Roberto Carlos Lyra da Silva

Tempo estímulo-resposta da equipe de saúde aos alarmes de monitorização na terapia intensiva: implicações para a segurança do paciente grave

Objective To define the characteristics and measure the reaction time of a health care team monitoring alarms in the intensive care unit. Methods A quantitative, observational, and descriptive study developed at the coronary care unit of a cardiology public hospital in Rio de Janeiro state (RJ). Data were obtained from the information collected on the patients, the monitoring used, and the measurement of the teams reaction time to the alarms of multi-parameter monitors during a non-participatory field observation. Results Eighty-eight patients were followed (49 during the day shift and 39 during the night shift). During the 40 hours of observation (20 hours during the day shift and 20 hours during the night shift), the total number of monitoring alarms was 227, with 106 alarms during the day shift and 121 during the night shift, an average of 5.7 alarms/hour. In total, 145 alarms unanswered by the team were observed, with 68 occurring during the day shift (64.15%) and 77 during the night shift (63.64%). This study demonstrated that the reaction time was longer than 10 minutes in more than 60% of the alarms, which were considered as unanswered alarms. The median reaction time of the answered alarms was 4 minutes and 54 seconds during the day shift and 4 minutes and 55 seconds during the night shift. The respiration monitoring was activated in only nine patients (23.07%) during the night shift. Regarding the alarm quality of these variables, the arrhythmia alarm was qualified in only 10 (20.40%) of the day-shift patients and the respiration alarm in four night-shift patients (44.44%). Conclusion The programming and configuration of the physiological variables monitored and the parameters of alarms in the intensive care unit were inadequate; there was a delay and lack of response to the alarms, suggesting that relevant alarms may have been ignored by the health care team, thus compromising the patient safety.

Clinical Alarms in intensive care: implications of alarm fatigue for the safety of patients

Objetivos: identificar el numero de alarmas de los equipamientos electromedicos en una unidad coronariana, caracterizar el tipo y analizar las implicaciones para la seguridad del paciente en la perspectiva de fatiga de alarmas. Metodo: se trata de un estudio cuantitativo, observacional, descriptivo, no participante, desarrollado en una unidad coronariana de un hospital de cardiologia, con capacidad de 170 camas. Resultados: se registro un total de 426 senales de alarmas, siendo 227 disparadas por monitores multiparametricos y 199 disparadas por otros equipamientos (bombas de infusion, hemodialisis, ventiladores mecanicos y balon intraaortico), durante 40h, con un promedio total de 10,6 alarmas/hora. Conclusion: los resultados encontrados refuerzan la importancia de la configuracion de las variables fisiologicas, del volumen y de los parametros de alarma de los monitores multiparametricos, a la rutina de las unidades de terapia intensiva. Las alarmas de los equipamientos destinados a proteger a los pacientes, han llevado al aumento del ruido en la unidad, a la fatiga de alarmas, a las distracciones e interrupciones en el flujo de trabajo y a una falsa sensacion de seguridad.Descriptores: Enfermeria; Cuidados Intensivos; Monitoreo; Alarmas Clinicas; Enfermedad Iatrogenica; Seguridad del Paciente.OBJECTIVES: to identify the number of electro-medical pieces of equipment in a coronary care unit, characterize their types, and analyze implications for the safety of patients from the perspective of alarm fatigue. METHOD: this quantitative, observational, descriptive, non-participatory study was conducted in a coronary care unit of a cardiology hospital with 170 beds. RESULTS: a total of 426 alarms were recorded in 40 hours of observation: 227 were triggered by multi-parametric monitors and 199 were triggered by other equipment (infusion pumps, dialysis pumps, mechanical ventilators, and intra-aortic balloons); that is an average of 10.6 alarms per hour. CONCLUSION: the results reinforce the importance of properly configuring physiological variables, the volume and parameters of alarms of multi-parametric monitors within the routine of intensive care units. The alarms of equipment intended to protect patients have increased noise within the unit, the level of distraction and interruptions in the workflow, leading to a false sense of security.

