-
Journal of Electrocardiology 2018Research demonstrates that the majority of alarms derived from continuous bedside monitoring devices are non-actionable. This avalanche of unreliable alerts causes... (Review)
Review
Research demonstrates that the majority of alarms derived from continuous bedside monitoring devices are non-actionable. This avalanche of unreliable alerts causes clinicians to experience sensory overload when attempting to sort real from false alarms, causing desensitization and alarm fatigue, which in turn leads to adverse events when true instability is neither recognized nor attended to despite the alarm. The scope of the problem of alarm fatigue is broad, and its contributing mechanisms are numerous. Current and future approaches to defining and reacting to actionable and non-actionable alarms are being developed and investigated, but challenges in impacting alarm modalities, sensitivity and specificity, and clinical activity in order to reduce alarm fatigue and adverse events remain. A multi-faceted approach involving clinicians, computer scientists, industry, and regulatory agencies is needed to battle alarm fatigue.
Topics: Clinical Alarms; Diagnostic Errors; Electrocardiography; Equipment Failure; Humans; Patient Safety; Point-of-Care Systems; Sound
PubMed: 30077422
DOI: 10.1016/j.jelectrocard.2018.07.024 -
Kidney Medicine May 2022The Henry Ford Health System provides patients with a safe, improved system of continuous kidney replacement therapy using a proprietary, 24-hour sustained... (Review)
Review
The Henry Ford Health System provides patients with a safe, improved system of continuous kidney replacement therapy using a proprietary, 24-hour sustained low-efficiency dialysis (SLED). The SLED system utilizes regional citrate anticoagulation (RCA) in conventional hemodialysis machines that have been configured to provide slow dialytic therapy. Within our hospital complex, SLED-RCA systems are deployed in intensive care units distributed over 4 floors in 2 buildings. This widespread footprint represents a spatial challenge for hemodialysis technicians. Fifteen SLED-RCA machines may be running at one time, and each deployed unit may signal an alarm for multiple reasons. Previously, audible alarms prompted intensive care unit nurses to identify the alarming machine and manually notify technicians by telephone. Technicians would then travel to resolve the alarm. To improve the process of addressing SLED-RCA machine alarms, we developed a remote alert alarm system that wirelessly notifies hemodialysis technicians of specific machine alarms. A quality improvement analysis of nearly 1,000 SLED-RCA alarms over a 1-week period revealed that the average time for alarm correction with a remote alert alarm system was approximately 5 minutes. Reducing alarm resolution time may free technicians and nurses for other critical duties.
PubMed: 35518838
DOI: 10.1016/j.xkme.2022.100452 -
Schizophrenia Research. Cognition Dec 2023Schizophrenia is characterized by memory impairments, yet the relationships between its distinct symptom clusters (i.e., positive, negative, disorganized) and specific...
Schizophrenia is characterized by memory impairments, yet the relationships between its distinct symptom clusters (i.e., positive, negative, disorganized) and specific aspects of memory dysfunction remain poorly characterized. In the present study, we compiled a large analog sample ( = 795) to test whether positive symptoms, versus negative and disorganized symptoms, were uniquely and differentially related to false alarm versus miss errors during recognition memory. Mixed-effects beta regression analyses revealed that both positive schizotypy and paranoia were more strongly associated with false alarms than misses. Disorganized schizotypy showed a similar pattern, though to a lesser extent; negative schizotypy showed a significant relationship with neither false alarm nor miss errors. We suggest that those higher in positive schizotypy are especially prone to misattribute signal to noise stimuli during recognition memory - characteristic of an "intrusive-like" profile of memory impairment, wherein context-irrelevant stimuli trigger spurious retrieval events - and speculate on the neural processes that might give rise to this asymmetry.
PubMed: 37869417
DOI: 10.1016/j.scog.2023.100291 -
Studies in Health Technology and... May 2022Alarms help to detect medical conditions in intensive care units and improve patient safety. However, up to 99% of alarms are non-actionable, i.e. alarm that did not...
Alarms help to detect medical conditions in intensive care units and improve patient safety. However, up to 99% of alarms are non-actionable, i.e. alarm that did not trigger a medical intervention in a defined time frame. Reducing their amount through machine learning (ML) is hypothesized to be a promising approach to improve patient monitoring and alarm management. This retrospective study presents the technical and medical pre-processing steps to annotate alarms into actionable and non-actionable, creating a basis for ML applications.
Topics: Clinical Alarms; Critical Care; Humans; Intensive Care Units; Machine Learning; Monitoring, Physiologic; Retrospective Studies
PubMed: 35612072
DOI: 10.3233/SHTI220453 -
Nursing May 2021Alarm fatigue among working nurses is a well-documented, high-priority safety issue. This article describes a study to learn whether alarm fatigue develops in...
PURPOSE
Alarm fatigue among working nurses is a well-documented, high-priority safety issue. This article describes a study to learn whether alarm fatigue develops in undergraduate nursing student populations.
