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Salameh B, Abdallah J, Alkubati SA, ALBashtawy M. Alarm fatigue and perceived stress among critical care nurses in the intensive care units: Palestinian perspectives. BMC Nurs 2024; 23:261. [PMID: 38654236 PMCID: PMC11036661 DOI: 10.1186/s12912-024-01897-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE The frequency of alarms generated by monitors and other electro-medical devices is undeniably valuable but can simultaneously escalate the workload for healthcare professionals, potentially subjecting intensive care unit nurses to alarm fatigue. The aim of this study is to investigate alarm fatigue and stress levels among critical care nursing personnel. Additionally, the study aims to assess predictors for both alarm fatigue and perceived stress. METHODOLOGY A descriptive cross-sectional study recruited 187 Intensive Care Unit (ICU) nurses from hospitals located in the northern and central regions of the West Bank, Palestine. Data were gathered through online surveys due to logistic concerns using the Alarm Fatigue Scale and the Perceived Stress Scale. The research was conducted between November 2023 and January 2024. RESULTS The mean overall alarm fatigue score was 23.36 (SD = 5.57) out of 44. The study showed that 62.6% of the participating ICU nurses experience average to high degree of alarm fatigue, while 69.5% experience average to high levels of perceived stress. A significant positive Pearson correlation was found between stress and alarm fatigue (0.40, P < 0.01). Important predictors of alarm fatigue include perceived stress, nurse-to-patient ratio, gender, and years of experience, while important predictors of perceived stress include alarm fatigue, type of working shift and hospital unit. CONCLUSION Alarm fatigue can compromise the timely intervention required to prevent adverse outcomes by causing delayed responses or missed critical alarm, which can have major ramifications for patient safety. Addressing stress is crucial for mitigating alarm fatigue and fostering a supportive work environment to ensure optimal patient care. Consequently, exploring strategies to alleviate the negative impacts of alarm fatigue on critical care nurses' stress merits further investigation in future research studies.
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Affiliation(s)
- Basma Salameh
- Faculty of Nursing, Arab American University, Jenin, Palestine.
| | - Jihad Abdallah
- Department of Animal Production, An-Najah National University,Nablus, Jenin, Palestine
| | - Sameer A Alkubati
- Department of Nursing, Faculty of Medicine and Health Sciences, Hodeida University, Hodeida, Yemen
- Department of Medical Surgical Nursing, College of Nursing, University of Hail, Hail, Saudi Arabia
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Batur M, Özdemir PG, Bilmez Tan R, Şahin Taş Z. Assessment of metacognition and retinal optical coherence tomography findings in shift workers. Chronobiol Int 2024; 41:393-405. [PMID: 38438316 DOI: 10.1080/07420528.2024.2325017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/25/2024] [Indexed: 03/06/2024]
Abstract
It is known that working in the shift system, especially the night shift, affects physical, mental, and social well-being. We investigated the changes in the inner retinal layers and choroidal layer of the eyes of nurses working night and day shifts using optical coherence tomography (OCT). We also explored the effect of night shift work on metacognition and the relationships between these variables. A total of 79 nurses participated in the study, of whom 40 worked night shifts. The researcher gave the participants sociodemographic information and the Metacognition Questionnaire-30 (MCQ-30) form. Retinal nerve fiber layer (RNFL) thickness, ganglion cell layer (GCL) thickness, inner nuclear layer (INL) thickness, inner plexiform layer (IPL) thickness, central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) were measured with OCT. It was found that the level of metacognitive activity associated with cognitive confidence was higher (p = 0.044) for nurses who worked night shifts and that the level of metacognitive activity associated with cognitive awareness was lower (p = 0.015) for nurses who worked night shifts. RNFL-nasal superior (NS) thickness was lower in night shift workers than the day shift group (p = 0.017). Our study revealed significant relationships between metacognition and the OCT findings among night and day shift workers. Our study revealed that RNFL measurements and metacognitive activity may differ and there may be a relationship between these parameters in nurses who work shifts. Further research is needed to investigate the long-term effects of night shift work on retinal health.
