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Wen MH, Chen PY, Lin S, Lien CW, Tu SH, Chueh CY, Wu YF, Tan Cheng Kian K, Hsu YL, Bai D. Enhancing Patient Safety Through an Integrated Internet of Things Patient Care System: Large Quasi-Experimental Study on Fall Prevention. J Med Internet Res 2024; 26:e58380. [PMID: 39361417 DOI: 10.2196/58380] [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: 03/14/2024] [Revised: 04/17/2024] [Accepted: 08/23/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND The challenge of preventing in-patient falls remains one of the most critical concerns in health care. OBJECTIVE This study aims to investigate the effect of an integrated Internet of Things (IoT) smart patient care system on fall prevention. METHODS A quasi-experimental study design is used. The smart patient care system is an integrated IoT system combining a motion-sensing mattress for bed-exit detection, specifying different types of patient calls, integrating a health care staff scheduling system, and allowing health care staff to receive and respond to alarms via mobile devices. Unadjusted and adjusted logistic regression models were used to investigate the relationship between the use of the IoT system and bedside falls compared with a traditional patient care system. RESULTS In total, 1300 patients were recruited from a medical center in Taiwan. The IoT patient care system detected an average of 13.5 potential falls per day without any false alarms, whereas the traditional system issued about 11 bed-exit alarms daily, with approximately 4 being false, effectively identifying 7 potential falls. The bedside fall incidence during hospitalization was 1.2% (n=8) in the traditional patient care system ward and 0.1% (n=1) in the smart ward. We found that the likelihood of bedside falls in wards with the IoT system was reduced by 88% (odds ratio 0.12, 95% CI 0.01-0.97; P=.047). CONCLUSIONS The integrated IoT smart patient care system might prevent falls by assisting health care staff with efficient and resilient responses to bed-exit detection. Future product development and research are recommended to introduce IoT into patient care systems combining bed-exit alerts to prevent inpatient falls and address challenges in patient safety.
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Affiliation(s)
- Ming-Huan Wen
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Yin Chen
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shirling Lin
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Wen Lien
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sheng-Hsiang Tu
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Yi Chueh
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Fang Wu
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kelvin Tan Cheng Kian
- S R Nathan School of Human Development, Singapore University of Social Sciences, Singapore, Singapore
| | - Yeh-Liang Hsu
- Gerontechnology Research Center, Yuan Ze University, Taoyuan, Taiwan
| | - Dorothy Bai
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
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2
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Conway A, Goudarzi Rad M, Chang K, Parotto M, Mafeld S. Integrated pulmonary index during procedural sedation and analgesia: A cluster-randomized trial. J Adv Nurs 2024. [PMID: 38924169 DOI: 10.1111/jan.16286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/05/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
AIM To evaluate the effectiveness of utilizing the integrated pulmonary index for capnography implementation during sedation administered by nurses. DESIGN Cluster-randomized trial. METHODS Participants were enrolled from the interventional radiology department at an academic hospital in Canada. Nurses were randomized to either enable or disable the Integrated Pulmonary Index feature of the capnography monitor. Procedures were observed by a research assistant to collect information about alarm performance characteristics. The primary outcome was the number of seconds in an alert condition state without an intervention being applied. RESULTS The number of seconds in an alarm state without intervention was higher in the group that enabled the integrated pulmonary index compared to the group that disabled this feature, but this difference did not reach statistical significance. Likewise, the difference between groups for the total alarm duration, total number of alarms and the total number of appropriate alarms was not statistically significant. The number of inappropriate alarms was higher in the group that enabled the Integrated Pulmonary Index, but this estimate was highly imprecise. There was no difference in the odds of an adverse event (measured by the Tracking and Reporting Outcomes of Procedural Sedation tool) occurring between groups. Desaturation events were uncommon and brief in both groups but the area under the SpO2 90% desaturation curve scores were lower for the group that enabled the integrated pulmonary index. CONCLUSION Enabling the integrated pulmonary index during nurse-administered procedural sedation did not reduce nurses' response times to alarms. Therefore, integrating multiple physiological parameters related to respiratory assessment into a single index did not lower the threshold for intervention by nurses. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The time it takes to respond to capnography monitor alarms will not be reduced if the integrated pulmonary Iindex feature of capnography monitors is enabled during nurse-administered procedural sedation. IMPACT Results do not support the routine enabling of the integrated pulmonary index when nurses use capnography to monitor patients during procedural sedation as a strategy to reduce the time it takes to initiate responses to alarms. REPORTING METHOD CONSORT. PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution. TRIAL REGISTRATION This study was prospectively registered at ClinicalTrials.gov (ID: NCT05068700).
