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Journal of Hospital Medicine Feb 2016Alarm fatigue from frequent nonactionable physiologic monitor alarms is frequently named as a threat to patient safety. (Review)
Review
BACKGROUND
Alarm fatigue from frequent nonactionable physiologic monitor alarms is frequently named as a threat to patient safety.
PURPOSE
To critically examine the available literature relevant to alarm fatigue.
DATA SOURCES
Articles published in English, Spanish, or French between January 1980 and April 2015 indexed in PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Cochrane Library, Google Scholar, and ClinicalTrials.gov.
STUDY SELECTION
Articles focused on hospital physiologic monitor alarms addressing any of the following: (1) the proportion of alarms that are actionable, (2) the relationship between alarm exposure and nurse response time, and (3) the effectiveness of interventions in reducing alarm frequency.
DATA EXTRACTION
We extracted data on setting, collection methods, proportion of alarms determined to be actionable, nurse response time, and associations between interventions and alarm rates.
DATA SYNTHESIS
Our search produced 24 observational studies focused on alarm characteristics and response time and 8 studies evaluating interventions. Actionable alarm proportion ranged from <1% to 36% across a range of hospital settings. Two studies showed relationships between high alarm exposure and longer nurse response time. Most intervention studies included multiple components implemented simultaneously. Although studies varied widely, and many had high risk of bias, promising but still unproven interventions include widening alarm parameters, instituting alarm delays, and using disposable electrocardiographic wires or frequently changed electrocardiographic electrodes.
CONCLUSIONS
Physiologic monitor alarms are commonly nonactionable, and evidence supporting the concept of alarm fatigue is emerging. Several interventions have the potential to reduce alarms safely, but more rigorously designed studies with attention to possible unintended consequences are needed.
Topics: Clinical Alarms; Electrocardiography; Hospitals; Humans; Monitoring, Physiologic; Nursing Staff, Hospital; Patient Safety; Time Factors
PubMed: 26663904
DOI: 10.1002/jhm.2520 -
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 -
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 -
Contributions To Nephrology 2019Peritoneal dialysis (PD) is a self-administered chronic renal replacement therapy. It is a home-based therapy, and thus subject to the risk of discrepancy between... (Review)
Review
Peritoneal dialysis (PD) is a self-administered chronic renal replacement therapy. It is a home-based therapy, and thus subject to the risk of discrepancy between prescribed dose and effective dialysis delivery. Till now automated peritoneal dialysis (APD) cyclers have recorded the dialysis treatments on a card that patients bring to the hospital for consultation in the PD unit. This card contains the operative parameters of each APD session. Recently, Baxter Healthcare developed a cloud-based tool for remote patient and treatment management. The new platform named Sharesource® embedded into the cycler HOMECHOICE CLARIA® allows to overcome the problems related to poor compliance and feeling of uncertainty by the patient, reducing the number of hospital visits and the workload for physician and nurses of the PD Unit. This new system uploads all treatment information to a secure cloud-based software. The 2-way communication platform gives remote visibility to patient's treatment and allows for feedback and correction of inadequate treatment program. Remote patient management (RPM) allows to visualize the course of home PD day after day, evaluating adherence to prescription, possible alarms during treatment, drainage times, and ultrafiltration amount. The evaluation of all the data can be done by the physician at his desk in the Hospital in front of the computer. RPM allows a patient's dialytic management in real time and enables the nephrologist to remotely modify treatment operative parameters, leaving the patient at home saving kilometers, money and time. In this chapter, we describe a simple algorithm used in our unit to define alarm thresholds and to describe actions to be instituted to correct any possible problem occurring during APD.
PubMed: 34569511
DOI: 10.1159/000496317 -
Pediatric Quality & Safety 2023Prolonged periods spent outside the target range of oxygen saturation (SpO) in preterm infants, along with frequent desaturation events, predispose them to retinopathy...
UNLABELLED
Prolonged periods spent outside the target range of oxygen saturation (SpO) in preterm infants, along with frequent desaturation events, predispose them to retinopathy of prematurity (ROP) and long-term neurodevelopmental impairment. The primary aim of this study was to increase the mean time spent within the target SpO range (WTR) by 10% and to reduce the frequency of desaturation events by 5 events per patient day, respectively, within 18 months of implementing a care bundle.