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Affiliation(s)
- Muhammed Batur
- Medical Faculty Department of Ophthalmology, Yuzuncu Yıl University, Van, Turkey
| | - Pınar Güzel Özdemir
- Medical Faculty Department of Psychiatry, Yuzuncu Yil University, Van, Turkey
| | - Rumeysa Bilmez Tan
- Medical Faculty Department of Ophthalmology, Yuzuncu Yıl University, Van, Turkey
| | - Zeynep Şahin Taş
- Medical Faculty Department of Psychiatry, Yuzuncu Yil University, Van, Turkey
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Li B, Yue L, Nie H, Cao Z, Chai X, Peng B, Zhang T, Huang W. The effect of intelligent management interventions in intensive care units to reduce false alarms: An integrative review. Int J Nurs Sci 2024; 11:133-142. [PMID: 38352290 PMCID: PMC10859571 DOI: 10.1016/j.ijnss.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/03/2023] [Accepted: 12/11/2023] [Indexed: 02/16/2024] Open
Abstract
Objective In intensive care units (ICU), frequent false alarms from medical equipment can cause alarm fatigue among nurses, which might lead to delayed or missed responses and increased risk of adverse patient events. This review was conducted to evaluate the effectiveness of intelligent management interventions to reduce false alarms in ICU. Method Following the framework of Whitmore and Knafl, the reviewers systematically searched six databases: PubMed, EMBASE, CINAHL, OVID, Cochrane Library, and Scopus, and studies included intelligent management of clinical alarms published in the English or Chinese language from the inception of each database to December 2022 were retrieved. The researchers used the PICOS framework to formulate the search strategy, developed keywords, screened literature, and assessed the studies' quality using the Joanna Briggs Institute-Meta-Analysis of Statistics, Assessment, and Review Instrument (JBI-MAStARI). The review was preregistered on PROSPERO (CRD42023411552). Results Seven studies met the inclusion criteria. The results showed that different interventions for intelligent management of alarms were beneficial in reducing the number of false alarms, the duration of alarms, the response time to important alarms for nurses, and the alarm fatigue levels among nurses. Positive results were found in practice after the application of the novel alarm management approaches. Conclusion Intelligent management intervention may be an effective way to reduce false alarms. The application of systems or tools for the intelligent management of clinical alarms is urgent in hospitals. To ensure more effective patient monitoring and less distress for nurses, more alarm management approaches combined with artificial intelligence will be needed in the future to enable accurate identification of critical alarms, ensure nurses are responding accurately to alarms, and make a real difference to alarm-ridden healthcare environments.
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Affiliation(s)
- Bingyu Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Liqing Yue
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Huiyu Nie
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ziwei Cao
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaoya Chai
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Bin Peng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Tiange Zhang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Weihong Huang
- “Mobile Health” Ministry of Education - China Mobile Joint Laboratory, Xiangya Hospital of Central South University, Changsha, Hunan, China
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Hansen CJ, Rayo MF, Patterson ES, Yamokoski T, Abdel-Rasoul M, Allen TT, Socha JJ, Moffatt-Bruce SD. Perceptually Discriminating the Highest Priority Alarms Reduces Response Time: A Retrospective Pre-Post Study at Four Hospitals. HUMAN FACTORS 2023; 65:636-650. [PMID: 34320859 DOI: 10.1177/00187208211032870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Reduce nurse response time for emergency and high-priority alarms by increasing discriminability between emergency and all other alarms and suppressing redundant and likely false high-priority alarms in a secondary alarm notification system (SANS). BACKGROUND Emergency alarms are the most urgent, requiring immediate action to address a dangerous situation. They are clinician-triggered and have higher positive predictive value (PPV). High-priority alarms are automatically triggered and have lower PPV. METHOD We performed a retrospective pre-post study, analyzing data 15 months before and 25 months after a SANS redesign was implemented in four hospitals. For emergency alarms, we incorporated digitized human speech to distinguish them from automatically triggered alarms, leaving their onset and escalation pathways unchanged. For automatically triggered alarms, we suppressed some by delaying initial onset and escalation by 20 s. We used linear mixed models to assess the change in response time, Fisher's exact test for the proportion of response times longer than 120 s, and control charts for process stability. RESULTS Response time for emergency alarms decreased at all hospitals (main, from 26.91 s to 22.32 s, p < .001; cardiac, from 127.10 s to 52.43 s, p < .001; cancer, from 18.03 s to 15.39 s, p < .001). Improvements were sustained. Automatically triggered alarms decreased 25.0%. Response time for the three automatically triggered cardiac alarms increased at the four hospitals. CONCLUSION Auditory sound disambiguation was associated with a sustained reduced nurse response time for emergency alarms, but suppressing some high-priority automatically triggered alarms was not. APPLICATION Distinguishing and escalating urgent, actionable alarms with higher PPV improves response time.
