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Nursing Nov 2021
Topics: Clinical Alarms; Humans; Patient Safety
PubMed: 34678809
DOI: 10.1097/01.NURSE.0000795340.17852.cc -
Biological Reviews of the Cambridge... Jun 2023A key benefit of grouping in prey species is access to social information, including information about the presence of predators. Larger groups of prey animals respond... (Review)
Review
A key benefit of grouping in prey species is access to social information, including information about the presence of predators. Larger groups of prey animals respond both sooner and at greater distances from predators, increasing the likelihood that group members will successfully avoid capture. However, identifying predators in complex environments is a difficult task, and false alarms (alarm behaviours without genuine threat) appear surprisingly frequent across a range of taxa including insects, amphibians, fish, mammals, and birds. In some bird flocks, false alarms have been recorded to substantially outnumber true alarms. False alarms can be costly in terms of both the energetic costs of producing alarm behaviours as well as lost opportunity costs (e.g. abandoning a feeding patch which was in fact safe, losing sleep if an animal is resting/roosting, or losing mating opportunities). Models have shown that false alarms may be a substantial but underappreciated cost of group living, introducing an inherent risk to using social information and a vulnerability to the propagation of false information. This review will focus on false alarms, introducing a two-stage framework to categorise the different factors hypothesised to influence the propensity of animal groups to produce false alarms. A number of factors may affect false alarm rate, and this new framework splits these factors into two core processing stages: (i) individual perception and response; and (ii) group processing of predator information. In the first stage, individuals in the group monitor the environment for predator cues and respond. The factors highlighted in this stage influence the likelihood that an individual will misclassify stimuli and produce a false alarm (e.g. lower light levels can make predator identification more difficult and false alarms more common). In the second stage, alarm information from individuals is processed by the group. The factors highlighted in this stage influence the likelihood of alarm information being copied by group members and propagated through the group (e.g. some animals implement group processing mechanisms that regulate the spread of behavioural responses such as consensus decision making through the quorum response). This review follows the structure of this new framework, focussing on the causes of false alarms, factors that influence false alarm rate, the transmission of alarm information through animal groups, mechanisms to mitigate the spread of false alarms, and the consequences of false alarms.
Topics: Animals; Birds; Mammals
PubMed: 36653332
DOI: 10.1111/brv.12932 -
PLoS Biology Apr 2021Across many species, scream calls signal the affective significance of events to other agents. Scream calls were often thought to be of generic alarming and fearful...
Across many species, scream calls signal the affective significance of events to other agents. Scream calls were often thought to be of generic alarming and fearful nature, to signal potential threats, with instantaneous, involuntary, and accurate recognition by perceivers. However, scream calls are more diverse in their affective signaling nature than being limited to fearfully alarming a threat, and thus the broader sociobiological relevance of various scream types is unclear. Here we used 4 different psychoacoustic, perceptual decision-making, and neuroimaging experiments in humans to demonstrate the existence of at least 6 psychoacoustically distinctive types of scream calls of both alarming and non-alarming nature, rather than there being only screams caused by fear or aggression. Second, based on perceptual and processing sensitivity measures for decision-making during scream recognition, we found that alarm screams (with some exceptions) were overall discriminated the worst, were responded to the slowest, and were associated with a lower perceptual sensitivity for their recognition compared with non-alarm screams. Third, the neural processing of alarm compared with non-alarm screams during an implicit processing task elicited only minimal neural signal and connectivity in perceivers, contrary to the frequent assumption of a threat processing bias of the primate neural system. These findings show that scream calls are more diverse in their signaling and communicative nature in humans than previously assumed, and, in contrast to a commonly observed threat processing bias in perceptual discriminations and neural processes, we found that especially non-alarm screams, and positive screams in particular, seem to have higher efficiency in speeded discriminations and the implicit neural processing of various scream types in humans.
Topics: Adult; Auditory Pathways; Auditory Perception; Brain; Discrimination, Psychological; Fear; Female; Humans; Magnetic Resonance Imaging; Male; Pattern Recognition, Physiological; Recognition, Psychology; Sex Characteristics; Voice Recognition; Young Adult
PubMed: 33848299
DOI: 10.1371/journal.pbio.3000751 -
The American Journal of Nursing Feb 2015
Topics: Attitude of Health Personnel; Clinical Alarms; Equipment Failure; Humans; Medical Errors; Mental Fatigue; Monitoring, Physiologic; Patient Safety; Practice Patterns, Nurses'; Safety Management; United States
PubMed: 25629183
DOI: 10.1097/01.NAJ.0000460671.80285.6b -
The Nursing Clinics of North America Mar 2019Alarm fatigue is the most common contributing factor in alarm-related sentinel events. Researchers have demonstrated a 35% overuse of telemetry, a key factor in alarm... (Review)
Review
Alarm fatigue is the most common contributing factor in alarm-related sentinel events. Researchers have demonstrated a 35% overuse of telemetry, a key factor in alarm fatigue. This project evaluates practice patterns for the ordering and discontinuation of telemetry on medical-surgical units. Practice patterns were reviewed to determine if they aligned with the American Heart Association evidence-based practice guidelines for telemetry monitoring and whether the order indication was congruent with the patient's clinical status. Nurse's attitudes and practices related to alarm safety were evaluated.