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Affiliation(s)
- Aaron Conway
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Mohammad Goudarzi Rad
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Kristina Chang
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Matteo Parotto
- Department of Anesthesiology and Pain Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
| | - Sebastian Mafeld
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
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3
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Ruppel H, Makeneni S, Rasooly IR, Ferro DF, Bonafide CP. Pediatric Characteristics Associated With Higher Rates of Monitor Alarms. Biomed Instrum Technol 2024; 57:171-179. [PMID: 38170941 PMCID: PMC10764059 DOI: 10.2345/0899-8205-57.4.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background: Continuous physiologic monitoring commonly is used in pediatric medical-surgical (med-surg) units and is associated with high alarm burden for clinicians. Characteristics of pediatric patients generating high rates of alarms on med-surg units are not known. Objective: To describe the demographic and clinical characteristics of pediatric med-surg patients associated with high rates of clinical alarms. Methods: We conducted a cross-sectional, single-site, retrospective study using existing clinical and alarm data from a children's hospital. Continuously monitored patients from med-surg units who had available alarm data were included. Negative binomial regression models were used to test the association between patient characteristics and the rate of clinical alarms per continuously monitored hour. Results: Our final sample consisted of 1,569 patients with a total of 38,501 continuously monitored hours generating 265,432 clinical alarms. Peripheral oxygen saturation (SpO2) low alarms accounted for 57.5% of alarms. Patients with medical complexity averaged 11% fewer alarms per hour than those without medical complexity (P < 0.01). Patients older than 5 years had up to 30% fewer alarms per hour than those who were younger than 5 years (P < 0.01). Patients using supplemental oxygen averaged 39% more alarms per hour compared with patients who had no supplemental oxygen use (P < 0.01). Patients at high risk for deterioration averaged 19% more alarms per hour than patients who were not high risk (P = 0.01). Conclusion: SpO2 alarms were the most common type of alarm in this study. The results highlight patient populations in pediatric medical-surgical units that may be high yield for interventions to reduce alarms. Most physiologic monitor alarms in pediatric medical-surgical (med-surg) units are not informative and likely could be safely eliminated to reduce noise and alarm fatigue.1-3 However, identifying and sustaining successful alarm-reduction strategies is a challenge. Research shows that 25% of patients in pediatric med-surg units produce almost three-quarters of all alarms.4 These patients are a potential high-yield target for alarm-reduction strategies; however, we are not aware of studies describing characteristics of pediatric patients generating high rates of alarms. The patient populations seen on pediatric med-surg units are diverse. Children of all ages are cared for on these units, with diagnoses ranging from acute respiratory infections, to management of chronic conditions, and to psychiatric conditions. Not all patients on pediatric med-surg units have physiologic parameters continuously monitored,4 but among those who do, understanding patient characteristics associated with high rates of alarms may help clinicians, healthcare technology management (HTM) professionals, and others working on alarm management strategies to develop targeted interventions. We conducted an exploratory retrospective study to describe patient characteristics associated with high rates of alarms in pediatric med-surg units.
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4
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Myatra SN, Jagiasi BG, Singh NP, Divatia JV. Role of artificial intelligence in haemodynamic monitoring. Indian J Anaesth 2024; 68:93-99. [PMID: 38406336 PMCID: PMC10893816 DOI: 10.4103/ija.ija_1260_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 12/28/2023] [Accepted: 01/08/2024] [Indexed: 02/27/2024] Open
Abstract
This narrative review explores the evolving role of artificial intelligence (AI) in haemodynamic monitoring, emphasising its potential to revolutionise patient care. The historical reliance on invasive procedures for haemodynamic assessments is contrasted with the emerging non-invasive AI-driven approaches that address limitations and risks associated with traditional methods. Developing the hypotension prediction index and introducing CircEWSTM and CircEWS-lite TM showcase AI's effectiveness in predicting and managing circulatory failure. The crucial aspects include the balance between AI and healthcare professionals, ethical considerations, and the need for regulatory frameworks. The use of AI in haemodynamic monitoring will keep growing with ongoing research, better technology, and teamwork. As we navigate these advancements, it is crucial to balance AI's power and healthcare professionals' essential role. Clinicians must continue to use their clinical acumen to ensure that patient outliers or system problems do not compromise the treatment of the condition and patient safety.
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Affiliation(s)
- Sheila N. Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bharat G. Jagiasi
- Director of Critical Care Department, Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai, Maharashtra, India
| | - Neeraj P. Singh
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jigeeshu V. Divatia
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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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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Ruppel H, Dougherty M, Bonafide CP, Lasater KB. Alarm burden and the nursing care environment: a 213-hospital cross-sectional study. BMJ Open Qual 2023; 12:e002342. [PMID: 37880160 PMCID: PMC10603400 DOI: 10.1136/bmjoq-2023-002342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/23/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND High rates of medical device alarms in hospitals are a well-documented threat to patient safety. Little is known about organisational features that may be associated with nurses' experience of alarm burden. AIMS To evaluate the association between nurse-reported alarm burden, appraisals of patient safety, quality of care and hospital characteristics. METHODS Secondary analysis of cross-sectional survey data from 3986 hospital-based direct-care registered nurses in 213 acute care hospitals in New York and Illinois, USA. We evaluated associations of alarm burden with appraisals of patient safety and quality of care and hospital characteristics (work environment, staffing adequacy, size, teaching status) using χ2 tests. RESULTS The majority of respondents reported feeling overwhelmed by alarms (83%), delaying their response to alarms because they were unable to step away from another patient/task (76%), and experiencing situations where a patient needed urgent attention but no one responded to an alarm (55%). Nurses on medical-surgical units reported these experiences at higher rates than nurses working in intensive care units (p<0.001). Alarm burden items were significantly associated with poorer nurse-reported patient safety, quality of care, staffing and work environment. Findings were most pronounced for situations where a patient needed urgent attention but no one responded to the alarm, which was frequently/occasionally experienced by 72% of those who rated their hospital's safety as poor versus 38% good, p<0.001; 80% who rated overall quality of care poor/fair versus 46% good/excellent, p<0.001 and 65% from poor work environments versus 42% from good work environments, p<0.001. CONCLUSION Most nurses reported feeling overwhelmed by medical device alarms, and our findings suggest that alarm burden may be more pronounced in hospitals with unfavourable working conditions and suboptimal quality and safety. Because this was a cross-sectional study, further research is needed to explore causal relationships and the role of modifiable systems factors in reducing alarm burden.