Stimulus-response time to invasive blood pressure alarms: implications for the safety of critical-care patients

Observational, descriptive, exploratory, case study with the objective of measuring the stimulus-response time of the team to alarms monitoring invasive blood pressure (IBP) and analyzing the implications of this time for the safety of the patient From January to March 2013, 60 hours of structured observation were conducted with registration of the alarms activated by IBP monitors in an adult ICU at a military hospital in the city of Rio de Janeiro. 76 IBP alarms were recorded (1.26 alarms/hour), 21 of which (28%) were attended to and 55 (72%) considered as fatigued. The average response time to the alarms was 2 min. 45 sec. The deficit in human resource and physical layout were factors determining the delay in response to the alarms. The increase in response times to these alarms may compromise the safety of patients with hemodynamic instability, especially in situations such as shock and the use of vasoactive drugs. Descriptors: Clinical alarms. Fatigue. Patient safety. Intensive care.

The incorporation of the hard technologies in the care of nursing in intensive therapy and the development of the speech of the humanization

ABSTRACT Objectives : this is a reflective study that raised questions about the speech development of humanization in nursing from the incorporation of hard technologies in intensive care in their everyday routine care. Method : descriptive study, result of an initial literature review. Results : it requires discussion about the implications of using the heavy technology in nursing care, as these are present in the work in intensive care in many ways: monitors, artificial respirators, pacemakers, prostheses, etc, becoming as objects of attention of the care dispensed. This perspective emerged from various discussions, which are: the technical-scientific development, technology, technology in nursing care, nursing care in intensive care, the ethical-legal, and humanization of nursing care. Conclusion : it is for nurses to reflect on this subject should not shying away from these discussions, since they are daily conditions faced by these professionals in their work, because if they do not if they become aware of their share in this process, they may lose space for other professions. Descriptors : nursing; intensive care; technology. RESUMO Objetivos : trata-se de um estudo reflexivo, que abordou questoes acerca do desenvolvimento do discurso da humanizacao na assistencia de enfermagem a partir da incorporacao das tecnologias duras em terapia intensiva em seu fazer cotidiano assistencial. Metodos : estudo descritivo, resultado de um levantamento bibliografico. Resultados : faz-se mister discutir a respeito das implicacoes do uso de tecnologias-duras na assistencia de enfermagem, pois estas encontram-se presentes no ambiente de trabalho em terapia intensiva de varias maneiras: monitores, respiradores artificiais, marcapassos, proteses, etc, se tornando assim objetos de atencao do cuidado dispensado. Nesta perspectiva emergiram variadas discussoes, quais sejam: o desenvolvimento tecnico-cientifico, as tecnologias, a tecnologia na assistencia de enfermagem, a assistencia de enfermagem em terapia intensiva, os aspectos etico-legais, e a humanizacao na assistencia de enfermagem. Conclusoes : compete aos profissionais de enfermagem refletir acerca deste tema, nao devendo se omitir destas discussoes, pois constituem situacoes enfrentadas diariamente por estes profissionais em seu ambiente de trabalho, pois se caso os mesmos nao se derem conta de sua parcela neste processo, podem vir a perder espaco para outras profissoes. Descritores : enfermagem; cuidados intensivos; tecnologia. RESUMEN Objetivos : este es un estudio reflexivo de que las cuestiones planteadas acerca del desarrollo del lenguaje de la humanizacion en la enfermeria de la incorporacion de las tecnologias duras en cuidados intensivos en sus cuidados de rutina diaria. Metodo : estudio descritivo, resultado de una revision de la literatura. Resultados : se requiere una discusion acerca de las consecuencias de utilizar la tecnologia en la atencion de enfermeria, ya que estos estan presentes en el ambiente de trabajo en cuidados intensivos de varias maneras: monitores, respiradores, marcapasos artificiales, protesis, etc, convirtiendose en como objetos de atencion de los cuidados dispensados. Esta perspectiva surgio de varias discusiones, que son: el desarrollo tecnico-cientifico, la tecnologia, la tecnologia en los cuidados de enfermeria, cuidados de enfermeria en cuidados intensivos, lo etico-legal, y la humanizacion de los cuidados de enfermeria. Conslusion : corresponde a las enfermeras a reflexionar sobre este tema no debe rehuir los debates, ya que las condiciones que se enfrentan a diario estos profesionales en su ambiente de trabajo, porque si no lo hacen, si se dan cuenta de su participacion en este proceso, pueden perder espacio para otras profesiones. Descriptores : enfermeria; cuidado intensivo; tecnologia.

