Types Of Alarms Research Articles

False Alarms and Overmonitoring: Major Factors in Alarm Fatigue Among Labor Nurses.

Nurses can be exposed to hundreds of alarms during their shift, contributing to alarm fatigue. The purposes were to explore similarities and differences in perceptions of clinical alarms by labor nurses caring for generally healthy women compared with perceptions of adult intensive care unit (ICU) and neonatal ICU nurses caring for critically ill patients and to seek nurses' suggestions for potential improvements. Nurses were asked via focus groups about the utility of clinical alarms from medical devices. There was consensus that false alarms and too many devices generating alarms contributed to alarm fatigue, and most alarms lacked clinical relevance. Nurses identified certain types of alarms that they responded to immediately, but the vast majority of the alarms did not contribute to their clinical assessment or planned nursing care. Monitoring only those patients who need it and only those physiologic values that are warranted, based on patient condition, may decrease alarm burden.

New concept of safeprocess based on a fault detection methodology: Super Alarms

Abstract Industrial plants, especially on mining, metal processing, energy and chemical/petrochemical processes require integrated management of all the events that may cause accidents and translate into alarms. Process alarm management can be formulated as an event-based pattern recognition problem in which temporal patterns are used to characterize different typical situations, particularly at startup and shutdown stages. In this paper, a new layer based on a diagnosis process is proposed over the typical layers of protection in industrial processes. Considering the alarms and the actions of the standard operating procedure as discrete events, the diagnosis step relies on situation recognition to provide the operators with relevant information about the failures inducing the alarm flow. The new concept of super alarms is based on a methodology with a diagnosis step that permits generate these types of superior alarms. For example, the Chronicle Based Alarm Management (CBAM) methodology involves different techniques to take the hybrid aspect and the standard operational procedures of the concerned processes into account.

Liquefied Petroleum Gas (LPG) Leakage Detection and Monitoring System

A system consists of detection and monitoring system is very common in industrial field. However, this system still very rare in domestic. Detection and monitoring system of Liquefied Petroleum Gas (LPG) is very important in home because it is common to be used at homes. The purpose of this project is to develop Liquefied Petroleum Gas leakage detection and monitoring system. This system consists of two sensing unit, two types of alarm alert and an online monitoring system. Gas sensor is used for gas leakage detection specified to LPG gas only and load cell sensor is used to weigh the gas cylinder. A physical alarm alert using buzzer is installed for gas detection only while non-physical alert alarm which is sending notification and email to user through smartphone are developed to equip the system with Internet of Thing (IoT) technology. This includes notification of both gas leakage and empty gas cylinder. For monitoring purpose, Blynk application is used as the IoT platform because of its user friendliness for both iOS and Android smartphone users. Real-time data is sent through WiFi so that users can monitor their kitchen condition remotely and receive alert for both gas leakage and gas cylinder condition through their smartphones. In conclusion, the proposed LPG leakage detection and monitoring system has been successfully developed and has lower cost compared to existing system on the shelves. This system is suitable for domestic usage and small premise usage.

Acoustic similarity elicits responses to heterospecific distress calls in bats (Mammalia: Chiroptera)

Frequently, individuals of one species respond to alarm calls produced by another species. This form of interspecies communication can be critical for survival. How animals recognize and respond to heterospecific alarm calls is, however, still poorly understood. This is especially true for bats, which are highly vocal and possess a specialized auditory system. We hypothesized that, among bat species, acoustic similarity between heterospecific and conspecific alarm calls is a key factor that underlies call recognition. However, this ability could also be acquired via associative learning from prior exposure or result from phylogenetic relatedness among caller and receiver species, as shown by others. Here we focused on distress calls of bats as representing a certain type of alarm call. To test our hypothesis, we recorded distress calls of 11 bat species from four families at five different sites. We broadcast the recorded calls to three of these species (Rhinolophus sinicus, Myotis badius and Myotis laniger). For all three species, neither prior exposure (familiarity) nor phylogenetic relatedness explained the variation in the response strength, as measured by echolocation vocalizations of receiver species in response to playback of heterospecific distress calls. In contrast, acoustic similarity, especially in peak frequency, between conspecific and heterospecific distress calls, was positively correlated with response strength in the receiver species. Thus, our findings emphasize that, at least among bats, acoustic similarity is a key factor allowing recognition of heterospecific alarm calls. It remains unclear whether evolutionary, genetic and/or neurophysiological mechanisms entrain an individual to respond selectively to a specific acoustic feature.

Frequency and Duration of Infusion Pump Alarms: Establishing National Benchmarks.