Topics: Aged; Clinical Alarms; Evidence-Based Nursing; Female; Humans; Male; Medical-Surgical Nursing; Middle Aged; Monitoring, Physiologic; Philadelphia; Practice Guidelines as Topic; Telemetry
PubMed: 30712547
DOI: 10.1016/j.cnur.2018.10.001 -
Clinical Nurse Specialist CNS 2015
Topics: Caregivers; Clinical Alarms; Humans; Mental Fatigue; Nurse Clinicians; Organizational Culture; Patient Safety; Safety Management
PubMed: 26258829
DOI: 10.1097/NUR.0000000000000152 -
Pharmacotherapy Aug 2018Although smart infusion pumps are intended to prevent medication errors by alerting users about doses that exceed set thresholds, a large number of clinically... (Review)
Review
Although smart infusion pumps are intended to prevent medication errors by alerting users about doses that exceed set thresholds, a large number of clinically insignificant alarms and alerts create the potential for alert and alarm fatigue. We searched the PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for peer-reviewed literature (January 1, 2004-August 31, 2017) on managing smart pump alerts, alarms, and related fatigue. Twenty-nine articles that met the inclusion criteria were reviewed and organized into themes. Smart pumps give users two types of signals: alarms that indicate mechanical issues such as occlusion, air in the line, or low battery; and clinical alerts that indicate that a programmed dose exceeds a predefined safety limit. Mechanical alarms occur with greater frequency than clinical alerts, but alarms and alerts vary widely by pump model, patient population, time of day, month, and type of drug. Several causes of clinically insignificant alerts and alarms may be actionable, and strategies proposed in the literature include development of a multidisciplinary team to oversee the quality improvement effort with involvement of end users, standardization of medication administration practices, widening of drug limit library thresholds when clinically appropriate, maintaining up-to-date drug limit libraries, and interoperability. Whereas many strategies have been proposed, and case studies have been reported, none have been rigorously evaluated. In addition, more research is needed related to managing occlusion and air-in-line alarms, especially for complicated infusions. Future work should focus on the evaluation of specific and replicable alert and alarm reduction strategies with a greater emphasis on quantitative metrics.
Topics: Clinical Alarms; Fatigue; Humans; Infusion Pumps; Medication Errors
PubMed: 29883535
DOI: 10.1002/phar.2153 -
Journal of Medical Systems Oct 2022The design of medical alarms has been heavily criticized in the past decade. Auditory medical alarms have poor learnability, discernibility, and relevance, leading to...
The design of medical alarms has been heavily criticized in the past decade. Auditory medical alarms have poor learnability, discernibility, and relevance, leading to poor patient outcomes, and alarm fatigue, and overall poor informatic system design. We developed a novel trimodal patient monitoring smartwatch application for patient monitoring. Participants completed two phases: (1) control and (2) our novel trimodal system while identifying alarms (heart rate, oxygenation, and blood pressure) and completing a cognitively demanding task. Alarms were auditory icons presented as either solo or co-alarms. Participant performance was assessed by accuracy and response time (RT) of alarm identification. Using the novel system, accuracy was significantly improved overall (p < 0.01) and in co-alarm situations (p < 0.01), but not for solo alarms (p = 0.484). RT was also significantly faster (p < 0.01) while using the novel system for all alarm types. Participants reported decreased mental workload using the novel system. This feasibility study shows that our novel alarm system performs better than current standards. Improvements in accuracy, RT and perceived mental workload indicate the potential of this system to have a positive impact on medical informatic systems and clinical monitoring, for both the patient and the clinician.
Topics: Humans; Clinical Alarms; Monitoring, Physiologic; Workload
PubMed: 36261739
DOI: 10.1007/s10916-022-01869-1 -
Italian Journal of Dermatology and... Aug 2021
Topics: Clinical Alarms; Monitoring, Physiologic; Thumb
PubMed: 33890729
DOI: 10.23736/S2784-8671.21.06847-4