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Özcan E, Broekmeulen CLH, Luck ZA, van Velzen M, Stappers PJ, Edworthy JR. Acoustic Biotopes, Listeners and Sound-Induced Action: A Case Study of Operating Rooms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16674. [PMID: 36554556 PMCID: PMC9779544 DOI: 10.3390/ijerph192416674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
As socio-technological environments shape and direct listener behaviour, an ecological account is needed that encompasses listening in complexity (i.e., multiple listeners, multiple sounds and their sources, and multiple sound-induced actions that ensure the success of a mission). In this study, we explored sound-induced action under the framework of "acoustic biotopes" (a notion of ecological acoustics by Smolders, Aertsen, and Johanessma, 1979 and 1982) in a specific socio-technological environment, i.e., the context of an orthopaedic operating room. Our approach is based on literature research into the topics of environmental psychology and auditory perception and action and in situ observations in healthcare with field recordings, participatory observations, and interviews on the spot. The results suggest a human-centered definition of sound-induced action in acoustic biotopes: Acoustic biotope is an active and shared sound environment with entangled interactions and sound-induced actions taking place in a specific space that has a critical function. Listening in highly functional environments is an individual experience and is influenced by hearing function, physical position and role in an environment, and the task at hand. There is a range of active and passive sound listeners as a function of their attentive state and listeners as sound sources within the acoustic biotope. There are many different sound sources and sound locals in socio-technological environments and sounds have great potential to serve critical information to operators. Overall, our study provides a holistic, multi-layered and yet a listener-centric view on the organisation of complex spaces and the results can immediately be applicable for rethinking the acoustic environment for ORs for better listening and sound-induced action.
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Affiliation(s)
- Elif Özcan
- Critical Alarms Lab, Faculty of Industrial Design Engineering, Delft University of Technology, 2628 CE Delft, The Netherlands
| | - Cornelis L. H. Broekmeulen
- Critical Alarms Lab, Faculty of Industrial Design Engineering, Delft University of Technology, 2628 CE Delft, The Netherlands
| | - Zoe Alexandra Luck
- Critical Alarms Lab, Faculty of Industrial Design Engineering, Delft University of Technology, 2628 CE Delft, The Netherlands
| | - Monique van Velzen
- Department of Anaesthesiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Pieter Jan Stappers
- Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft University of Technology, 2628 CE Delft, The Netherlands
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Mallikarjuna S, Kadian S, Dhar M, Shekhar S. Use of a smartwatch as a remote monitoring device during transport to, and inside, a computed tomography suite. Anaesth Rep 2022; 10:e12189. [PMID: 36275393 PMCID: PMC9581723 DOI: 10.1002/anr3.12189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- S. Mallikarjuna
- Department of Anaesthesiology and Critical CareAll India Institute of Medical SciencesRishikeshIndia
| | - S. Kadian
- Department of Anaesthesiology and Critical CareAll India Institute of Medical SciencesRishikeshIndia
| | - M. Dhar
- Department of Anaesthesiology and Critical CareAll India Institute of Medical SciencesRishikeshIndia
| | - S. Shekhar
- Department of Anaesthesiology and Critical CareAll India Institute of Medical SciencesRishikeshIndia
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Patterson ES, Rayo MF, Edworthy JR, Moffatt-Bruce SD. Applying Human Factors Engineering to Address the Telemetry Alarm Problem in a Large Medical Center. HUMAN FACTORS 2022; 64:126-142. [PMID: 34011195 DOI: 10.1177/00187208211018883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Address the alarm problem by redesigning, reorganizing, and reprioritizing to better discriminate alarm sounds and displays in a hospital. BACKGROUND Alarms in hospitals are frequently misunderstood, disregarded, and overridden. METHOD Discovery-oriented, intervention, and translational studies were conducted. Study objectives and measures varied, but had the shared goals of increasing positive predictive value (PPV) of critical alarms by reducing low-PPV alarms in the background, prioritizing alarms, redesigning alarm sounds to increase information content, and transparently conveying who initiated alarms. An alarm ontology was iteratively generated and refined until consensus was achieved. RESULTS The ontology distinguishes five levels of urgency that incorporate likely PPV, three categories for who initiates the alarm (hospital staff, patient, or machine), whether it is clinical or technical, and clinical functions. CONCLUSION This unique collaboration allowed us to make progress on the alarm problem by making unintuitive leaps, avoiding common missteps, and refuting conventional healthcare approaches. APPLICATION Hospitals can consistently redesign, reorganize, reprioritize, and better discriminate alarms by priority, PPV, and content to reduce nurse response times.