Safety in the use of infusor pumps: analysis of alarms

ABSTRACT Objective : to analyze the profile of the infusion pump alarms in an intensive unit. Method : this is a quantitative, descriptive, observational, cross-sectional and sectional study carried out in an intensive cardiogenic unit with a sample of 72 alarms fired from infusion pumps, collected in a structured instrument. The analysis was performed with tabulation and statistical treatment in SPSS® software version 2.1. and presented in figures. Results : it was observed that the alarms triggered by the infusion pumps are related to the end of infusion (41.7%) and the manipulation by the team (29.2%). Regarding the time of the alarms, the average of 109.8 seconds was identified, characterized by four alarms with more time: “pre-alarm end of infusion”, “low flow”, “end of standby” and “end of infusion”. Conclusion : the characterization of the alarms helps the nurse to plan actions to minimize the stimulus-response time, improving the quality of the nursing care and increasing the safety for the patient. Descriptors : Nursing Care; Patient Safety; Clinical Alarms; Nursing; Infusion Pumps; Healthcare. RESUMO Objetivo : analisar o perfil dos alarmes de bombas infusoras em uma unidade intensiva. Metodo : estudo quantitativo, descritivo, observacional, transversal e seccional, realizado em uma unidade cardio intensiva, com amostra de 72 alarmes disparados de bombas infusoras, coletados em instrumento estruturado. Analise realizada com tabulacao e tratamento estatistico no programa SPSS ® versao 2.1. e apresentados em figuras. Resultados : observou-se que os alarmes mais disparados pelas bombas infusoras estao relacionados ao fim de infusao (41,7%) e o de manipulacao pela equipe (29,2%). Em relacao aos tempos dos alarmes, identificou-se a media de 109,8 segundos, caracterizados por quatro alarmes com maior tempo: “pre-alarme fim de infusao”, “fluxo baixo”, “fim de stand by” e “fim de infusao”. Conclusao : a caracterizacao dos alarmes auxilia o enfermeiro a planejar acoes para minimizar o tempo estimulo - resposta, com a finalidade de melhorar a qualidade da assistencia de enfermagem e de aumentar a seguranca para o paciente. Descritores : Cuidados de Enfermagem; Seguranca do Paciente; Alarmes Clinicos; Enfermagem; Bombas de Infusao. RESUMEN Objetivo : analizar el perfil de las alarmas de bombas de infusion en una unidad intensiva. Metodo : estudio cuantitativo, descriptivo, observacional, transversal y seccional, realizado en una unidad cardio-intensiva, con muestra de 72 alarmas disparadas de bombas de infusion, recolegidas en instrumento estructurado. El analisis fue realizado con tabulacion y tratamiento estadistico en el programa SPSS ® version 2.1. y presentados en figuras. Resultados : se observo que las alarmas mas disparadas por las bombas de infusion estan relacionadas al fin de infusion (41,7%) y la de manipulacion por el equipo (29,2%). En relacion a los tiempos de las alarmas, se identifico la media de 109,8 segundos, caracterizados por cuatro alarmas con mayor tiempo: “pre-alarma fin de infusion”, “flujo bajo”, “fin de stand by” y “fin de infusion”. Conclusao : la caracterizacion de las alarmas auxilia al enfermero a planear acciones para minimizar el tiempo estimulo - respuesta, con la finalidad de mejorar la calidad de la asistencia de enfermeria y de aumentar la seguridad para el paciente. Descriptores : Atencion de Enfermeria; Seguridad del Paciente; Alarmas Clinicas; Enfermeria; Bombas de Infusion.