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Affiliation(s)
- Halley Ruppel
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Clinical Futures, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maura Dougherty
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Christopher P Bonafide
- Clinical Futures, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania, USA
- Section of Hospital Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karen B Lasater
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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7
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Albanowski K, Burdick KJ, Bonafide CP, Kleinpell R, Schlesinger JJ. Ten Years Later, Alarm Fatigue Is Still a Safety Concern. AACN Adv Crit Care 2023; 34:189-197. [PMID: 37644627 DOI: 10.4037/aacnacc2023662] [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] [Indexed: 08/31/2023]
Abstract
Ten years after the publication of a landmark article in AACN Advanced Critical Care, alarm fatigue continues to be an issue that researchers, clinicians, and organizations aim to remediate. Alarm fatigue contributes to missed alarms and medical errors that result in patient death, increased clinical workload and burnout, and interference with patient recovery. Led by the American Association of Critical-Care Nurses, national patient safety organizations continue to prioritize efforts to battle alarm fatigue and have proposed alarm management strategies to mitigate the effects of alarm fatigue. Similarly, clinical efforts now use simulation studies, individualized alarm thresholds, and interdisciplinary teams to optimize alarm use. Finally, engineering research efforts have innovated the standard alarm to convey information more effectively for medical users. By focusing on patient and provider safety, clinical workflow, and alarm technology, efforts to reduce alarm fatigue over the past 10 years have been grounded in an evidence-based and personnel-focused approach.
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Affiliation(s)
- Kimberly Albanowski
- Kimberly Albanowski is Clinical Research Coordinator II, Section of Hospital Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kendall J Burdick
- Kendall J. Burdick is Pediatric Resident, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02215
| | - Christopher P Bonafide
- Christopher P. Bonafide is Academic Pediatric Hospitalist, Section of Hospital Medicine, Department of Pediatrics, Children's Hospital of Philadelphia; Director of Pediatric Implementation Research, Penn Implementation Science Center at the Leonard Davis Institute for Health Economics (PISCE@LDI); and Associate Professor, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ruth Kleinpell
- Ruth Kleinpell is Associate Dean for Clinical Scholarship, Independence Foundation Chair in Nursing Education, and Professor, Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Joseph J Schlesinger
- Joseph J. Schlesinger is Associate Professor, Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, and Adjunct Professor of Electrical and Computer Engineering, McGill University, Montreal, Quebec, Canada
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8
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Hardy M, Dallaire C, Bouchlaghem MA, Hajji I. The impact of the use of continuous pulse oximetry monitoring to monitor patients at high risk of respiratory depression on nursing practice. Nurs Open 2023; 10:6136-6142. [PMID: 37208961 PMCID: PMC10416034 DOI: 10.1002/nop2.1835] [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: 08/31/2022] [Revised: 02/07/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023] Open
Abstract
AIM To describe the impact on nursing practice of using continuous pulse oximetry monitoring to monitor patients at high risk for respiratory depression after surgery. DESIGN A convergent mixed method design. METHODS Thirty (30) hours of non-participant structured observation and explanatory interviews were conducted with 10 nurses from the surgery care unit and intensive care unit. RESULTS We found that nursing practice to evaluate and monitor at-risk patients through continuous pulse oximetry monitoring is mainly linked to technical care. Nurses generally meet the frequency of bedside monitoring required by established protocols. During the structured non-participant observation periods, it was observed that 90% of the alarms were false (unsustained desaturations). This was confirmed by the nurses during the explanatory interviews. Noisy environments, high number of false alarms, poor communication between nurses and various operational failures might have a negative impact on nursing practice. CONCLUSION Several challenges must be overcome for this technology to achieve the desired outcomes of continuous surveillance and rapid detection of respiratory depression episodes for post-surgical patients. No Patient or Public Contribution.
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Affiliation(s)
| | | | | | - Issam Hajji
- Faculty of Nursing ScienceUniversité LavalQuébec CityQuébecCanada
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9
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Winters BD, Sarwal A. Pulse Oximetry Con: Stop Living in the Cave. Crit Care Med 2023; 51:1249-1254. [PMID: 37042669 DOI: 10.1097/ccm.0000000000005892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- Bradford D Winters
- Critical Care Medicine, Surgical Intensive Care Units and Burn ICU, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aarti Sarwal
- Wake Forest University School of Medicine, Winston Salem, NC
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Wunderlich MM, Amende-Wolf S, Krampe H, Kruppa J, Spies C, Weiß B, Memmert B, Balzer F, Poncette AS. A brief questionnaire for measuring alarm fatigue in nurses and physicians in intensive care units. Sci Rep 2023; 13:13860. [PMID: 37620385 PMCID: PMC10449802 DOI: 10.1038/s41598-023-40290-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
When exposed to hundreds of medical device alarms per day, intensive care unit (ICU) staff can develop "alarm fatigue" (i.e., desensitisation to alarms). However, no standardised way of quantifying alarm fatigue exists. We aimed to develop a brief questionnaire for measuring alarm fatigue in nurses and physicians. After developing a list of initial items based on a literature review, we conducted 15 cognitive interviews with the target group (13 nurses and two physicians) to ensure that the items are face valid and comprehensible. We then asked 32 experts on alarm fatigue to judge whether the items are suited for measuring alarm fatigue. The resulting 27 items were sent to nurses and physicians from 15 ICUs of a large German hospital. We used exploratory factor analysis to further reduce the number of items and to identify scales. A total of 585 submissions from 707 participants could be analysed (of which 14% were physicians and 64% were nurses). The simple structure of a two-factor model was achieved within three rounds. The final questionnaire (called Charité Alarm Fatigue Questionnaire; CAFQa) consists of nine items along two scales (i.e., the "alarm stress scale" and the "alarm coping scale"). The CAFQa is a brief questionnaire that allows clinical alarm researchers to quantify the alarm fatigue of nurses and physicians. It should not take more than five minutes to administer.