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DURSUN N, YILMAZ E. Cerrahi Hemşireliği Alanında Giyilebilir Teknoloji Kullanımı. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.38079/igusabder.948675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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9
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Andrade E, Quinlan L, Harte R, Byrne D, Fallon E, Kelly M, Casey S, Kirrane F, O'Connor P, O'Hora D, Scully M, Laffey J, Pladys P, Beuchée A, ÓLaighin G. Augmenting Critical Care Patient Monitoring Using Wearable Technology: Review of Usability and Human Factors. JMIR Hum Factors 2021; 8:e16491. [PMID: 34032574 PMCID: PMC8188324 DOI: 10.2196/16491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 07/13/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022] Open
Abstract
Background Continuous monitoring of the vital signs of critical care patients is an essential component of critical care medicine. For this task, clinicians use a patient monitor (PM), which conveys patient vital sign data through a screen and an auditory alarm system. Some limitations with PMs have been identified in the literature, such as the need for visual contact with the PM screen, which could result in reduced focus on the patient in specific scenarios, and the amount of noise generated by the PM alarm system. With the advancement of material science and electronic technology, wearable devices have emerged as a potential solution for these problems. This review presents the findings of several studies that focused on the usability and human factors of wearable devices designed for use in critical care patient monitoring. Objective The aim of this study is to review the current state of the art in wearable devices intended for use by clinicians to monitor vital signs of critical care patients in hospital settings, with a focus on the usability and human factors of the devices. Methods A comprehensive literature search of relevant databases was conducted, and 20 studies were identified and critically reviewed by the authors. Results We identified 3 types of wearable devices: tactile, head-mounted, and smartwatch displays. In most cases, these devices were intended for use by anesthesiologists, but nurses and surgeons were also identified as potentially important users of wearable technology in critical care medicine. Although the studies investigating tactile displays revealed their potential to improve clinical monitoring, usability problems related to comfort need to be overcome before they can be considered suitable for use in clinical practice. Only a few studies investigated the usability and human factors of tactile displays by conducting user testing involving critical care professionals. The studies of head-mounted displays (HMDs) revealed that these devices could be useful in critical care medicine, particularly from an ergonomics point of view. By reducing the amount of time the user spends averting their gaze from the patient to a separate screen, HMDs enable clinicians to improve their patient focus and reduce the potential of repetitive strain injury. Conclusions Researchers and designers of new wearable devices for use in critical care medicine should strive to achieve not only enhanced performance but also enhanced user experience for their users, especially in terms of comfort and ease of use. These aspects of wearable displays must be extensively tested with the intended end users in a setting that properly reflects the intended context of use before their adoption can be considered in clinical settings.