Use of technologies in intravenous therapy: contributions to a safer practice

Objectives To identify what are the difficulties of the nursing staff in the management of technologies during intravenous therapy (IVT) and discuss the difficulties identified under the perspective of patients safety. Method Descriptive study of qualitative approach with data collected by semi-structured interview and analyzed by the Alceste software. Results The greatest difficulty of cognitive and technical emphasis was the lack of training; and regarding administrative emphasis, the greatest difficulty was the lack of material and human resources. Infusion pumps and their proper use were highlighted as the technological resource that most contributed to patient safety. Final considerations The lack of training is presented as the greatest difficulty of nursing professionals and permeates safety issues of both patient and professional when using the hard technologies in IVT. Training is essential to the development of techniques, considered nursing tools.

Stimulus-response time to alarms of the intra-aortic balloon pump: safe care practices.

OBJECTIVE To characterize the sound alarms of the Intra-Aortic Balloon Pump (IABP) during aortic counterpulsation therapy; to measure the stimulus-response time of the team to these; and to discuss the implications of increasing this time for patient safety from the alarm fatigue perspective. METHOD This is an observational and descriptive study with quantitative and qualitative approach, case study type, carried out in a Cardiac Surgical Intensive Care Unit. RESULTS The most audible IABP alarm was the one of high priority increased-reduced diastolic blood pressure. The stimulus-response time was 33.9 seconds on average. CONCLUSION Managing the alarms of these equipment is essential to minimize the occurrence of the alarm fatigue phenomenon and to offer a safer assistance to patients who rely on this technology.

Sound pressure levels in a pediatric intensive care unit

Objective: to measure the sound pressure level emitted by electromedical equipment in the pediatric intensive care unit. Method: observational study, in which we proceeded to 10 measurements of the sound pressure level every 15 minutes in isolating the pediatric intensive care unit. After each SPL measurement, the alarm of 10 equipment, one for each measurement, was set off. Data were analyzed using descriptive statistics and presented in figures. The research project was approved by the Research Ethics Committee, CAEE: 05203412.9.0000.5285. Results: the average sound pressure level = 47,67dBA, standard deviation of 1.0089dBA and peak of 50,3dBA. After the subtraction of environmental sound pressure level with the Σenvironment equipment, median was of 23,75dBA, standard deviation = 10,187 and peak = 30dBA. The noise levels exceed recommendations of national and international organizations. The parameterization of the alarm may help decrease the pediatric intensive care unit. Conclusion: there is need to rethink this environment and establish strategies to reduce noise, making the PICU acoustically less uncomfortable. Descriptors: Nursing; Noise; Acoustics.

Alarmas clínicas en terapia intensiva: implicaciones de la fatiga de alarmas para la seguridad del paciente

