床旁心电监护仪报警管理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2021.03.023

摘要/Abstract

摘要：

目的检索、评价和整合患者床旁心电监护仪报警管理的最佳证据。方法检索BMJ Best Practice、UpTo-Date、Cochrane Library、乔安娜布里格斯研究所（Joanna Briggs Institute,JBI）循证卫生保健中心数据库、国际指南网、中国指南网、PubMed、Embase、CINAHL、万方、中国知网等网站或数据库关于患者床旁心电监护仪报警管理的所有证据,包括指南、系统评价、最佳实践信息册、证据总结、专家共识等。检索时限为建库至2020年1月。采用JBI循证卫生保健中心的文献评价标准和证据分级系统进行文献质量评价及证据级别判定。结果共纳入14篇文献,其中临床实践指南5篇、国际标准1篇、国家卫生行业标准1篇、专家共识2篇、证据总结1篇、系统评价4篇。从多学科合作、监测操作、报警评估、报警设置、报警处理、教育培训和监护仪维护7个方面总结20条证据。结论该研究总结了床旁心电监护仪报警管理的最佳证据,建议实施多学科合作的报警管理模式,规范报警临床实践,加强医护人员培训和设备维护,以达到报警安全管理目标。

关键词: 心电监护仪, 床旁, 报警, 循证护理学

Abstract: Objective To retrieve，appraise and synthesize the best available evidence on the management of bedside electrocardiogram monitor alarms. Methods We searched the literature from BMJ Best Practice，UpToDate，Cochrane Library，Joanna Briggs Institute（JBI），PubMed，Embase，Registered Nurses' Association of Ontario（RNAO），Guidelines International Network（GIN），CNKI，Wanfang to collect relevant guidelines，systematic reviews，best practice information sheets，evidence summaries and expert consensuses. The retrieval period was from the inception of databases to January 2020. 2 researchers independently appraised articles，and extracted data from eligible studies according to the judgment of professionals. Results A total of 14 related articles were enrolled，including 5 clinical practice guidelines，1 national standard，1 national health industry standard，2 expert consensuses，1 evidence summary，4 systematic reviews. Totally 20 pieces of best evidence were summarized from 7 aspects，namely multidisciplinary cooperation，monitoring operation，alarm evaluation，alarm setting，alarm processing，training and education，and monitor maintenance. Conclusion This study summarized the best evidence on management of bedside monitor alarms. It is recommended to implement a multidisciplinary alarm management model，standardize the clinical practice of alarms，and strengthen training and equipment maintenance to achieve safety management goals.

Key words: Electrocardiogram Monitor, Bedside, Alarm, Evidence-Based Nursing

张奕, 陈香萍, 邵桑, 庄一渝, 劳月文, 丁茱萸, 汪萍, 肖艳萍. 床旁心电监护仪报警管理的最佳证据总结[J]. 中华护理杂志, 2021, 56(3): 445-451.

ZHANG Yi, CHEN Xiangping, SHAO Sang, ZHUANG Yiyu, LAO Yuewen, DING Zhuyu, WANG Ping, XIAO Yanping. Evidence summary for management of bedside electrocardiogram monitor alarms[J]. Chinese Journal of Nursing, 2021, 56(3): 445-451.