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Affiliation(s)
- Evismar Andrade
- Electrical & Electronic Engineering, School of Engineering, National University of Ireland, Galway, Galway, Ireland.,Human Movement Laboratory, CÚRAM Centre for Research in Medical Devices, National University of Ireland, Galway, Galway, Ireland
| | - Leo Quinlan
- Human Movement Laboratory, CÚRAM Centre for Research in Medical Devices, National University of Ireland, Galway, Galway, Ireland.,Physiology, School of Medicine, National University of Ireland, Galway, Galway, Ireland
| | - Richard Harte
- Electrical & Electronic Engineering, School of Engineering, National University of Ireland, Galway, Galway, Ireland.,Human Movement Laboratory, CÚRAM Centre for Research in Medical Devices, National University of Ireland, Galway, Galway, Ireland
| | - Dara Byrne
- General Practice, School of Medicine, NUI Galway, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation (ICAPSS), University Hospital Galway, Galway, Ireland
| | - Enda Fallon
- Mechanical Engineering, School of Engineering, NUI Galway, Galway, Ireland
| | - Martina Kelly
- Mechanical Engineering, School of Engineering, NUI Galway, Galway, Ireland
| | - Siobhan Casey
- Intensive Care Unit, University Hospital Galway, Galway, Ireland
| | - Frank Kirrane
- Medical Physics and Clinical Engineering, University Hospital Galway, Galway, Ireland
| | - Paul O'Connor
- General Practice, School of Medicine, NUI Galway, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation (ICAPSS), University Hospital Galway, Galway, Ireland
| | - Denis O'Hora
- School of Psychology, NUI Galway, Galway, Ireland
| | - Michael Scully
- Anaesthesia, School of Medicine, NUI Galway, Galway, Ireland.,Department of Anaesthesia & Intensive Care Medicine, Galway, Ireland
| | - John Laffey
- Anaesthesia, School of Medicine, NUI Galway, Galway, Ireland.,Department of Anaesthesia & Intensive Care Medicine, Galway, Ireland
| | - Patrick Pladys
- Centre Hospitalier Universitaire de Rennes (CHU Rennes), Rennes, France.,Faculté de Médicine de l'Université de Rennes, Rennes, France
| | - Alain Beuchée
- Centre Hospitalier Universitaire de Rennes (CHU Rennes), Rennes, France.,Faculté de Médicine de l'Université de Rennes, Rennes, France
| | - Gearoid ÓLaighin
- Electrical & Electronic Engineering, School of Engineering, National University of Ireland, Galway, Galway, Ireland.,Human Movement Laboratory, CÚRAM Centre for Research in Medical Devices, National University of Ireland, Galway, Galway, Ireland
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Lee SJ, Lee YM, Seo EJ, Son YJ. Impact of Hospital Nurses' Perception on Clinical Alarms and Patient Safety Culture on Alarm Management Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4018. [PMID: 33921203 PMCID: PMC8069512 DOI: 10.3390/ijerph18084018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/17/2021] [Accepted: 04/09/2021] [Indexed: 01/02/2023]
Abstract
This study aimed to identify the impact of nurses' perception of clinical alarms and patient safety culture on alarm management. Additionally, we aimed to describe the importance of clinical alarm issues. The data were collected from 21 August to 10 September 2020. The study participants were 116 nurses working in a tertiary acute care hospital in Korea. The self-report questionnaire included general characteristics, clinical alarm issues, nurses' alarm perception, patient safety culture, and alarm management practice. The mean age of nurses was 28.04 ± 4.06 years, with 5.71 ± 4.35 years of total clinical experience. For the importance of alarm issues, frequent false alarms leading to reduced attention or response was the most important issue. Hierarchical linear regression analysis revealed that a higher level of nurses' perceived patient safety culture was the strongest predictor of better alarm management practice (p < 0.001), followed by their perception of clinical alarms (p = 0.034). In addition, female nurses (p = 0.004), charge nurses (p = 0.013), and nurses who work less than 40 h per week (p = 0.008) were more likely to work better in alarm management practice. Future studies are needed to develop standardized alarm management guidelines by improving nurses' positive perceptions of clinical alarms and patient safety culture.