Objetivos: identificar el numero de alarmas de los equipamientos electromedicos en una unidad coronariana, caracterizar el tipo y analizar las implicaciones para la seguridad del paciente en la perspectiva de fatiga de alarmas. Metodo: se trata de un estudio cuantitativo, observacional, descriptivo, no participante, desarrollado en una unidad coronariana de un hospital de cardiologia, con capacidad de 170 camas. Resultados: se registro un total de 426 senales de alarmas, siendo 227 disparadas por monitores multiparametricos y 199 disparadas por otros equipamientos (bombas de infusion, hemodialisis, ventiladores mecanicos y balon intraaortico), durante 40h, con un promedio total de 10,6 alarmas/hora. Conclusion: los resultados encontrados refuerzan la importancia de la configuracion de las variables fisiologicas, del volumen y de los parametros de alarma de los monitores multiparametricos, a la rutina de las unidades de terapia intensiva. Las alarmas de los equipamientos destinados a proteger a los pacientes, han llevado al aumento del ruido en la unidad, a la fatiga de alarmas, a las distracciones e interrupciones en el flujo de trabajo y a una falsa sensacion de seguridad.Descriptores: Enfermeria; Cuidados Intensivos; Monitoreo; Alarmas Clinicas; Enfermedad Iatrogenica; Seguridad del Paciente.OBJECTIVES: to identify the number of electro-medical pieces of equipment in a coronary care unit, characterize their types, and analyze implications for the safety of patients from the perspective of alarm fatigue. METHOD: this quantitative, observational, descriptive, non-participatory study was conducted in a coronary care unit of a cardiology hospital with 170 beds. RESULTS: a total of 426 alarms were recorded in 40 hours of observation: 227 were triggered by multi-parametric monitors and 199 were triggered by other equipment (infusion pumps, dialysis pumps, mechanical ventilators, and intra-aortic balloons); that is an average of 10.6 alarms per hour. CONCLUSION: the results reinforce the importance of properly configuring physiological variables, the volume and parameters of alarms of multi-parametric monitors within the routine of intensive care units. The alarms of equipment intended to protect patients have increased noise within the unit, the level of distraction and interruptions in the workflow, leading to a false sense of security.

Alarmes clínicos em terapia intensiva: implicações da fadiga de alarmes para a segurança do paciente

Objetivos: identificar el numero de alarmas de los equipamientos electromedicos en una unidad coronariana, caracterizar el tipo y analizar las implicaciones para la seguridad del paciente en la perspectiva de fatiga de alarmas. Metodo: se trata de un estudio cuantitativo, observacional, descriptivo, no participante, desarrollado en una unidad coronariana de un hospital de cardiologia, con capacidad de 170 camas. Resultados: se registro un total de 426 senales de alarmas, siendo 227 disparadas por monitores multiparametricos y 199 disparadas por otros equipamientos (bombas de infusion, hemodialisis, ventiladores mecanicos y balon intraaortico), durante 40h, con un promedio total de 10,6 alarmas/hora. Conclusion: los resultados encontrados refuerzan la importancia de la configuracion de las variables fisiologicas, del volumen y de los parametros de alarma de los monitores multiparametricos, a la rutina de las unidades de terapia intensiva. Las alarmas de los equipamientos destinados a proteger a los pacientes, han llevado al aumento del ruido en la unidad, a la fatiga de alarmas, a las distracciones e interrupciones en el flujo de trabajo y a una falsa sensacion de seguridad.Descriptores: Enfermeria; Cuidados Intensivos; Monitoreo; Alarmas Clinicas; Enfermedad Iatrogenica; Seguridad del Paciente.OBJECTIVES: to identify the number of electro-medical pieces of equipment in a coronary care unit, characterize their types, and analyze implications for the safety of patients from the perspective of alarm fatigue. METHOD: this quantitative, observational, descriptive, non-participatory study was conducted in a coronary care unit of a cardiology hospital with 170 beds. RESULTS: a total of 426 alarms were recorded in 40 hours of observation: 227 were triggered by multi-parametric monitors and 199 were triggered by other equipment (infusion pumps, dialysis pumps, mechanical ventilators, and intra-aortic balloons); that is an average of 10.6 alarms per hour. CONCLUSION: the results reinforce the importance of properly configuring physiological variables, the volume and parameters of alarms of multi-parametric monitors within the routine of intensive care units. The alarms of equipment intended to protect patients have increased noise within the unit, the level of distraction and interruptions in the workflow, leading to a false sense of security.