conducted a meta-analysis of studies published in English language from 1 January 2010 to 15 August 2022. Binomial data were pooled using a random effect model, with 95% confidence intervals. Meta-regression was also computed to identify factors that may contribute to variations in the proportion estimates.
A total of 77 studies were included in this meta-analysis. The pooled prevalence of physical restraint, seclusion and chemical restraint was 14.4%, 15.8% and 25.7%, respectively. Data were heterogeneous across studies (I 2 > 99%). Reporting practices and geographical locations contributed to the variability in the reported estimates of restrictive care practices, with studies from Asian countries reporting higher proportions.
There appear differences between geographical locations in the proportion of restrictive practices in mental health inpatients; however, this is complicated by how these prevalence data have been measured and defined. Consistency in the reporting of restrictive care practices in mental health is required to make valid comparisons between geographical regions, policy settings and practice innovations.
Efforts are needed to develop training programmes and policy changes to ensure consistency in defining and reporting of restrictive care practices in mental health facilities.
This is a systematic review that analysed data from previously published studies, and there was no patient/public contribution in this study.
The protocol for this review has been registered to PROSPERO: CRD42022335167.
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