降低心臟內科病房無線心電圖監測器非必要警報件數

Reducing Noncritical Wireless Electrocardiography Monitor Alarm Incidences in a Cardiovascular Ward

黃惠鈺(Hui-Yu Huang) ； 許惠珊(Hui-Shan Hsu) ； 林渼璇(Mei-Hsuan Lin) ； 陳慧玲(Hui-Ling Chen)

《新臺北護理期刊》 23卷2期 (2021/09) Pp. 64-77

https://doi.org/10.6540/NTJN.202109_23(2).0006

摘要

無線心電圖監測器是心臟內科病房照護病人時不可或缺的設備，但卻常在監測過程中因警報疲憊而忽視該即刻處理的警報，對病人安全造成威脅。經現況調查無線心電圖監測器非必要警報發生件數多達1431件，分析原因為：病人自行拔除貼片、貼片導線鬆脫；護理人員設定調整時機認知錯誤、黏貼部位錯誤及波形未依標準設定；傳導器無電力、最低基準值不符臨床使用、未訂定更換貼片頻率、無檢測設定值時機及無書面教育訓練資料等。經專案小組介入措施為重新設定基準值、設置蓄電標準、舉辦無線心電圖監測器操作工作坊、設置無線心電圖部位黏貼提示圖卡、修訂病房護理常規作業。結果顯示非必要警報件數由1431件降至567件，達本專案之目的，讓臨床醫護人員能專注處理更重要的警報，提升醫療照護品質。

關鍵字

警報處理 ； 警報疲憊 ； 無線心電圖監測器

並列摘要

The wireless Electrocardiography (ECG) monitor is an indispensable device for patient care in the cardiac medical ward, but it is often ignored during the monitoring process due to alarm fatigue. A study of the existing project environment found the number of noncritical ECG alarms to be as high as 1,431. Analysis revealed these noncritical alarms to be caused by patients removing electrodes themselves or electrode leads becoming loose, nursing staff's incorrect understanding of setting adjustment timing, electrode locations or wave form settings per standard, transmitter lacking power supply, minimum base values not sufficient for clinical use, not regulating electrode replacement frequency, not setting measurement standards, and no published training references. The project team implemented improvement measures, such as updating ECG system's base setting values, instituting power charge requirements, conducting wireless ECG monitor operation training workshops, creating wireless ECG electrode placement reminder placards, and revising ward-wide standard care procedures for patient care. These measures resulted in the number of noncritical alarm incidences dropping from 1,431 to 567, achieving the project goal of allowing the clinical staff to focus on handling more important alarms to improve care quality.

並列關鍵字

alarm handling ； alarm fatigue ； wireless ECG monitor

參考文獻

邵彥瑋、賈德蓉、程素玲、黃嘉雯、劉思穎、王美妮（2019）。運用多媒體影片改善呼吸治療衛教之完整性。呼吸治療，18（1），98-98。https://doi.10.6269/JRT.201907_18（1）.0024。

侯佳弦、徐邦治、怡懋、蘇米（2020）。早期警示系統之簡介與運用。護理雜誌，67（1），6-11。https://doi.10.6224/JN.202002_67（1）.02。

劉佩伶、周碧玲、劉桂君、李采儀、陳淑惠、鄭蓓雯（2019）。提升內科加護病房護理人員對監視器警訊聲響及時處理率。護理雜誌，66（2），85-92。https://doi.10.6224/JN.201904_66（2）.11。

Fidler, R., Hu, X., & Pelter, M. M. (2017). Visible but wide QRS complexes are associated with false asystole alarms. Journal of Electrocardiology, 50(6), 860. https://doi.org/10.1016/j.jelectrocard.2017.08.049。

Graham, K. C., & Cvach, M. (2010). Monitor alarm fatigue: Standardizing use of physiological monitors and decreasing nuisance alarms. American Journal of Critical Care, 19(1), 28-34. https://doi.org/10.4037/ajcc2010651。