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Affiliation(s)
- Soo-Joung Lee
- Division of Nursing, Inje University Haeundae Paik-Hospital, Busan 48108, Korea;
| | - Yun-Mi Lee
- Institute of Health Science, College of Nursing, Inje University, Busan 47392, Korea;
| | - Eun Ji Seo
- Research Institute of Nursing Science, College of Nursing, Ajou University, Suwon 16499, Korea;
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea
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Mumaw RJ, Roth EM, Patterson ES. Lessons from the Glass Cockpit: Innovation in Alarm Systems to Support Cognitive Work. Biomed Instrum Technol 2021; 55:29-40. [PMID: 33662139 DOI: 10.2345/0899-8205-55.1.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Nurses working in the hospital setting increasingly have become overburdened by managing alarms that, in many cases, provide low information value regarding patient health. The current trend, aided by disposable, wearable technologies, is to promote patient monitoring that does not require entering a patient's room. The development of telemetry alarms and middleware escalation devices adds to the continued growth of auditory, visual, and haptic alarms to the hospital environment but can fail to provide a more complete understanding of patient health. As we begin to innovate to both address alarm overload and improve patient management, perhaps using fundamentally different integration architectures, lessons from the aviation flight deck are worth considering. Commercial jet transport systems and their alarms have evolved slowly over many decades and have developed integration methods that account for operational context, provide multiple response protocol levels, and present a more integrated view of the airplane system state. We articulate three alarm system objectives: (1) supporting hazard management, (2) establishing context, and (3) supporting alarm prioritization. More generally, we present the case that alarm design in aviation can spur directions for innovation for telemetry monitoring systems in hospitals.
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Wright MC, Radcliffe S, Janzen S, Edworthy J, Reese T, Segall N. Organizing Audible Alarm Sounds in the Hospital: A Card-Sorting Study. IEEE TRANSACTIONS ON HUMAN-MACHINE SYSTEMS 2020; 50:623-627. [PMID: 33777543 PMCID: PMC7996481 DOI: 10.1109/thms.2020.3019363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In hospitals, clinicians are presented with varied and disorganized alarm sounds from disparate devices. While there has been attention to reducing inactionable alarms to address alarm overload, little effort has focused on organizing, simplifying, or improving the informativeness of alarms. We sought to elicit nurses' tacit interpretation of alarm events to create an organizational structure to inform the design of advanced alarm sounds or integrated alert systems. We used open card sorting to evaluate nurses' perception of the relatedness of different alarm events. Seventy hospital nurses sorted 89 alarm events into groups they believed could or should be indicated by the same sound. We conducted factor analysis on a similarity matrix of frequency of alarm event pairings to interpret how strongly alarm events loaded on different alarm groups (factors). We interpreted participants' grouping rationale from their group labels and comments. Urgency of response was the most common grouping rationale. Participants also grouped: 1) monitoring-related events, 2) device-related events, and 3) events related to calls and patients. Our findings support standardization and integration of alarm sounds across devices toward a simpler and more informative hospital alarm environment.
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Affiliation(s)
| | | | - Suzanne Janzen
- Saint Alphonsus Regional Medical Center, Boise, ID 83706 USA
| | - Judy Edworthy
- University of Plymouth, Plymouth UK. Dr. Edworthy provides consulting to Masimo
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Pascale MT, Sanderson P, Liu D, Mohamed I, Brecknell B, Loeb RG. The Impact of Head-Worn Displays on Strategic Alarm Management and Situation Awareness. HUMAN FACTORS 2019; 61:537-563. [PMID: 30608190 DOI: 10.1177/0018720818814969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate whether head-worn displays (HWDs) help mobile participants make better alarm management decisions and achieve better situation awareness than alarms alone. BACKGROUND Patient alarms occur frequently in hospitals but often do not require clinical intervention. Clinicians may become desensitized to alarms and fail to respond to clinically relevant alarms. HWDs could make patient information continuously accessible, support situation awareness, and help clinicians prioritize alarms. METHOD Experiment 1 ( n = 76) tested whether nonclinicians monitoring simulated patients benefited from vital sign information continuously displayed on an HWD while they performed a secondary calculation task. Experiment 2 ( n = 13) tested, across three separate experimental sessions, how effectively nursing trainees monitored simulated patients' vital signs under three different display conditions while they assessed a simulated patient. RESULTS In Experiment 1, participants who had access to continuous patient information on an HWD responded to clinically important alarms 25.9% faster and were 6.7 times less likely to miss alarms compared to participants who only heard alarms. In Experiment 2, participants using an HWD answered situation awareness questions 18.9% more accurately overall than when they used alarms only. However, the effect was significant in only two of the three experimental sessions. CONCLUSION HWDs may help users maintain continuous awareness of multiple remote processes without affecting their performance on ongoing tasks. APPLICATION The outcomes may apply to contexts where access to continuous streams of information from remote locations is useful, such as patient monitoring or clinical supervision.