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Affiliation(s)
- Maximilian Markus Wunderlich
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sandro Amende-Wolf
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henning Krampe
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jochen Kruppa
- Hochschule Osnabrück, University of Applied Sciences, Osnabrück, Germany
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Björn Weiß
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Belinda Memmert
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Akira-Sebastian Poncette
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
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Balzer F, Agha-Mir-Salim L, Ziemert N, Schmieding M, Mosch L, Prendke M, Wunderlich MM, Memmert B, Spies C, Poncette AS. Staff perspectives on the influence of patient characteristics on alarm management in the intensive care unit: a cross-sectional survey study. BMC Health Serv Res 2023; 23:729. [PMID: 37407989 DOI: 10.1186/s12913-023-09688-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 06/12/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND High rates of clinical alarms in the intensive care unit can result in alarm fatigue among staff. Individualization of alarm thresholds is regarded as one measure to reduce non-actionable alarms. The aim of this study was to investigate staff's perceptions of alarm threshold individualization according to patient characteristics and disease status. METHODS This is a cross-sectional survey study (February-July 2020). Intensive care nurses and physicians were sampled by convenience. Data was collected using an online questionnaire. RESULTS Staff view the individualization of alarm thresholds in the monitoring of vital signs as important. The extent to which alarm thresholds are adapted from the normal range varies depending on the vital sign monitored, the reason for clinical deterioration, and the professional group asked. Vital signs used for hemodynamic monitoring (heart rate and blood pressure) were most subject to alarm individualizations. Staff are ambivalent regarding the integration of novel technological features into alarm management. CONCLUSIONS All relevant stakeholders, including clinicians, hospital management, and industry, must collaborate to establish a "standard for individualization," moving away from ad hoc alarm management to an intelligent, data-driven alarm management. Making alarms meaningful and trustworthy again has the potential to mitigate alarm fatigue - a major cause of stress in clinical staff and considerable hazard to patient safety. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov (NCT03514173) on 02/05/2018.
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Affiliation(s)
- Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Louis Agha-Mir-Salim
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nicole Ziemert
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Malte Schmieding
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lina Mosch
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mona Prendke
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maximilian Markus Wunderlich
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Belinda Memmert
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Akira-Sebastian Poncette
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
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Ruppel H, Pohl E, Rodriguez-Paras C, Froh E, Perry K, McNamara M, Muthu N, Ferro D, Rasooly I, Bonafide CP. Clinician Perspectives on Specifications for Metrics to Inform Pediatric Alarm Management. Biomed Instrum Technol 2023; 57:18-25. [PMID: 37084247 PMCID: PMC10512991 DOI: 10.2345/0899-8205-57.1.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Background: Ongoing management of monitor alarms is important for reducing alarm fatigue among clinicians (e.g., nurses, physicians). Strategies to enhance clinician engagement in active alarm management in pediatric acute care have not been well explored. Access to alarm summary metrics may enhance clinician engagement. Objective: To lay the foundation for intervention development, we sought to identify functional specifications for formulating, packaging, and delivering alarm metrics to clinicians. Methods: Our team of clinician scientists and human factors engineers conducted focus groups with clinicians from medical-surgical inpatient units in a children's hospital. We inductively coded transcripts, developed codes into themes, and grouped themes into "current state" and "future state." Results: We conducted five focus groups with 13 clinicians (eight registered nurses and five doctors of medicine). In the current state, information exchanged among team members about alarm burden is initiated by nurses on an ad hoc basis. For a future state, clinicians identified ways in which alarm metrics could help them manage alarms and described specific information, such as alarm trends, benchmarks, and contextual data, that would support decision-making. Conclusion: We developed four recommendations for future strategies to enhance clinicians' active management of patient alarms: (1) formulate alarm metrics for clinicians by categorizing alarm rates by type and summarizing alarm trends over time, (2) package alarm metrics with contextual patient data to facilitate clinicians' sensemaking, (3) deliver alarm metrics in a forum that facilitates interprofessional discussion, and (4) provide clinician education to establish a shared mental model about alarm fatigue and evidence-based alarm-reduction strategies.
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13
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Zahradka N, Geoghan S, Watson H, Goldberg E, Wolfberg A, Wilkes M. Assessment of Remote Vital Sign Monitoring and Alarms in a Real-World Healthcare at Home Dataset. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 10:bioengineering10010037. [PMID: 36671610 PMCID: PMC9854741 DOI: 10.3390/bioengineering10010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/10/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
The importance of vital sign monitoring to detect deterioration increases during healthcare at home. Continuous monitoring with wearables increases assessment frequency but may create information overload for clinicians. The goal of this work was to demonstrate the impact of vital sign observation frequency and alarm settings on alarms in a real-world dataset. Vital signs were collected from 76 patients admitted to healthcare at home programs using the Current Health (CH) platform; its wearable continuously measured respiratory rate (RR), pulse rate (PR), and oxygen saturation (SpO2). Total alarms, alarm rate, patient rate, and detection time were calculated for three alarm rulesets to detect changes in SpO2, PR, and RR under four vital sign observation frequencies and four window sizes for the alarm algorithms' median filter. Total alarms ranged from 65 to 3113. The alarm rate and early detection increased with the observation frequency for all alarm rulesets. Median filter windows reduced alarms triggered by normal fluctuations in vital signs without compromising the granularity of time between assessments. Frequent assessments enabled with continuous monitoring support early intervention but need to pair with settings that balance sensitivity, specificity, clinical risk, and provider capacity to respond when a patient is home to minimize clinician burden.