图/表 4

Table 1 Characteristics of included studies

Table 2 Methodological quality appraisementof the included guidelines

Table 3 Methodological quality appraisement of included systematic reviews

Table 4 Evidence summary for management of bedside monitor alarms

参考文献 42

[1]	潘春里 . 安全护理在预防急诊室心电心电监护仪误报警中的应用效果[J]. 国际护理学杂志, 2016,35(18):2504-2506.
	Pan CL . Application effect of safety nursing in preventing false alarm of ECG and ECG monitor in emergency room[J]. Int J Nurs, 2016,35(18):2504-2506.
[2]	吴俊, 叶志弘, 陈香萍 . ICU床边监护仪报警现状及影响因素分析[J]. 护理学杂志, 2015,30(24):20-26.
	Wu J, Ye ZH, Chen XP . Current status and influencing factors of bedside monitor alarms in ICU[J]. J Nurs Sci, 2015,30(24):20-26.
[3]	Bonafide CP, Localio AR, Holmes JH , et al. Video analysis of factors associated with response time to physiologic monitor alarms in a children's hospital[J]. JAMA Pediatr, 2017,171(6):524-531.
[4]	The Joint Commission. Sentinel event alert issue 50:medical device alarm safety in hospitals[EB/OL].( 2013 -04-08)[2020-03-05].
[5]	Sendelbach S, Funk M . Alarm fatigue:a patient safety concern[J]. AACN Adv Crit Care, 2013,24(4):378-386.
[6]	Kane-Gill SL , O'Connor MF,Rothschild JM,et al. Technologic distractions(part 1):summary of approaches to manage alert quantity with intent to reduce alert fatigue and suggestions for alert fatigue metrics[J]. Crit Care Med, 2017,45(9):1481-1488.
[7]	Ruppel H, Funk M, Whittemore R , et al. Critical care nurses' clinical reasoning about physiologic monitor alarm customization:an interpretive descriptive study[J]. J Clin Nurs, 2019,28(15/16):3033-3041.
[8]	The Joint Commission. National patient safety goals effective [EB/OL].( 2015 -01-01)[2020-03-05]. http://www.jointcommis-sion.org/assets/1/6/2015_NPSG_ HAP.
[9]	Drew BJ, Harris P, Zègre-Hemsey JK , et al. Insights into the pro-blem of alarm fatigue with physiologic monitor devices:a comprehensive observational study of consecutive intensive care unit patients[J]. PLoS One, 2014,9(10):e110274.
[10]	王婧, 王建宁, 周松 , 等. ICU护士医疗设备报警疲劳程度及其影响因素的研究[J]. 中华护理杂志, 2017,52(2):211-215.
	Wang J, Wang JN, Zhou S , et al. The status and influencing factors of alarm fatigue towards medical devices among ICU nurses[J]. Chin J Nurs, 2017,52(2):211-215.
[11]	Brouwers MC, Kho ME, Browman GP , et al. AGREE II:advancing guideline development,reporting and evaluation in health care[J]. Prev Med, 2010,51(5):421-424.
[12]	The Joanna Briggs Institute. Critical appraisal tools for use in JBI systematic reviews[EB/OL].( 2017- 07- 15)[2020-03-01]. .
[13]	陈耀龙, 李幼平, 杜亮 , 等. 医学研究中证据分级和推荐强度的演进[J]. 中国循证医学杂志, 2008,8(2):127-133.
	Chen YL, Li YP, Du L , et al. Evolution of levels of evidence and strength of recommendations in medical research[J]. Chin J Evid-Based Med, 2008,8(2):127-133.
[14]	王春青, 胡雁 . JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015,30(11):964-967.
	Wang CQ, Hu Y . JBI evidence pre-grading and evidence recommendation level system(2014)[J]. J Nurses Train, 2015,30(11):964-967.
[15]	Sandau KE, Funk M, Auerbach A , et al. Update to practice standards for electrocardiographic monitoring in hospital settings:a scientific statement from the American Heart Association[J]. Circulation, 2017,136(19):e1-e73.
[16]	Emergency Care Research Institute. Clinical alarms[EB/OL].( 2013 -12-23)[2020-03-05].
[17]	National Center for Patient Safety( NCPS) . Alarms on bedside physiological monitors[EB/OL].( 2009 -07-10)[2020-03-05]. http://www.patientsafety.va.gov/professionals/onthejob/rca.asp.
[18]	The Joint Commission.National patient safety goals effective january 2020[EB/OL].( 2020-01-01)[2020-03-05].
[19]	许锋, 田金, 徐恒 , 等 . 多参数心电监护仪安全管理[EB/OL].( 2019 -10-18)[2020-03-05]. http://www.nhc.gov.cn/fzs/s7852d/201911/9841e17b4c334d55b6ef3e0fb5fc36fd.shtml.
	Xu F, Tian J, Xu H , et al. Safety management of multi-parameter ECG monitor[EB/OL].( 2019 -10-18)[2020-03-05]. http://www.nhc.gov.cn/fzs/s7852d/201911/9841e17b4c334d55b6ef3e0f-b5fc36fd.shtml.
