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"Alarm Fatigue"

Michele M Pelter, Richard Fidler, Xiao Hu
BACKGROUND: Although electrocardiographic monitoring is valuable for continuous surveillance of intensive care unit (ICU) patients, false alarms are common and have been cited as a cause of alarm fatigue. ANSI/AAMI EC12:2002 states that electrocardiograms (ECGs) should not detect a QRS if the waveform is less than 0.15 mV (1.5 mm) for adult patients, in order to avoid mislabeling P waves or baseline noise as QRSs during complete heart block or asystole. However, ECG software algorithms often use more conservative QRS thresholds, which may result in false-positive asystole alarms in patients with low-amplitude QRS complexes...
September 2016: Biomedical Instrumentation & Technology
Mohamed Abdelazez, Patrick Quesnel, Adrian Chan, Homer Yang
: The objective of this study is to propose and validate an alarm gating system for a myocardial ischemia monitoring system that uses ambulatory electrocardiogram (AECG). The PeriOperative ISchemic Evaluation (POISE) study recommended the selective administration of β blockers to patients at risk of cardiac events following non-cardiac surgery. Patients at risk are identified by monitoring ST-segment deviations in the electrocardiogram (ECG); however, patients are encouraged to ambulate to improve recovery, which deteriorates the signal quality of the ECG leading to false alarms...
August 25, 2016: IEEE Transactions on Bio-medical Engineering
Scott B Hu, Deborah J L Wong, Aditi Correa, Ning Li, Jane C Deng
INTRODUCTION: Clinical deterioration (ICU transfer and cardiac arrest) occurs during approximately 5-10% of hospital admissions. Existing prediction models have a high false positive rate, leading to multiple false alarms and alarm fatigue. We used routine vital signs and laboratory values obtained from the electronic medical record (EMR) along with a machine learning algorithm called a neural network to develop a prediction model that would increase the predictive accuracy and decrease false alarm rates...
2016: PloS One
Jacob W Turmell, Lola Coke, Rachel Catinella, Tracy Hosford, Amy Majeski
The purpose of this article is to describe the impact of an evidence-based alarm management strategy on patient safety. An alarm management program reduced alarms up to 30%. Evaluation of patients on continuous cardiac monitoring showed a 3.5% decrease in census. This alarm management strategy has the potential to save $136 500 and 841 hours of registered nurses' time per year. No patient harm occurred during the 2-year project.
August 5, 2016: Journal of Nursing Care Quality
Veena V Goel, Sarah F Poole, Christopher A Longhurst, Terry S Platchek, Natalie M Pageler, Paul J Sharek, Jonathan P Palma
INTRODUCTION: Modification of alarm limits is one approach to mitigating alarm fatigue. We aimed to create and validate heart rate (HR) and respiratory rate (RR) percentiles for hospitalized children, and analyze the safety of replacing current vital sign reference ranges with proposed data-driven, age-stratified 5th and 95th percentile values. METHODS: In this retrospective cross-sectional study, nurse-charted HR and RR data from a training set of 7202 hospitalized children were used to develop percentile tables...
July 14, 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
George W Williams, Christy A George, Brian C Harvey, Jenny E Freeman
BACKGROUND: Current respiratory monitoring technologies such as pulse oximetry and capnography have been insufficient to identify early signs of respiratory compromise in nonintubated patients. Pulse oximetry, when used appropriately, will alert the caregiver to an episode of dangerous hypoxemia. However, desaturation lags significantly behind hypoventilation and alarm fatigue due to false alarms poses an additional problem. Capnography, which measures end-tidal CO2 (EtCO2) and respiratory rate (RR), has not been universally used for nonintubated patients for multiple reasons, including the inability to reliably relate EtCO2 to the level of impending respiratory compromise and lack of patient compliance...
July 5, 2016: Anesthesia and Analgesia
Susan P McGrath, Andreas H Taenzer, Nancy Karon, George Blike
BACKGROUND: The growing number of monitoring devices, combined with suboptimal patient monitoring and alarm management strategies, has increased "alarm fatigue," which have led to serious consequences. Most reported alarm man- agement approaches have focused on the critical care setting. Since 2007 Dartmouth-Hitchcock (Lebanon, New Hamp- shire) has developed a generalizable and effective design, implementation, and performance evaluation approach to alarm systems for continuous monitoring in general care settings (that is, patient surveillance monitoring)...