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14
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Bawua LK, Miaskowski C, Suba S, Badilini F, Rodway GW, Hu X, Pelter MM. Thoracic Impedance Pneumography-Derived Respiratory Alarms and Associated Patient Characteristics. Am J Crit Care 2022; 31:355-365. [PMID: 36045046 DOI: 10.4037/ajcc2022295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Respiratory rate (RR) alarms alert clinicians to a change in a patient's condition. However, RR alarms are common occurrences. To date, no study has examined RR alarm types and associated patient characteristics, which could guide alarm management strategies. OBJECTIVES To characterize RR alarms by type, frequency, duration, and associated patient demographic and clinical characteristics. METHODS A secondary data analysis of alarms generated with impedance pneumography in 461 adult patients admitted to either a cardiac, a medical/surgical, or a neurological intensive care unit (ICU). The RR alarms included high parameter limit (≥30 breaths/min), low parameter limit (≤5 breaths/min), and apnea (no breathing ≥20 s). The ICU type; total time monitored; and alarm type, frequency, and duration were evaluated. RESULTS Of 159 771 RR alarms, parameter limit alarms (n = 140 975; 88.2%) were more frequent than apnea alarms (n = 18 796; 11.8%). High parameter limit alarms were most frequent (n = 131 827; 82.5%). After ICU monitoring time was controlled for, multivariate analysis showed that alarm rates were higher in patients in the cardiac and neurological ICUs (P = .001), patients undergoing mechanical ventilation (P = .005), and patients without a ventricular assist device or pacemaker (P = .02). Male sex was associated with low parameter limit (P = .01) and apnea (P = .005) alarms. CONCLUSION High parameter limit RR alarms were most frequent. Factors associated with RR alarms included monitoring time, ICU type, male sex, and mechanical ventilation. Although these factors are not modifiable, these data could be used to guide management strategies.
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Affiliation(s)
- Linda K Bawua
- Linda K. Bawua is a former PhD student, School of Nursing, University of California, San Francisco, California
| | - Christine Miaskowski
- Christine Miaskowski is a professor, School of Nursing, University of California, San Francisco, California
| | - Sukardi Suba
- Sukardi Suba is a postdoctoral associate, School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Fabio Badilini
- Fabio Badilini is director of the Center for Physiological Research, School of Nursing, University of California, San Francisco, California
| | - George W Rodway
- George W. Rodway is an assistant professor, School of Medicine, University of Nevada, Reno, Nevada
| | - Xiao Hu
- Xiao Hu is a professor, School of Nursing, Duke University, Durham, North Carolina
| | - Michele M Pelter
- Michele M. Pelter is an associate professor, School of Nursing, University of California, San Francisco, California
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15
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Joshi M, Ashrafian H, Arora S, Sharabiani M, McAndrew K, Khan SN, Cooke GS, Darzi A. A pilot study to investigate real-time digital alerting from wearable sensors in surgical patients. Pilot Feasibility Stud 2022; 8:140. [PMID: 35794669 PMCID: PMC9258087 DOI: 10.1186/s40814-022-01084-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/01/2022] [Indexed: 11/28/2022] Open
Abstract
Background Continuous vital sign monitoring may identify changes sooner than current standard monitoring. Objective To investigate if the use of real-time digital alerts sent to healthcare staff can improve the time taken to identify unwell patients and those with sepsis. Design A prospective cohort study design. Setting West Middlesex University Hospital, UK. Participants Fifty acutely unwell surgical patients admitted to hospital. Intervention Patients wore a lightweight wearable sensor measuring heart rate (HR), respiratory rate (RR) and temperature every 2 min whilst standard intermittent ward monitoring of vital signs was performed by nurses. Digital alerts were sent to healthcare staff from the sensor to a smartphone device. All alerts were reviewed for recruited patients to identify the exact time on the sensor in which deterioration occurred. The time to acknowledgement was then reviewed for each action and an average time to acknowledgement calculated. Results There were 50 patients recruited in the pilot study, of which there were vital sign alerts in 18 patients (36%). The total number of vital sign alerts generated in these 18 patients was 51. Of these 51 alerts, there were 7 alerts for high HR (13.7%), 33 for RR (64.7%) and 11 for temperature (21.6%). Out of the 27 acknowledged alerts, there were 2 alerts for HR, 17 for RR and 8 for temperature. The average time to staff acknowledgement of the notification for all alerts was 154 min (2.6 h). There were some patients which had shown signs of deterioration in the cohort. The frequency of routine observation monitoring was increased in 2 cases, 3 patients were referred to a senior clinician and 2 patients were initiated on the sepsis pathway. Conclusion This study demonstrates the evaluation of digital alerts to nurses in real time. Although not all alerts were acknowledged, deterioration on the ward observations was detected and actions were taken accordingly. Patients were started on the sepsis pathway and escalation to senior clinicians occurred. Further research is required to review why only some alerts were acknowledged and the effects of digital alerting on patient outcomes. Trial registration ClinicalTrials.gov, NCT04638738
