Measuring alarm fatigue in intensive care units: translation and validation of the Charité Alarm Fatigue Questionnaire

BACKGROUND: Alarm fatigue can negatively impact patient safety and quality of health care, particularly in Intensive Care Units (ICUs). The Charité Alarm Fatigue Questionnaire (CAFQa) is a German questionnaire measuring alarm fatigue in two scales (alarm stress and alarm coping) in nurses and physicians. Its hypothesized dimensionality has not been investigated in non-German-speaking countries. This multi-centre study aimed to translate and validate CAFQa in Dutch-speaking ICUs. METHODS: Forward and backward translation of CAFQa by two bilingual staff members, evaluation by an expert panel, cognitive interviews and a pilot test were performed to obtain the final Dutch questionnaire. Confirmatory factor analysis was performed, Cronbach's alpha (internal homogeneity) and correlation between self-reported alarm fatigue and item scores (convergent validity) were calculated. RESULTS: CAFQa was translated into Dutch, approved by the expert panel and cognitive interviews showed good face validity. Responses from 418 healthcare professionals from 11 centres (10 Dutch, 1 Belgian) were used. Cronbach's alpha was 0.69 (overall), 0.74 (alarm stress scale) and 0.46 (alarm coping scale). Strong correlations of item scores with self-reported alarm fatigue were found (overall: r = 0.51, alarm stress: r = 0.48, alarm coping: r = 0.30), supporting convergent validity. Confirmatory factor analysis indicated an adequate model fit (CFI = 0.961, TLI = 0.946, RMSEA = 0.052), and all factor loadings (0.20-0.74) proved statistically significant, albeit being higher for alarm stress (0.60-0.74) than alarm coping (0.21-0.70). CONCLUSIONS: CAFQa was translated and validated in a Dutch speaking population for the first time. This instrument can benchmark, measure and compare alarm fatigue of nurses and physicians.