July 2016: Joint Commission Journal on Quality and Patient Safety
Michael F Rayo, Susan D Moffatt-Bruce
No abstract text is available yet for this article.
July 2016: Joint Commission Journal on Quality and Patient Safety
Krystal Lansdowne, David G Strauss, Christopher G Scully
BACKGROUND: The cacophony of alerts and alarms in a hospital produced by medical devices results in alarm fatigue. The pulse oximeter is one of the most common sources of alarms. One of the ways to reduce alarm rates is to adjust alarm settings at the bedside. This study is aimed to retrospectively examine individual pulse oximeter alarm settings on alarm rates and inter- and intra- patient variability. METHODS: Nine hundred sixty-two previously collected intensive care unit (ICU) patient records were obtained from the Multiparameter Intelligent Monitoring in Intensive Care II Database (Beth Israel Deaconess Medical Center, Boston, MA)...
2016: BMC Nursing
Azizeh Khaled Sowan, Tiffany Michelle Gomez, Albert Fajardo Tarriela, Charles Calhoun Reed, Bruce Michael Paper
BACKGROUND: Clinical alarm systems safety is a national concern, specifically in intensive care units (ICUs) where alarm rates are known to be the highest. Interventional projects that examined the effect of changing default alarm settings on overall alarm rate and on clinicians' attitudes and practices toward clinical alarms and alarm fatigue are scarce. OBJECTIVE: To examine if (1) a change in default alarm settings of the cardiac monitors and (2) in-service nursing education on cardiac monitor use in an ICU would result in reducing alarm rate and in improving nurses' attitudes and practices toward clinical alarms...
2016: JMIR Human Factors
Rohan Joshi, Carola van Pul, Louis Atallah, Loe Feijs, Sabine Van Huffel, Peter Andriessen
Patient monitoring generates a large number of alarms, the vast majority of which are false. Excessive non-actionable medical alarms lead to alarm fatigue, a well-recognized patient safety issue. While multiple approaches to reduce alarm fatigue have been explored, patterns in alarming and inter-alarm relationships, as they manifest in the clinical workspace, are largely a black-box and hamper research efforts towards reducing alarms. The aim of this study is to detect opportunities to safely reduce alarm pressure, by developing techniques to identify, capture and visualize patterns in alarms...
April 2016: Physiological Measurement
Amanda C Schondelmeyer, Patrick W Brady, Heidi Sucharew, Guixia Huang, Kelsey E Hofacer, Jeffrey M Simmons
BACKGROUND: Concerns about alarm fatigue prompted The Joint Commission to issue a Sentinel Event Alert urging hospitals to minimize alarms. We previously conducted a quality improvement project on a single unit that reduced time on continuous pulse oximetry, a common source of physiologic monitor alarms, for patients with wheezing (ie, asthma and bronchiolitis, wheezing-associated respiratory infections). OBJECTIVE: To study the impact of our improvement work on overall physiologic monitor alarm frequency for these patients...
April 2016: Hospital Pediatrics
Azizeh Khaled Sowan, Albert Fajardo Tarriela, Tiffany Michelle Gomez, Charles Calhoun Reed, Kami Marie Rapp
BACKGROUND: Intensive care units (ICUs) are complex work environments where false alarms occur more frequently than on non-critical care units. The Joint Commission National Patient Safety Goal .06.01.01 targeted improving the safety of clinical alarm systems and required health care facilities to establish alarm systems safety as a hospital priority by July 2014. An important initial step toward this requirement is identifying ICU nurses' perceptions and common clinical practices toward clinical alarms, where little information is available...