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16
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López‐Espuela F, Martin BR, García JL, Felipe RT, Donoso FJA, Almagro JJR, Ribeiro ASF, Fernandes VS, Moran‐García JM. Experiences and mediating factors in nurses’ responses to electronic device alarms. A phenomenological study. J Nurs Manag 2022; 30:1303-1316. [DOI: 10.1111/jonm.13614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/19/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Fidel López‐Espuela
- Nursing Department Nursing and Occupational Therapy College, University of Extremadura, Caceres Caceres Spain
| | - Beatriz Rodríguez Martin
- Nursing, Physiotherapy and Occupational Therapy Department, Faculty of Health Sciences University of Castilla la Mancha Talavera de la Reina Spain
| | - Jesús Lavado García
- Nursing Department Nursing and Occupational Therapy College, University of Extremadura, Caceres Caceres Spain
| | - Rosaura Toribio Felipe
- Nursing Department Nursing and Occupational Therapy College, University of Extremadura, Caceres Caceres Spain
| | | | - Julián Javier Rodríguez Almagro
- Nursing, Physiotherapy and Occupational Therapy Department, Faculty of Health Sciences University of Castilla la Mancha Talavera de la Reina Spain
| | - Ana S. F. Ribeiro
- Department of Health Sciences. San Juan de Dios School of Nursing and Physical Therapy Comillas Pontifical University Madrid Spain
| | - Vítor S. Fernandes
- Department of physiology, Faculty of Pharmacy Complutense University of Madrid Spain
| | - José María Moran‐García
- Nursing Department Nursing and Occupational Therapy College, University of Extremadura, Caceres Caceres Spain
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17
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Bawua LK, Miaskowski C, Suba S, Badilini F, Mortara D, Hu X, Rodway GW, Hoffmann TJ, Pelter MM. Agreement between respiratory rate measurement using a combined electrocardiographic derived method versus impedance from pneumography. J Electrocardiol 2021; 71:16-24. [PMID: 35007832 DOI: 10.1016/j.jelectrocard.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Impedance pneumography (IP) is the current device-driven method used to measure respiratory rate (RR) in hospitalized patients. However, RR alarms are common and contribute to alarm fatigue. While RR derived from electrocardiographic (ECG) waveforms hold promise, they have not been compared to the IP method. PURPOSE Study examined the agreement between the IP and combined-ECG derived (EDR) for normal RR (≥12 or ≤20 breaths/minute [bpm]); low RR (≤5 bpm); and high RR (≥30 bpm). METHODOLOGY One-hundred intensive care unit patients were included by RR group: (1) normal RR (n = 50; 25 low RR and 25 high RR); (2) low RR (n = 50); and (3) high RR (n = 50). Bland-Altman analysis was used to evaluate agreement. RESULTS For normal RR, a significant bias difference of -1.00 + 2.11 (95% CI -1.60 to -0.40) and 95% limit of agreement (LOA) of -5.13 to 3.13 was found. For low RR, a significant bias difference of -16.54 + 6.02 (95% CI: -18.25 to -14.83) and a 95% LOA of -28.33 to - 4.75 was found. For high RR, a significant bias difference of 17.94 + 12.01 (95% CI: 14.53 to 21.35) and 95% LOA of -5.60 to 41.48 was found. CONCLUSION Combined-EDR method had good agreement with the IP method for normal RR. However, for the low RR, combined-EDR was consistently higher than the IP method and almost always lower for the high RR, which could reduce the number of RR alarms. However, replication in a larger sample including confirmation with visual assessment is warranted.
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Affiliation(s)
- Linda K Bawua
- School of Nursing, University of California, San Francisco, CA, USA.
| | | | - Sukardi Suba
- School of Nursing, University of Rochester, NY, USA.
| | - Fabio Badilini
- School of Nursing, University of California, San Francisco, CA, USA.
| | - David Mortara
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Xiao Hu
- School of Nursing, Duke University Durham, NC, USA.
| | | | - Thomas J Hoffmann
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Michele M Pelter
- School of Nursing, University of California, San Francisco, CA, USA.
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18
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Deschamps MLFA, Sanderson P. Nurses' use of auditory alarms and alerts in high dependency units: A field study. APPLIED ERGONOMICS 2021; 96:103475. [PMID: 34107432 DOI: 10.1016/j.apergo.2021.103475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 04/09/2021] [Accepted: 05/23/2021] [Indexed: 06/12/2023]
Abstract
A fieldwork study conducted in six units of a major metropolitan Australian hospital revealed that nurses' attitudes towards alarms are influenced by each unit's physical layout and caseload. Additionally, nurses relied heavily on both non-actionable and actionable alarms to maintain their awareness of the status of their patients' wellbeing, and used auditory alarms beyond the scope of their intended design. Results suggest that before reducing or removing auditory alarms from the clinical environment to improve patient safety, it is important to understand how nurses in different clinical contexts use current alarm systems to extract meaningful information. Such an understanding could guide appropriate alarm reduction strategies and guide alternative design solutions to support nurses' situation awareness during monitoring.
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Affiliation(s)
| | - Penelope Sanderson
- School of Psychology, The University of Queensland, Brisbane, Queensland, 4072, Australia.