METHODS
This study was completed in a 46-bed neonatal intensive care unit (NICU), involving 246 staff members and led by a quality improvement team. The change interventions included implementing new practice guidelines, reviewing daily summaries of SpO maintenance, daily infant wellness assessment, standardizing workflow, and responding to SpO alarms. In addition, we collected staff satisfaction and compliance with change interventions, resource use, and morbidity and mortality data at discharge.
RESULTS
The mean time spent WTR increased from 65.3% to 75.3%, and the frequency of desaturation events decreased from 25.1 to 16.5 events per patient day, respectively, with a higher magnitude of benefit in infants on days with supplemental oxygen. Postimplementation, the duration of high-frequency ventilation and supplemental oxygen were lower, but morbidity and mortality rates were similar. Staff satisfaction with training workshops, coaching, use of the infant wellness assessment tool, and SpO alarm management algorithms were 74%, 82%, 80%, and 74%, respectively.
CONCLUSION
Implementing a care bundle to improve oxygen maintenance and reduce desaturation events increased the time spent WTR and reduced the frequency of desaturation events.
PubMed: 36926217
DOI: 10.1097/pq9.0000000000000639 -
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 -
Journal of Animal Science and Technology Nov 2022Horse breeders suffer massive economic losses due to dystocia, abortion, and stillbirths. In Thoroughbred mares, breeders often miss the foaling process because...
Horse breeders suffer massive economic losses due to dystocia, abortion, and stillbirths. In Thoroughbred mares, breeders often miss the foaling process because approximately 86% of the foaling events occur from 19:00 to 7:00; consequently, breeders cannot assist mares experiencing dystocia. To solve this problem, various foaling alarm systems have been developed. However, there is a need to develop a new system to overcome the shortcomings of the existing devices and improve their accuracy. To this end, the present study aimed to (1) develop a novel foaling alarm system and (2) compare its accuracy with that of the existing Foalert™ system. Specifically, eighteen Thoroughbred mares (11.9 ± 4.0 years old) were included. An accelerometer was used to analyze specific foaling behaviors. Behavioral data were transmitted to a data server every second. Depending on the acceleration value, behaviors were automatically classified by the server as categorized behaviors 1 (behaviors without change in body rotation), 2 (behaviors with sudden change in body rotation, such as rolling over), and 3 (behaviors with long-term change in body rotation, such as lying down laterally). The system was designed to alarm when the duration of categorized behaviors 2 and 3 was 12.9% and that of categorized behavior 3 was 1% during 10 min. The system measured the duration of each categorized behavior every 10 min and transmitted an alarm to the breeders when foaling was detected. To confirm its accuracy, the foaling detection time of the novel system was compared with that of Foalert™. The novel foaling alarm system and Foalert™ alarmed foaling onset respectively 32.6 ± 17.9 and 8.6 ± 1.0 min prior to foal discharge, and the foaling detection rate of both systems was 94.4%. Therefore, the novel foaling alarm system equipped with an accelerometer can precisely detect and alert foaling onset.
PubMed: 36811996
DOI: 10.5187/jast.2022.e75 -
Scientific Reports May 2021In very preterm infants, cardio-respiratory events and associated hypoxemia occurring during early postnatal life have been associated with risks of retinopathy, growth... (Observational Study)
Observational Study
In very preterm infants, cardio-respiratory events and associated hypoxemia occurring during early postnatal life have been associated with risks of retinopathy, growth alteration and neurodevelopment impairment. These events are commonly detected by continuous cardio-respiratory monitoring in neonatal intensive care units (NICU), through the associated bradycardia. NICU nurse interventions are mainly triggered by these alarms. In this work, we acquired data from 52 preterm infants during NICU monitoring, in order to propose an early bradycardia detector which is based on a decentralized fusion of three detectors. The main objective is to improve automatic detection under real-life conditions without altering performance with respect to that of a monitor commonly used in NICU. We used heart rate lower than 80 bpm during at least 10 sec to define bradycardia. With this definition we observed a high rate of false alarms (64%) in real-life and that 29% of the relevant alarms were not followed by manual interventions. Concerning the proposed detection method, when compared to current monitors, it provided a significant decrease of the detection delay of 2.9 seconds, without alteration of the sensitivity (97.6% vs 95.2%) and false alarm rate (63.7% vs 64.1%). We expect that such an early detection will improve the response of the newborn to the intervention and allow for the development of new automatic therapeutic strategies which could complement manual intervention and decrease the sepsis risk.