2015: JMIR Human Factors
Lujie Chen, Artur Dubrawski, Donghan Wang, Madalina Fiterau, Mathieu Guillame-Bert, Eliezer Bose, Ata M Kaynar, David J Wallace, Jane Guttendorf, Gilles Clermont, Michael R Pinsky, Marilyn Hravnak
OBJECTIVE: The use of machine-learning algorithms to classify alerts as real or artifacts in online noninvasive vital sign data streams to reduce alarm fatigue and missed true instability. DESIGN: Observational cohort study. SETTING: Twenty-four-bed trauma step-down unit. PATIENTS: Two thousand one hundred fifty-three patients. INTERVENTION: Noninvasive vital sign monitoring data (heart rate, respiratory rate, peripheral oximetry) recorded on all admissions at 1/20 Hz, and noninvasive blood pressure less frequently, and partitioned data into training/validation (294 admissions; 22,980 monitoring hours) and test sets (2,057 admissions; 156,177 monitoring hours)...
July 2016: Critical Care Medicine
Henry Anhalt
Much progress has been made in diabetes treatments since the first dose of insulin was administered in 1921. However, a truly transformational moment in diabetes care occurred when urine testing gave way to capillary blood home glucose monitoring. As improvements were made to these devices, continuous glucose monitoring (CGM) was introduced. The advantages of experiential learnings gleaned from seeing continuous real-time data have been borne out in numerous peer-reviewed journals. Limitations to use of CGM include patient's level of numeracy and literacy, development of alarm fatigue, interfering substances leading to erroneous readings, high rates of discontinuation, and poor reimbursement...
March 2016: Diabetes Technology & Therapeutics
Judith van Andel, Roland D Thijs, Al de Weerd, Johan Arends, Frans Leijten
OBJECTIVE: This study aimed to (1) evaluate available systems and algorithms for ambulatory automatic seizure detection and (2) discuss benefits and disadvantages of seizure detection in epilepsy care. METHODS: PubMed and EMBASE were searched up to November 2014, using variations and synonyms of search terms "seizure prediction" OR "seizure detection" OR "seizures" AND "alarm". RESULTS: Seventeen studies evaluated performance of devices and algorithms to detect seizures in a clinical setting...
April 2016: Epilepsy & Behavior: E&B
Byron L Burlingame, Kerrie Chambers
Increasing ambient room temperature Key words: OR temperature, core temperature, unplanned hypothermia, ambient room temperature, thermoregulation. Clinical alarm management Key words: alarm fatigue, clinical alarms, alert alarms.
March 2016: AORN Journal
Nicolò Gambarotta, Federico Aletti, Giuseppe Baselli, Manuela Ferrario
The assessment of signal quality has been a research topic since the late 1970s, as it is mainly related to the problem of false alarms in bedside monitors in the intensive care unit (ICU), the incidence of which can be as high as 90 %, leading to alarm fatigue and a drop in the overall level of nurses and clinicians attention. The development of efficient algorithms for the quality control of long diagnostic electrocardiographic (ECG) recordings, both single- and multi-lead, and of the arterial blood pressure (ABP) signal is therefore essential for the enhancement of care quality...
July 2016: Medical & Biological Engineering & Computing
Ok Min Cho, Hwasoon Kim, Young Whee Lee, Insook Cho
OBJECTIVES: The purpose of this descriptive study was to investigate the current situation of clinical alarms in intensive care unit (ICU), nurses' recognition of and fatigue in relation to clinical alarms, and obstacles in alarm management. METHODS: Subjects were ICU nurses and devices from 48 critically ill patient cases. Data were collected through direct observation of alarm occurrence and questionnaires that were completed by the ICU nurses. The observation time unit was one hour block...
January 2016: Healthcare Informatics Research
Matthias Görges, Nicholas C West, Nancy A Christopher, Jennifer L Koch, Sonia M Brodie, Nasim Lowlaavar, Gillian R Lauder, J Mark Ansermino
BACKGROUND: Respiratory depression in children receiving postoperative opioid infusions is a significant risk because of the interindividual variability in analgesic requirement. Detection of respiratory depression (or apnea) in these children may be improved with the introduction of automated acoustic respiratory rate (RR) monitoring. However, early detection of adverse events must be balanced with the risk of alarm fatigue. Our objective was to evaluate the use of acoustic RR monitoring in children receiving opioid infusions on a postsurgical ward and identify the causes of false alarm and optimal alarm thresholds...
April 2016: Anesthesia and Analgesia
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