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19
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Guo X, Swenor BK, Smith K, Boland MV, Goldstein JE. Developing an Ophthalmology Clinical Decision Support System to Identify Patients for Low Vision Rehabilitation. Transl Vis Sci Technol 2021; 10:24. [PMID: 34003955 PMCID: PMC7991974 DOI: 10.1167/tvst.10.3.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to develop and evaluate an electronic health record (EHR) clinical decision support system to identify patients meeting criteria for low vision rehabilitation (LVR) referral. Methods In this quality improvement project, we applied a user-centered design approach to develop an interactive electronic alert for LVR referral within the Johns Hopkins Wilmer Eye Institute. We invited 15 ophthalmology physicians from 8 subspecialties to participate in the design and implementation, and to provide user experience feedback. The three project phases incorporated development evaluation, feedback analysis, and system refinement. We report on the final alert design, firing accuracy, and user experiences. Results The alert was designed as physician-centered and patient-specific. Alert firing relied on visual acuity and International Classification of Diseases (ICD)-10 diagnosis (hemianopia/quadrantanopia) criteria. The alert suppression considerations included age < 5 years, recent surgeries, prior LVR visit, and related alert actions. False positive rate (firing when alert should have been suppressed or when firing criteria not met) was 0.2%. The overall false negative rate (alert not firing when visual acuity or encounter diagnosis criteria met) was 5.6%. Of the 13 physicians who completed the survey, 8 agreed that the alert is easy to use, and 12 would consider ongoing usage. Conclusions This EHR-based clinical decision support system shows reliable firing metrics in identifying patients with vision impairment and promising acceptance by ophthalmologist users to facilitate care and LVR referral. Translational Relevance The use of real-time data offers an opportunity to translate ophthalmic guidelines and best practices into systematic action for clinical care and research purposes across subspecialties.
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Affiliation(s)
- Xinxing Guo
- Johns Hopkins Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bonnielin K Swenor
- Johns Hopkins Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kerry Smith
- Johns Hopkins Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael V Boland
- Johns Hopkins Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Judith E Goldstein
- Johns Hopkins Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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20
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Abstract
This integrative review presents the most recent and relevant critical care nursing research publications in the United States. A comprehensive search identified publications on the topics of delirium; early mobility; communication; palliative care; tele-intensive care unit; care bundle implementation; and prevention, detection, and early management of infection. The evidence is summarized for each of these topics, as well as other research, with suggestions and guidance for end users.
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Affiliation(s)
- Sheila A Alexander
- Acute and Tertiary Care, School of Nursing, Critical Care Medicine, School of Medicine, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA.
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21
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Kaur D, Panos RJ, Badawi O, Bapat SS, Wang L, Gupta A. Evaluation of clinician interaction with alerts to enhance performance of the tele-critical care medical environment. Int J Med Inform 2020; 139:104165. [PMID: 32402986 DOI: 10.1016/j.ijmedinf.2020.104165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Identify opportunities to improve the interaction between clinicians and Tele-Critical Care (Tele-CC) programs through an analysis of alert occurrence and reactivation in a specific Tele-CC application. MATERIALS AND METHODS Data were collected automatically through the Philips eCaremanager® software system used at multiple hospitals in the Avera health system. We evaluated the distribution of alerts per patient, frequency of alert types, time between consecutive alerts, and Tele-CC clinician choice of alert reactivation times. RESULTS Each patient generated an average of 79.8 alerts during their ICU stay (median 31.0; 25th - 75th percentile 10.0-89.0) with 46.4 for blood pressure and 38.4 for oxygenation. The most frequent alerts for continuous physiological parameters were: MAP limit (28.9 %), O2/RR (26.4 %), MAP trend (16.5 %), HR trend (12.1 %), and HR limit (11.3 %). The median time between consecutive alerts for one parameter was less than 10 min for 86 % of patients. Tele-CC providers responded to all alert types with immediate reactivation 47-88 % of the time. Limit alerts had longer reactivation times than their trend alert counterparts (p-value < .001). CONCLUSIONS The alert type specific differences in frequency, time occurrence and provider choice of reactivation time provide insight into how clinicians interact with the Tele-CC system. Systems engineering enhancements to Tele-CC software algorithms may reduce alert burden and thereby decrease clinicians' cognitive workload for alert assessment. Further study of Tele-CC alert generation, alert presentation to clinicians, and the clinicians' options to respond to these alerts may reduce provider workload, minimize alert desensitization, and optimize the ability of Tele-CC clinicians to provide efficient and timely critical care management.
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Affiliation(s)
- Dhamanpreet Kaur
- Massachusetts Institute of Technology, 32 Vassar Street, Cambridge, MA 02139, United States.
| | - Ralph J Panos
- Cincinnati VA Medical Center, 3100 Vine Street, Cincinnati, OH 45220, United States.
| | - Omar Badawi
- Philips, 217 E Redwood St, Baltimore, MD 21202, United States.
| | - Sanika S Bapat
- Wellesley College, 106 Central St, Wellesley, MA 02481, United States.
| | - Li Wang
- Massachusetts Institute of Technology, 32 Vassar Street, Cambridge, MA 02139, United States.
| | - Amar Gupta
- Massachusetts Institute of Technology, 32 Vassar Street, Cambridge, MA 02139, United States.
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22
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Dursun Ergezen F, Kol E. Nurses' responses to monitor alarms in an intensive care unit: An observational study. Intensive Crit Care Nurs 2020; 59:102845. [PMID: 32238311 DOI: 10.1016/j.iccn.2020.102845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 02/11/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The present study aimed to determine the types of monitor alarms and nurses' responses to them in an adult intensive care unit. DESIGN AND METHODS This was an observational descriptive research study conducted in the adult intensive care unit of a university hospital in the Mediterranean region of Turkey. The nonparticipant observation method was used. Data were collected by two observers using a semi-structured observation form developed according to literature. RESULTS Between August 2016 and January 2017, 13 registered nurses were observed for 328 hours. There were 1781 alarms, which included alarms for blood pressure (37.6%), respiration and oxygen saturation (35.3%) and heart rate and arrhythmia (27.1%). Nurses responded to approximately half (46.9%) of the alarms that required a response. Responses to alarms included silencing them, responding to the patient's clinical condition and solving contact and transmission problems. CONCLUSION In the present study, according to response requirement, the division of the alarms was different. The number of alarms that do not reflect the clinical status of the patient was high. It was found that as the false alarm rate increased, the response rate of nurses to these alarms decreased.
