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BMJ Quality & Safety Sep 2020
Topics: Child; Clinical Alarms; Hospitals, Pediatric; Humans; Sound
PubMed: 32086299
DOI: 10.1136/bmjqs-2019-010561 -
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 Clinical Monitoring and... Aug 2023The poor design of conventional auditory medical alarms has contributed to alarm desensitization, and eventually, alarm fatigue in medical personnel. This study tested a...
The poor design of conventional auditory medical alarms has contributed to alarm desensitization, and eventually, alarm fatigue in medical personnel. This study tested a novel multisensory alarm system which aims to help medical personnel better interpret and respond to alarm annunciation during periods of high cognitive load such as those found within intensive care units. We tested a multisensory alarm that combined auditory and vibrotactile cues to convey alarm type, alarm priority, and patient identity. Testing was done in three phases: control (conventional auditory), Half (limited multisensory alarm), and Full (complete multisensory alarm). Participants (N = 19, undergraduates) identified alarm type, priority, and patient identity (patient 1 or 2) using conventional and multisensory alarms, while simultaneously completing a cognitively demanding task. Performance was based on reaction time (RT) and identification accuracy of alarm type and priority. Participants also reported their perceived workload. RT was significantly faster for the Control phase (p < 0.05). Participant performance in identifying alarm type, priority, and patient did not differ significantly between the three phase conditions (p = 0.87, 0.37, and 0.14 respectively). The Half multisensory phase produced the lowest mental demand, temporal demand, and overall perceived workload score. These data suggest that implementation of a multisensory alarm with alarm and patient information may decrease perceived workload without significant changes in alarm identification performance. Additionally, a ceiling effect may exist for multisensory stimuli, with only part of an alarm benefitting from multisensory integration.
Topics: Humans; Workload; Feasibility Studies; Clinical Alarms; Reaction Time; Intensive Care Units; Monitoring, Physiologic
PubMed: 37133627
DOI: 10.1007/s10877-023-01014-4 -
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 -
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 -
Journal of Cardiovascular... May 2022A wearable cardioverter defibrillator (WCD) is indicated in appropriate patients to reduce the risk for sudden cardiac death. Challenges for patients wearing a WCD have...
INTRODUCTION
A wearable cardioverter defibrillator (WCD) is indicated in appropriate patients to reduce the risk for sudden cardiac death. Challenges for patients wearing a WCD have been frequent false shock alarms primarily due to electrocardiogram noise and wear discomfort. The objective of this study was to test a contemporary WCD designed for reduced false shock alarms and improved comfort.
METHODS
One hundred and thirty patients with left ventricular ejection fraction ≤40% and an active implantable cardioverter defibrillator (ICD) were fitted with the ASSURE WCD (Kestra Medical Technologies) and followed for 30 days. WCD detection was enabled and shock alarm markers recorded, but shocks and shock alarms were disabled. All WCD episodes and ICD ventricular tachycardia/ventricular fibrillation (VT/VF) episodes were adjudicated. The primary endpoint was the false-positive shock alarm rate with a performance goal of 1 every 3.4 days (0.29 per patient-day).
RESULTS
Of 163 WCD episodes, 4 were VT/VF and 159 non-VT/VF (121 rhythms with noise, 32 uncertain with noise, 6 atrial flutter without noise). Only three false-positive shock alarm markers were recorded; one false-positive shock alarm every 1333 patient-days (0.00075 per patient-day, 95% confidence interval: 0.00015-0.00361; p < .001). No ICD recorded VT/VF episodes meeting WCD detection criteria (≥170 bpm for ≥20 s) were missed by the WCD during 3501 patient-days of use. Median wear was 31.0 days (interquartile range [IQR] 2.0) and median daily use 23.0 h (IQR 1.7). Adverse events were mostly mild: skin irritation (19.4%) and musculoskeletal discomfort (8.5%).
CONCLUSION
The ASSURE WCD demonstrated a low false-positive shock alarm rate, low patient-reported discomfort, and no serious adverse events.
Topics: Arrhythmias, Cardiac; Death, Sudden, Cardiac; Defibrillators; Defibrillators, Implantable; Electric Countershock; Electrocardiography; Humans; Stroke Volume; Ventricular Fibrillation; Ventricular Function, Left; Wearable Electronic Devices
PubMed: 35174572
DOI: 10.1111/jce.15417 -
British Journal of Anaesthesia Jul 2006Alarms are used in many clinical applications, but they are often less than optimal because the design and implementation of alarms has not always taken the cognitive... (Review)
Review
Alarms are used in many clinical applications, but they are often less than optimal because the design and implementation of alarms has not always taken the cognitive capacity and processing mechanisms of the user into account. As a result alarms are frequently too loud, irritating, confusing, badly designed, and too numerous, resulting in them often being turned off and hindering, rather than enhancing, task performance. This paper reviews some of the main areas where it is essential to take account of the cognitive system of the user and behavioural processes more generally. Five central areas of concern are discussed: the number of alarms and ways that this might be reduced; false alarm rates and their impact on human responses; the design of alarms and the application of research into auditory cognition on design; intelligent alarm systems; and the proposals for alarm design set out in a recent worldwide medical alarms standard. In each area some background is given and the implications for alarm design and implementation outlined. The conclusion is that there are some indications that alarm design and implementation takes account of relevant research data, but that there is still some way to go before these findings are fully integrated and the situation is improved upon further.
Topics: Anesthesiology; Auditory Perception; Equipment Design; Equipment Failure; Humans; Monitoring, Intraoperative; Monitoring, Physiologic; Noise, Occupational
PubMed: 16698858
DOI: 10.1093/bja/ael114 -
Heart & Lung : the Journal of Critical... 2013
Topics: Clinical Alarms; Fatigue; Humans; Telemetry
PubMed: 24183197
DOI: 10.1016/j.hrtlng.2013.09.001 -
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