METHODS
This longitudinal quantitative study employed survey data from a single cohort of nursing students in the Southeastern US over a period of 18 months to assess nursing students' level of sensitivity to alarms, including the call bell, bathroom, fall and safety, I.V. infusion pumps, and telemetry alarms.
RESULTS
These data were significant for I.V. infusion pump alarms and indicated a general decrease in sensitivity over an 18-month period. Nursing students with previous healthcare experience also noted decreased sensitivity to bathroom call bells and fall and safety alarms.
CONCLUSION
Alarm fatigue was recognized among the surveyed nursing students. Nurse educators also identified a performance-based strategy to increase student awareness of alarm fatigue and evidence-based strategies to minimize desensitization to alarms in both education and practice.
Topics: Clinical Alarms; Education, Nursing, Baccalaureate; Humans; Longitudinal Studies; Mental Fatigue; Nursing Education Research; Schools, Nursing; Southeastern United States; Students, Nursing; Surveys and Questionnaires
PubMed: 33885434
DOI: 10.1097/01.NURSE.0000743284.73649.7a -
Patient Safety Implications of Electronic Alerts and Alarms of Maternal - Fetal Status During Labor.Nursing For Women's Health 2016When nurses care for women during labor, they encounter numerous alerts and alarms from electronic fetal monitors and their surveillance systems. Notifications of values... (Review)
Review
When nurses care for women during labor, they encounter numerous alerts and alarms from electronic fetal monitors and their surveillance systems. Notifications of values of physiologic parameters for a woman and fetus that may be outside preset limits are generated via visual and audible cues. There is no standardization of these alert and alarm parameters among electronic fetal monitoring vendors in the United States, and there are no data supporting their sensitivity and specificity. Agreement among professional organizations about physiologic parameters for alerts and alarms commonly used during labor is lacking. It is unknown if labor nurses view the alerts and alarms as helpful or a nuisance. There is no evidence that they promote or hinder patient safety. This clinical issue warrants our attention as labor nurses.
Topics: Alert Fatigue, Health Personnel; Anxiety; Cardiotocography; Equipment Failure; Female; Heart Rate, Fetal; Humans; Obstetric Labor Complications; Patient Safety; Pregnancy
PubMed: 27520600
DOI: 10.1016/j.nwh.2016.07.004 -
Studies in Health Technology and... 2017The term "Alarm fatigue" is commonly used to describe the effect which a high number of alarms can have on caregivers: Frequent alarms, many of which are avoidable, can...
The term "Alarm fatigue" is commonly used to describe the effect which a high number of alarms can have on caregivers: Frequent alarms, many of which are avoidable, can lead to inadequate responses, severely impacting patient safety. In the first step of a long-term effort to address this problem, both the direct and indirect impact of alarms, as well as possible causes of unnecessary alarms were focused. Models of these causes and impacts were developed using a scoping review which included guided interviews with experts from medical informatics, clinicians and medical device manufacturers. These models can provide the methodical grounds for the definition of targeted interventions and the assessment of their effects.
Topics: Alert Fatigue, Health Personnel; Clinical Alarms; Equipment Failure; Humans; Monitoring, Physiologic; Patient Safety
PubMed: 28883181
DOI: No ID Found -
American Journal of Critical Care : An... Sep 2022Respiratory rate (RR) alarms alert clinicians to a change in a patient's condition. However, RR alarms are common occurrences. To date, no study has examined RR alarm...
BACKGROUND
Respiratory rate (RR) alarms alert clinicians to a change in a patient's condition. However, RR alarms are common occurrences. To date, no study has examined RR alarm types and associated patient characteristics, which could guide alarm management strategies.
OBJECTIVES
To characterize RR alarms by type, frequency, duration, and associated patient demographic and clinical characteristics.
METHODS
A secondary data analysis of alarms generated with impedance pneumography in 461 adult patients admitted to either a cardiac, a medical/surgical, or a neurological intensive care unit (ICU). The RR alarms included high parameter limit (≥30 breaths/min), low parameter limit (≤5 breaths/min), and apnea (no breathing ≥20 s). The ICU type; total time monitored; and alarm type, frequency, and duration were evaluated.
RESULTS
Of 159 771 RR alarms, parameter limit alarms (n = 140 975; 88.2%) were more frequent than apnea alarms (n = 18 796; 11.8%). High parameter limit alarms were most frequent (n = 131 827; 82.5%). After ICU monitoring time was controlled for, multivariate analysis showed that alarm rates were higher in patients in the cardiac and neurological ICUs (P = .001), patients undergoing mechanical ventilation (P = .005), and patients without a ventricular assist device or pacemaker (P = .02). Male sex was associated with low parameter limit (P = .01) and apnea (P = .005) alarms.
CONCLUSION
High parameter limit RR alarms were most frequent. Factors associated with RR alarms included monitoring time, ICU type, male sex, and mechanical ventilation. Although these factors are not modifiable, these data could be used to guide management strategies.