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Affiliation(s)
| | - Emine Kol
- Nursing Faculty, Akdeniz University, Antalya, Turkey
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23
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Hyland SL, Faltys M, Hüser M, Lyu X, Gumbsch T, Esteban C, Bock C, Horn M, Moor M, Rieck B, Zimmermann M, Bodenham D, Borgwardt K, Rätsch G, Merz TM. Early prediction of circulatory failure in the intensive care unit using machine learning. Nat Med 2020; 26:364-373. [DOI: 10.1038/s41591-020-0789-4] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 02/04/2020] [Indexed: 01/12/2023]
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24
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Pater CM, Sosa TK, Boyer J, Cable R, Egan M, Knilans TK, Schondelmeyer AC, Schuler CL, Madsen NL. Time series evaluation of improvement interventions to reduce alarm notifications in a paediatric hospital. BMJ Qual Saf 2020; 29:717-726. [PMID: 31959714 DOI: 10.1136/bmjqs-2019-010368] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/08/2019] [Accepted: 12/29/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND10: The Joint Commission identified inpatient alarm reduction as an opportunity to improve patient safety; enhance patient, family and nursing satisfaction; and optimise workflow. We used quality improvement (QI) methods to safely decrease non-actionable alarm notifications to bedside providers. METHODS In a paediatric tertiary care centre, we convened a multidisciplinary team to address alarm notifications in our acute care cardiology unit. Alarm notification was defined as any alert to bedside providers for each patient-triggered monitor alarm. Our aim was to decrease alarm notifications per monitored bed per day by 60%. Plan-Do-Study-Act testing cycles included updating notification technology, establishing alarm logic and modifying bedside workflow processes, including silencing the volume on all bedside monitors. Our secondary outcome measure was nursing satisfaction. Balancing safety measures included floor to intensive care unit transfers and patient acuity level. RESULTS At baseline, there was an average of 71 initial alarm notifications per monitored bed per day. Over a 3.5-year improvement period (2014-2017), the rate decreased by 68% to 22 initial alarm notifications per monitored bed per day. The proportion of initial to total alarm notifications remained stable, decreasing slightly from 51% to 40%. There was a significant improvement in subjective nursing satisfaction. At baseline, 32% of nurses agreed they were able to respond to alarms appropriately and quickly. Following interventions, agreement increased to 76% (p<0.001). We sustained these improvements over a year without a change in monitored balancing measures. CONCLUSION We successfully reduced alarm notifications while preserving patient safety over a 4-year period in a complex paediatric patient population using technological advances and QI methodology. Continued efforts are needed to further optimise monitor use across paediatric hospital units.
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Affiliation(s)
- Colleen M Pater
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Tina K Sosa
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jacquelyn Boyer
- Facilities Management, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rhonda Cable
- Strategic Projects, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Melinda Egan
- Information Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Timothy K Knilans
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Amanda C Schondelmeyer
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Hospital Medicine, James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christine L Schuler
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nicolas L Madsen
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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25
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Could "Big Brother" Be Joining the Early Mobilization Team? Crit Care Med 2019; 47:1274-1276. [PMID: 31415314 DOI: 10.1097/ccm.0000000000003886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ruppel H, Funk M, Whittemore R, Wung SF, Bonafide CP, Powell Kennedy H. Critical care nurses' clinical reasoning about physiologic monitor alarm customisation: An interpretive descriptive study. J Clin Nurs 2019; 28:3033-3041. [PMID: 30938915 DOI: 10.1111/jocn.14866] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/05/2019] [Accepted: 03/23/2019] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore clinical reasoning about alarm customisation among nurses in intensive care units. BACKGROUND Critical care nurses are responsible for detecting and rapidly acting upon changes in patients' clinical condition. Nurses use medical devices including bedside physiologic monitors to assist them in their practice. Customising alarm settings on these devices can help nurses better monitor their patients and reduce the number of clinically irrelevant alarms. As a result, customisation may also help address the problem of alarm fatigue. However, little is known about nurses' clinical reasoning with respect to customising physiologic monitor alarm settings. DESIGN This article is an in-depth report of the qualitative arm of a mixed methods study conducted using an interpretive descriptive methodological approach. METHODS Twenty-seven nurses were purposively sampled from three intensive care units in an academic medical centre. Semi-structured interviews were conducted by telephone and were analysed using thematic analysis. Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guidelines were used. RESULTS Four themes were identified from the interview data: unit alarm culture and context, nurse attributes, motivation to customise and customisation "know-how." A conceptual model demonstrating the relationship of these themes was developed to portray the factors that affect nurses' customisation of alarms. CONCLUSIONS In addition to drawing on clinical data, nurses customised physiologic monitor alarms based on their level of clinical expertise and comfort. Nurses were influenced by the alarm culture on their clinical unit and colleagues' and patients' responses to alarms, as well as their own technical understanding of the physiologic monitors. RELEVANCE TO CLINICAL PRACTICE The results of this study can be used to design strategies to support the application of clinical reasoning to alarm management, which may contribute to more appropriate alarm customisation practices and improvements in safety.
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Affiliation(s)
- Halley Ruppel
- School of Nursing, Yale University, West Haven, Connecticut
| | - Marjorie Funk
- School of Nursing, Yale University, West Haven, Connecticut
| | | | - Shu-Fen Wung
- College of Nursing, The University of Arizona, Tucson, Arizona
| | - Christopher P Bonafide
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
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