Validation of the Charité Alarm Fatigue Questionnaire (CAFQa–Eng) for Use with English-Speaking Critical Care Clinicians

BACKGROUND: Alarm fatigue from medical device alarms is a persistent patient safety challenge in critical care. However, quantification of alarm fatigue is inhibited by lack of standardized measurement tools. The Charité Alarm Fatigue Questionnaire (CAFQa) is a measure of alarm fatigue originally developed and validated in German. Here, the authors report on the English-language validation of CAFQa (CAFQa-Eng). METHODS: To establish face validity of the English translation, an expert panel was convened, and the authors conducted cognitive interviews with US-based critical care nurses. Items were iteratively edited for clarity and cultural relevance. The study team then conducted a cross-sectional survey of English-speaking clinicians for psychometric evaluation. Confirmatory factor analysis (CFA) was used to assess construct validity based on the original 2-scale structure (alarm stress and alarm coping). RESULTS: Of 412 survey submissions, 248 (60.2%) were eligible for analysis; 82.3% from nurses, 9.3% from physicians, and 2.8% from advanced practice providers. The CFA chi-square test was statistically significant (χ²(26) = 101.84, p < 0.001), but other indices indicated adequate fit (Comparative Fit Index = 0.957, Tucker-Lewis Index = 0.940, Root Mean Square Error of Approximation = 0.079, and Standardized Root Mean Squared Residual = 0.077). Participants' total CAFQa-Eng scores correlated with self-reported alarm fatigue (r = 0.59, p < 0.001, 95% confidence interval [CI] 0.50-0.67), indicating convergent validity. CONCLUSION: CAFQa-Eng is a valid instrument for measuring the construct of alarm fatigue (as defined for development of the original CAFQa instrument) among English-speaking critical care clinicians. CAFQa-Eng may be useful for quality improvement and research efforts to make relative comparisons across groups (for example, units, roles). Research is needed to identify actionable thresholds and recommended frequency of use, as well as to further validate the instrument outside nursing and in non-critical care settings.