[20]	The International Electrotechniacal Commission. Medical electrical equipment-part 2-27:particular requirements for the basic safety and essential performance of electrocardiographic monitoring equipment[EB/OL].( 2011 -03-01)[2020-03-05].
[21]	Stacy J, Susan SH, Halley R , et al. Managing alarms in acute care across the life span:electrocardiography and pulse oxi-metry[J]. Crit Care Nurse, 2018,38(2):e16-e20.
[22]	The Association for the Advancement of Medical Instrumen-tation. Clinical alarms[EB/OL].( 2013 -09-30)[2020-03-05]. http://www.aami.org/publications/summits/2011_Alarms_Summit_ publication.pdf.
[23]	Roux PL, Menon DK, Citerio G , et al. Consensus summary state-ment of the international multidisciplinary consensus conference on multimodality monitoring in neurocritical care[J]. Intensive Care Med, 2014,40(9):1189-1209.
[24]	Whitehorn A. Intensive care units: noise reduction[EB/OL]. ( 2019- 01- 23)[2020-03-05]. .
[25]	Paine CW, Goel VV, Ely E , et al. Systematic review of physi-ologic monitor alarm characteristics and pragmatic interven-tions to reduce alarm frequency[J]. J Hosp Med, 2016,11(2):136-144.
[26]	Winters BD, Bonafide CP , O'Connor WF,et al. Technologic dis-tractions(part 2):a summary of approaches to manage clinical alarms with intent to reduce alarm fatigue[J]. Crit Care Med, 2017,7(6):1-8.
[27]	Cvach M . Monitor alarm fatigue:an integrative review[J]. Biomed Instrum Technol, 2012,46(4):68-77.
[28]	Konkani A, Oakley B, Bauld TJ . Reducing hospital noise:a re-view of medical device alarm management[J]. Biomed Instrum Technol, 2012,46(6):78-87.
[29]	Yeh J, Wilson R, Young L , et al. Team-based intervention to reduce the impact of nonactionable alarms in an adult intensive care unit[J]. J Nurs Care Qual, 2020,35(2):115-122.
[30]	薛燕, 仲骏, 郑吉莉 . 多学科团队在降低心脏外科ICU护士监护仪报警疲劳中的应用[J]. 护理管理杂志, 2018,18(8):601-604.
	Xue Y, Zhong J, Zheng JL . Application of multidisciplinary team on reducing ECG monitor alarm fatigue of nurses in cardiac surgery ICU[J]. J Nurs Adm, 2018,18(8):601-604.
[31]	Cvach MM, Biggs M, Rothwell KJ , et al. Daily electrode change and effect on cardiac monitor alarms:an evidence based prac-tice approach[J]. J Nurs Care Qual, 2013,28(3):265-271.
[32]	Walsh-Irwin C, Jurgens CY . Proper skin preparation and electrode placement decreases alarms on a telemetry unit[J]. Dimens Crit Care Nurs, 2015,34(3):134-139.
[33]	Turmell JW, Coke L, Catinella R , et al. Alarm fatigue:use of an evidence-based alarm management strategy[J]. J Nurs Care Qual, 2017,32(1):47-54.
[34]	Welch J . An evidence-based approach to reduce nuisance alarms and alarm fatigue[J]. Biomed Instrum Technol, 2011,45(s1):46-52.
[35]	Graham KC, Cvach M . Monitor alarm fatigue:standardizing use of physiological monitors and decreasing nuisance alarms[J]. Am J Crit Care, 2010,19(4):28-34.
[36]	Whalen DA, Covelle PM, Piepenbrink JC , et al. Novel approach to cardiac alarm management on telemetry units[J]. J Cardio-vasc Nurs, 2014,29(5):E13-E22.
[37]	陈香萍, 吴俊, 庄一渝 . 临床报警危害的研究进展[J]. 护理与康复, 2015,14(3):228-230.
	Chen XP, Wu J, Zhuang YY . Research progress of clinical alarm hazards[J]. J Nurs Rehabil, 2015,14(3):228-230.
[38]	Li X, Wang Y . Adaptive online monitoring for ICU patients by combining just-in-time learning and principal component analysis[J]. J Clin Monit Comput, 2015,7(12):9778.
[39]	杨雪柯, 王颖, 郭晓贝 , 等. 护士对心电监护仪报警的认知现状及影响因素分析[J]. 护理学杂志, 2020,35(4):44-47.
	Yang XK, Wang Y, Guo XB , et al. Knowledge of electrocardiogram monitor alarms among nurses and the influencing factors[J]. J Nurs Sci, 2020,35(4):44-47.
[40]	王菲玲, 韦美皓, 高卿卿 , 等. 提升监护室床边监护仪报警有效性[J]. 中华护理杂志, 2010,45(4):368.
	Wand FL, Wei MH, Gao QQ , et al. Improve alarm effectiveness of bedside monitors in intensive care unit[J]. Chin J Nurs, 2010,45(4):368.
[41]	Goodridge E, Furst C, Herrick J , et al. Accuracy of cardiac rhythm interpretation by medical surgical nurses:a pilot study[J]. J Nurses Prof Dev, 2013,29(1):35-40.
[42]	赵艳华 . 心电监护仪在临床使用中的常见问题及其处理方法[J]. 中国医疗器械信息, 2019,25(14):99-100.
	Zhao YH . Common problems and treatment methods of ECG monitor in clinical use[J]. China Med Device Inf, 2019,25(14):99-100.