Topics: Adult; Apnea; Clinical Alarms; Electric Impedance; Humans; Male; Monitoring, Physiologic; Respiratory Rate
PubMed: 36045046
DOI: 10.4037/ajcc2022295 -
Interactive Journal of Medical Research Jul 2023Nocturnal enuresis (NE) is a frequent diagnosis in pediatric and adolescent populations with an estimated prevalence of around 15% at the age of 6 years. NE can have a...
BACKGROUND
Nocturnal enuresis (NE) is a frequent diagnosis in pediatric and adolescent populations with an estimated prevalence of around 15% at the age of 6 years. NE can have a substantial impact on multiple health domains. Bedwetting alarms, which typically consist of a sensor and moisture-activated alarm, are a common treatment.
OBJECTIVE
This study aimed to determine areas of satisfaction versus dissatisfaction reported by the parents and caregivers of children using current bedwetting alarms.
METHODS
Using the search term "bedwetting alarms" on the Amazon marketplace, products with >300 reviews were included. For each product, the 5 reviews ranked the "most helpful" for each star category were selected for analysis. Meaning extraction method was applied to identify major themes and subthemes. A percent skew was calculated by summing the total number of mentions of each subtheme,+1 for a positive mention, 0 for a neutral mention, and -1 for a negative mention, and dividing this total by the number of reviews in which that particular subtheme was observed. Subanalyses were performed for age and gender.
RESULTS
Of 136 products identified, 10 were evaluated based on the selection criteria. The main themes identified across products were long-term concerns, marketing, alarm systems, and device mechanics and features. The subthemes identified as future targets for innovation included alarm accuracy, volume variability, durability, user-friendliness, and adaptability to girls. In general, durability, alarm accuracy, and comfort were the most negatively skewed subthemes (with a negative skew of -23.6%, -20.0%, and -12.4% respectively), which are indicative of potential areas for improvement. Effectiveness was the only substantially positively skewed subtheme (16.8%). Alarm sound and device features were positively skewed for older children, whereas ease of use had a negative skew for younger children. Girls and their caretakers reported negative experiences with devices that featured cords, arm bands, and sensor pads.
CONCLUSIONS
This analysis provides an innovation roadmap for future device design to improve patient and caregiver satisfaction and compliance with bedwetting alarms. Our results highlight the need for additional options in alarm sound features, as children of different ages have divergent preferences in this domain. Additionally, girls and their parents and caretakers provided more negative overall reviews regarding the range of current device features compared to boys, indicating a potential focus area for future development. The percent skew showed that subthemes were often more negatively skewed toward girls, with the ease of use being -10.7% skewed for boys versus -20.5% for girls, and comfort being -7.1% skewed for boys versus -29.4% for girls. Put together, this review highlights multiple device features that are targets for innovation to ensure translational efficacy regardless of age, gender, or specific family needs.
PubMed: 37410523
DOI: 10.2196/43194 -
Nursing Open Aug 2023To describe the frequencies of physiologic monitor clinical alarms and to investigate nurses' perceptions and practices regarding clinical alarms in ICUs. (Observational Study)
Observational Study
AIM
To describe the frequencies of physiologic monitor clinical alarms and to investigate nurses' perceptions and practices regarding clinical alarms in ICUs.
DESIGN
A descriptive study.
METHODS
A 24-h continuous nonparticipant observation study was conducted in ICU. Observers observed and recorded the occurrence time, detail information when electrocardiogram monitor alarms triggered. And a cross-sectional study was conducted among ICU nurses by convenience sampling, using the general information questionnaire and the Chinese version of clinical alarms survey questionnaire for medical devices. Data analysis was performed using SPSS 23.
RESULTS
A total of 13,829 physiologic monitor clinical alarms were recorded in 14-day observation and 1191 ICU nurses responded to the survey. Most nurses agreed or strongly agreed the sensitivity to alarms and responded quickly (81.28%), smart alarm systems (74.56%), alarm notification systems (72.04%) and set up alarm administrators (59.45%) were useful to improve alarm management, while frequent nuisance alarms disrupted patients care (62.47%) and reduced nurses' trust in alarms (49.03%), environmental noise interfered with nurses' recognition of the alarms (49.12%) and not everyone received education of alarm systems (64.65%).
CONCLUSIONS
Physiological monitor alarms occur frequently in ICU, and it is necessary to formulate or further optimize alarm management measures. It is recommended to use smart medical devices and alarm notification systems, formulate and implement standardized alarm management policies and norms, and strengthen alarm management education and training, so as to improve the nursing quality and patient safety.
PATIENT OR PUBLIC CONTRIBUTION
The patients in the observation study included all patients admitted to the ICU during the observation period. The nurses in the survey study were conveniently selected through an online survey.
Topics: Humans; Clinical Alarms; Cross-Sectional Studies; Intensive Care Units; Monitoring, Physiologic; Nurses
PubMed: 37101342
DOI: 10.1002/nop2.1792