Source: Dissertation Abstracts International, Volume: 79-12(E), Section: B.

Adviser: Marjorie Funk.

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Alarm fatigue in healthcare is caused by excessive medical device alarms that are often not accurate or clinically relevant. Nurses become desensitized to alarm signals or lose trust in alarms to signify an important event, and as a result, may delay their response to alarms or ignore them altogether. Alarm fatigue may also cause nurses to change alarm parameter settings to unsafe levels or to disable alarms. As a result, deteriorations in patient conditions have been missed and patient deaths have occurred. From 2009 to 2012, 80 of the 98 alarm-related events that were voluntarily reported to the Joint Commission resulted in patient death, and these events are likely underreported (The Joint Commission, 2013b). Subsequently, the Joint Commission issued both a sentinel event alert and a National Patient Safety Goal regarding clinical alarm management (The Joint Commission, 2013a, 2013b).

Evidence supporting interventions to address alarm fatigue is limited. Alarm fatigue research is complicated by lack of consistent terminology, challenges obtaining alarm data, and difficulty defining and measuring outcomes. The purpose of this dissertation was to describe the measurement of types of alarms that contribute to alarm fatigue and to explore alarm customization as a mechanism for addressing alarm fatigue. Specifically, in the primary dissertation study, I sought to generate an understanding of ICU nurses' approaches to customization of physiologic monitor alarm settings by describing their customization practices and exploring their clinical reasoning and judgment about the process.

The methods and results of this dissertation are described in three manuscripts. The first manuscript, titled "Measurement of Physiological Monitor Alarm Accuracy and Clinical Relevance in Intensive Care Units," was published in the American Journal of Critical Care and describes the measurement of two types of alarms that contribute to alarm fatigue---inaccurate and clinically irrelevant alarms---in an integrated review. Building on the findings of this review, the second and third manuscripts describe the results of my dissertation study, which used a mixed methods design to explore nurses' customization of physiologic monitor alarms as a mechanism for reducing clinically irrelevant alarms. In the second manuscript, "Challenges of Customizing Electrocardiography Alarms in Intensive Care Units: A Mixed Methods Study," I describe the findings from both the qualitative and quantitative arms of the mixed methods study. In the third manuscript, "Physiologic Monitor Alarm Customization Clinical Reasoning Among Intensive Care Unit Nurses," I present results from the qualitative arm in greater depth. The findings from this dissertation provide a foundation for future alarm fatigue research and for the development and implementation of interventions to remove barriers to alarm customization.