Reduction of clinical alarms is a priority due to alarm fatigue and the high incidence of nonactionable alarms, especially those generated from physiological monitors. However, research on infusion pump alarm types and frequencies is limited. The purpose of this study was to establish a baseline for infusion pump alarm frequencies and duration in the hospital setting. Frequency and duration of alarms across 29 hospitals using 11,410 infusion pumps revealed 987,240 alarms associated with 568,164 infusions during a consecutive 60-day period. Pump alarms accounted for only 0.8% of infusion time, with an average of 1.74 alarms per delivery and 0.18 alarms per hour. Average alarm duration was 0:02:38 (h:min:s), with 60% of alarms being addressed within 0:01:08. The most frequent alarms were keep vein open (33.77%), hold expired (27.18%), and downstream occlusion (22.94%). The medical/surgical and intensive care unit (ICU) care areas had the highest number of alarms (41.66% and 39.70% of total alarms, respectively), but pediatrics/neonatal ICU had the highest frequency of alarms per delivery (4.91). Intravenous fluids accounted for 47.16% of total alarms, with an average of 3.03 alarms per delivery, whereas parenteral nutrition and propofol had 6.77 and 6.74 average alarms per delivery, respectively. A higher average number of alarms per delivery occurred on Saturdays (1.74) and Sundays (1.73) compared with weekdays. Infusion pump alarm data collected and analyzed were sufficient to establish a reasonable baseline of infusion pump alarm types and relative frequencies for the device.

INCLUSIVE DISASTER RISK MANAGEMENT (DRM) FOR BERTAM VALLEY COMMUNITY

This paper focuses on the inclusiveness of Disaster Risk Management. The study assesses proactive adaptation of Early Warning System (EWS) for Disaster Risk Reduction Program in Bertam Valley. The study aims to identify community preferences as an initiative to improve the effectiveness of the EWS system. In order to sustain the awareness and preparedness of EWS, continuous involvement by the community is necessary to make them resilient. Specific focus is given to Person with Disabilities (PwDs), elderly and children. Therefore, it is vital to understand the efficient methods to alarm PwDs, elderly and children during emergencies occurrence, which will focus on the implementation of types of alarm in EWS with regards to the early warning alarm and emergency notification. The finding from this paper is useful to assist local authorities and emergency responder in the formulation of warning and evacuation procedures to save the PwDs if dam failure is imminent.

INCLUSIVE DISASTER RISK MANAGEMENT (DRM) FOR BERTAM VALLEY COMMUNITY

This paper focuses on the inclusiveness of Disaster Risk Management. The study assesses proactive adaptation of Early Warning System (EWS) for Disaster Risk Reduction Program in Bertam Valley. The study aims to identify community preferences as an initiative to improve the effectiveness of the EWS system. In order to sustain the awareness and preparedness of EWS, continuous involvement by the community is necessary to make them resilient. Specific focus is given to Person with Disabilities (PwDs), elderly and children. Therefore, it is vital to understand the efficient methods to alarm PwDs, elderly and children during emergencies occurrence, which will focus on the implementation of types of alarm in EWS with regards to the early warning alarm and emergency notification. The finding from this paper is useful to assist local authorities and emergency responder in the formulation of warning and evacuation procedures to save the PwDs if dam failure is imminent.

Perceptions of Infusion Pump Alarms: Insights Gained From Critical Care Nurses.

Between 1983 and 2011, equipment-related alarms in critical care have increased from 6 to 40 different alarm types. As nurses become overwhelmed, distracted, or desensitized by alarm noise, they may miss critical alarms that could result in patient harm. The findings of an infusion pump alarm survey indicated that nurses overwhelmingly agree that infusion pump nuisance alarms occur frequently and disrupt patient care. But nurses' perceptions of pump alarms are different from those previously reported for clinical alarms in general. It may not be appropriate to broadly apply general alarm management recommendations to infusion pump alarms at this time.

A Formal Analysis of Masking Between Reserved Alarm Sounds of the IEC 60601-1-8 International Medical Alarm Standard

The IEC 60601-1-8 international medical alarm standard was created to give engineers guidance for designing alarms that are easily perceivable by humans. Included within this are a number of reserved alarm sounds that use tonal melodies to represent common types of alarms. Despite the standard, practitioners can still fail to hear and respond to alarms. This can have a profound negative impact on patient life and health. One of the factors that contributes to this problem is simultaneous masking: a condition where one or more alarms can be rendered imperceptible in the presence of other alarms due to limitations of the human perception system. Unfortunately, the tonal nature of the IEC 60601-1-8 reserved sounds makes them particularly susceptible to masking. It can be difficult to determine how masking can manifest in a collection of alarms that can sound concurrently given the inherent complexity of the statespace. In this work, we employ a computational method that employs mathematical proof techniques to determine if masking is possible in a model of a configuration of medical alarms. We use this to analyze the low and medium priority reserved alarm sounds of the IEC 60601-1-8 standard. We describe our method, present the results of our analyses, discuss these results, and explore future research directions.

The Novel PrisMax Continuous Renal Replacement Therapy System in a Multinational, Multicentre Pilot Setting

Background/Aims: We assessed how the novel PrisMax continuous renal replacement therapy (CRRT) system performed in a prospective international multicentre setting. We compared this device to its predecessor, the Prismaflex, with regards to multiple treatment parameters. Additionally, we performed a survey, aiming to measure user satisfaction. Methods: Data was prospectively collected from 7 intensive care units (ICU) in 6 countries. The PrisMax device data logs constituted the raw material. Clinical parameters like treatment time, filter life span, downtime, delivered dose and number and type of alarms were recorded. A user questionnaire was sent out to 3 of the participating ICUs. Results: Filter life, downtime, blood pump stops, bag changing time and number of malfunction alarms showed significantly improved values compared to the historic Prismaflex data. The survey showed high scores with regards to user friendliness. Conclusion: The PrisMax CRRT device is safe and outperformed its’ previous generation counterpart in virtually all aspects. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=489213.

