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. 2021 Jul;11(7):703-710.
doi: 10.1542/hpeds.2020-003509. Epub 2021 Jun 1.

Physiologic Monitor Alarm Burden and Nurses' Subjective Workload in a Children's Hospital

Irit R Rasooly  1   2   3   4 , Andrew S Kern-Goldberger  5 , Rui Xiao  6 , Siddarth Ponnala  7 , Halley Ruppel  8 , Brooke Luo  5   2   4 , Sansanee Craig  2   4 , Amina Khan  7 , Melissa McLoone  9 , Daria Ferro  5   2   4 , Naveen Muthu  5   2   4 , James Won  4   7 , Christopher P Bonafide  5   2   3   4
Affiliations

Physiologic Monitor Alarm Burden and Nurses' Subjective Workload in a Children's Hospital

Irit R Rasooly et al. Hosp Pediatr. 2021 Jul.

Abstract

Background and objectives: Physiologic monitor alarms occur at high rates in children's hospitals; ≤1% are actionable. The burden of alarms has implications for patient safety and is challenging to measure directly. Nurse workload, measured by using a version of the National Aeronautics and Space Administration Task Load Index (NASA-TLX) validated among nurses, is a useful indicator of work burden that has been associated with patient outcomes. A recent study revealed that 5-point increases in the NASA-TLX score were associated with a 22% increased risk in missed nursing care. Our objective was to measure the relationship between alarm count and nurse workload by using the NASA-TLX.

Methods: We conducted a repeated cross-sectional study of pediatric nurses in a tertiary care children's hospital to measure the association between NASA-TLX workload evaluations (using the nurse-validated scale) and alarm count in the 2 hours preceding NASA-TLX administration. Using a multivariable mixed-effects regression accounting for nurse-level clustering, we modeled the adjusted association of alarm count with workload.

Results: The NASA-TLX score was assessed in 26 nurses during 394 nursing shifts over a 2-month period. In adjusted regression models, experiencing >40 alarms in the preceding 2 hours was associated with a 5.5 point increase (95% confidence interval 5.2 to 5.7; P < .001) in subjective workload.

Conclusion: Alarm count in the preceding 2 hours is associated with a significant increase in subjective nurse workload that exceeds the threshold associated with increased risk of missed nursing care and potential patient harm.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

Figure 1:
Figure 1:
Copy of NASA-TLX paper survey provided to nurses
See this image and copyright information in PMC

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