Topics: Bradycardia; Humans; Infant, Extremely Premature; Infant, Newborn; Infant, Premature, Diseases; Intensive Care Units, Neonatal; Monitoring, Physiologic
PubMed: 34006917
DOI: 10.1038/s41598-021-89468-x -
Scientific Reports Nov 2023Temperature is a primary factor affecting the physiology of ectothermic animals and global warming of water bodies may therefore impact aquatic life. Understanding the...
Temperature is a primary factor affecting the physiology of ectothermic animals and global warming of water bodies may therefore impact aquatic life. Understanding the effects of near-future predicted temperature changes on the behaviour and underlying molecular mechanisms of aquatic animals is of particular importance, since behaviour mediates survival. In this study, we investigate the effects of developmental temperature on locomotory behaviour and olfactory learning in the zebrafish, Danio rerio. We exposed zebrafish from embryonic stage to either control (28 °C) or elevated temperature (30 °C) for seven days. Overall, warming reduced routine swimming activity and caused upregulation of metabolism and neuron development genes. When exposed to olfactory cues, namely catfish cue, a non-alarming but novel odour, and conspecifics alarming cue, warming differently affected the larvae response to the two cues. An increase in locomotory activity and a large transcriptional reprogramming was observed at elevated temperature in response to novel odour, with upregulation of cell signalling, neuron development and neuron functioning genes. As this response was coupled with the downregulation of genes involved in protein translation and ATP metabolism, novel odour recognition in future-predicted thermal conditions would require energetic trade-offs between expensive baseline processes and responsive functions. To evaluate their learning abilities at both temperatures, larvae were conditioned with a mixture of conspecifics alarm cue and catfish cue. Regardless of temperature, no behavioural nor gene expression changes were detected, reinforcing our findings that warming mainly affects zebrafish molecular response to novel odours. Overall, our results show that future thermal conditions will likely impact developing stages, causing trade-offs following novel olfactory detection in the environment.
Topics: Animals; Zebrafish; Odorants; Larva; Swimming; Temperature; Fever
PubMed: 38030737
DOI: 10.1038/s41598-023-48287-y -
BMJ Open Feb 2015This literature review examined research into the impact of a previous 'all-clear' or non-cancer diagnosis following symptomatic presentation ('false alarm') on symptom... (Review)
Review
OBJECTIVES
This literature review examined research into the impact of a previous 'all-clear' or non-cancer diagnosis following symptomatic presentation ('false alarm') on symptom attribution and delays in help seeking for subsequent possible cancer symptoms.
DESIGN AND SETTING
The comprehensive literature review included original research based on quantitative, qualitative and mixed data collection methods. We used a combination of search strategies, including in-depth searches of electronic databases (PubMed, EMBASE, PsychInfo), searching key authors and articles listed as 'related' in PubMed, and reference lists. We performed a narrative synthesis of key themes shared across studies.
PARTICIPANTS
The review included studies published after 1990 and before February 2014 reporting information on adult patients having experienced a false alarm following symptomatic presentation. We excluded false alarms in the context of screening.
PRIMARY AND SECONDARY OUTCOME MEASURES
We evaluated the effect of a 'false alarm' on symptom attribution and help seeking for new or recurrent possible cancer symptoms.
RESULTS
Overall, 1442 papers were screened and 121 retrieved for full-text evaluation. Among them, 19 reported on false alarms and subsequent symptom attribution or help seeking. They used qualitative (n=14), quantitative (n=3) and mixed methods (n=2). Breast (n=7), gynaecological (n=3), colorectal (n=2), testicular (n=2), and head and neck cancers (n=2) were the most studied. Two broad themes emerged underlying delays in help seeking: (1) over-reassurance from the previous 'all-clear' diagnosis leading to subsequent symptoms being interpreted as benign, and (2) unsupportive healthcare experiences in which symptoms were dismissed, leaving patients concerned about appearing hypochondriacal or uncertain about the appropriate next actions. The evidence suggested that the effect of a false alarm can persist for months and even years.
CONCLUSIONS
In conclusion, over-reassurance and undersupport of patients after a false alarm can undermine help seeking in the case of new or recurrent potential cancer symptoms, highlighting the need for appropriate patient information when investigations rule out cancer.
Topics: Female; Humans; Male; Neoplasm Recurrence, Local; Neoplasms; Patient Acceptance of Health Care; Uncertainty
PubMed: 25652803
DOI: 10.1136/bmjopen-2014-007002