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Schlosser PD, Grundgeiger T, Sanderson PM, Happel O. An exploratory clinical evaluation of a head-worn display based multiple-patient monitoring application: impact on supervising anesthesiologists' situation awareness. J Clin Monit Comput 2019; 33:1119-1127. [PMID: 30721389 DOI: 10.1007/s10877-019-00265-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/23/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Supervising anesthesiologists overseeing several operating rooms must be aware of the status of multiple patients, so they can consult with the anesthetist in single operating rooms or respond quickly to critical events. However, maintaining good situation awareness can be challenging when away from patient bedsides or a central monitoring station. In this proof-of-concept study, we evaluated the potential of a head-worn display that showed multiple patients' vital signs and alarms to improve supervising anesthesiologists' situation awareness. METHODS Eight supervising anesthesiologists each monitored the vital signs of patients in six operating rooms for 3 h with the head-worn display, and for another 3 h without the head-worn display. In interviews with each anesthesiologist, we assessed in which situations the head-worn display was used and whether the continuous availability of the vital signs improved situation awareness. We also measured situation awareness quantitatively from six of the eight anesthesiologists, by instructing them to press a button whenever they noticed a patient alarm. RESULTS The median number of patient alarms occurring was similar when the anesthesiologists monitored with the head-worn display (42.0) and without the head-worn display (40.5). However, the anesthesiologists noticed significantly more patient alarms with the head-worn display (66.7%) than without (7.1%), P = 0.028, and they reported improved situation awareness with the head-worn display. The head-worn display helped the anesthesiologists to perceive and comprehend patients' current status and to anticipate future developments. A negative effect of the head-worn display was its tendency to distract during demanding procedures. CONCLUSIONS Head-worn displays can improve supervising anesthesiologists' situation awareness in multiple-patient monitoring situations. The anesthesiologists who participated in the study expressed enthusiasm about monitoring patients with a head-worn display and wished to use and evaluate it further.
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Affiliation(s)
- Paul D Schlosser
- Institute Human-Computer-Media, Julius-Maximilians-Universität Würzburg, Oswald-Külpe-Weg 82, 97074, Würzburg, Germany.
| | - Tobias Grundgeiger
- Institute Human-Computer-Media, Julius-Maximilians-Universität Würzburg, Oswald-Külpe-Weg 82, 97074, Würzburg, Germany
| | - Penelope M Sanderson
- Schools of Psychology, ITEE, and Clinical Medicine, The University of Queensland, St. Lucia, QLD, 4072, Australia
| | - Oliver Happel
- Department of Anesthesia and Critical Care, University Hospital of Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
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Poole S, Shah N. Incorporating Observed Physiological Data to Personalize Pediatric Vital Sign Alarm Thresholds. BIOMEDICAL INFORMATICS INSIGHTS 2019; 11:1178222618818478. [PMID: 30675101 PMCID: PMC6330722 DOI: 10.1177/1178222618818478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 10/16/2018] [Indexed: 11/16/2022]
Abstract
Bedside monitors are intended as a safety net in patient care, but their management in the inpatient setting is a significant patient safety concern. The low precision of vital sign alarm systems leads to clinical staff becoming desensitized to the sound of the alarm, a phenomenon known as alarm fatigue. Alarm fatigue has been shown to increase response time to alarms or result in alarms being ignored altogether and has negative consequences for patient safety. We present methods to establish personalized thresholds for heart rate and respiratory rate alarms. These thresholds are first chosen based on patient characteristics available at the time of admission and are then adapted to incorporate vital signs observed in the first 2 hours of monitoring. We demonstrate that the adapted thresholds are similar to those chosen by clinicians for individual patients and would result in fewer alarms than the currently used age-based thresholds. Personalized vital sign alarm thresholds can help to alleviate the problem of alarm fatigue in an inpatient setting while ensuring that all critical vital signs are detected.
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Affiliation(s)
- Sarah Poole
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, CA, USA
| | - Nigam Shah
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, CA, USA
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