Physiologic Monitor Alarm Rates at 5 Children's Hospitals.

Alarm fatigue has been linked to patient morbidity and mortality in hospitals due to delayed or absent responses to monitor alarms. We sought to describe alarm rates at 5 freestanding children's hospitals during a single day and the types of alarms and proportions of patients monitored by using a point-prevalence, cross-sectional study design. We collected audible alarms on all inpatient units and calculated overall alarm rates and rates by alarm type per monitored patient per day. We found a total of 147,213 alarms during the study period, with 3-fold variation in alarm rates across hospitals among similar unit types. Across hospitals, onequarter of monitored beds were responsible for 71%, 61%, and 63% of alarms in medical-surgical, neonatal intensive care, and pediatric intensive care units, respectively. Future work focused on addressing nonactionable alarms in patients with the highest alarm counts may decrease alarm rates.

Auditory Icon Alarms Are More Accurately and Quickly Identified than Current Standard Melodic Alarms in a Simulated Clinical Setting.

Current standard audible medical alarms are difficult to learn and distinguish from one another. Auditory icons represent a new type of alarm that has been shown to be easier to learn and identify in laboratory settings by lay subjects. In this study, we test the hypothesis that icon alarms are easier to learn and identify than standard alarms by anesthesia providers in a simulated clinical setting. Twenty anesthesia providers were assigned to standard or icon groups. Experiments were conducted in a simulated intensive care unit. After a brief group-specific alarm orientation, subjects identified patient-associated alarm sounds during the simulation and logged responses via a tablet computer. Each subject participated in the simulation twice and was exposed to 32 alarm annunciations. Primary outcome measures were response accuracy and response times. Secondary outcomes included assessments of perceived fatigue and task load. Overall accuracy rate in the standard alarm group was 43% (mean) and in the icon group was 88% (mean). Subjects in the icon group were 26.1 (odds ratio [98.75% CI, 8.4 to 81.5; P < 0.001]) times more likely to correctly identify an alarm. Response times in the icon group were shorter than in the standard alarm group (12 vs. 15 s, difference 3 s [98.75% CI ,1 to 5; P < 0.001]). Under our simulated conditions, anesthesia providers more correctly and quickly identified icon alarms than standard alarms. Subjects were more likely to perceive higher fatigue and task load when using current standard alarms than icon alarms.

Giving A Hand To Pilots With Animated Alarms Based On Mirror System Functioning

Controlled Flight Into Terrain (CFIT) accidents are among the most frequent and deadly accidents in aviation (IATA, 2016). Pilots have sometimes only a few seconds to react to the ‘Pull-Up’ alarm that indicates an imminent collision with the ground. The auditory modality of the alarm can generate stress, which can disrupt cognitive processes (Porcelli et al., 2008) and negatively impact the ability to take timely and appropriate actions (Scholz et al., 2009). While in general humans are less sensitive to auditory stimuli than to visual stimuli (Mrugalska et al. 2016), the auditory component of the ‘Pull-Up’ alarm is loud and prominent whereas its visual component is more discreet (i.e., small text). Consequently, a first step to enhance the efficiency of this alarm would be to increase the conspicuity of its visual component by enlarging the ‘Pull-Up’ text size and to increase its salience by displacing it from the artificial horizon to the bottom of the Primary Flight Display (PFD). However, enlarging the inscription may not be sufficient to cope with the loss of cognitive performance due to stress (BEA, 2009). Previous researched found that watching an action activates premotor cortex and pre-initiates the gesture imitation through the mirror neuron system (Ocampo & Kritikos, 2011). Therefore, presenting a video of the gesture to perform (i.e., a hand pulling the sidestick), in case of imminent impact with the ground, should pre-activate the motor reaction to the alarm and then improve the pilots’ performance in terms of reaction time. The present experiment aimed at assessing whether these ‘Pull-Up’ video better performance than more conventional ‘Pull-Up’ alarms. Both behavioral and electroencephalographic (EEG) results were used to assess the best alarm design.

Contextual encoding in titi monkey alarm call sequences

Many primates produce one type of alarm call to a broad range of events, usually terrestrial predators and non-predatory situations, which raises questions about whether primate alarm calls should be considered ‘functionally referential’. A recent example is black-fronted titi monkeys, Callicebus nigrifrons, which emit sequences of B-calls to terrestrial predators or when moving towards or near the ground. In this study, we reassess the context specificity of these utterances, focussing both on their acoustic and sequential structure. We found that B-calls could be differentiated into context-specific acoustic variants (terrestrial predators vs. ground-related movements) and that call sequences to predators had a more regular sequential structure than ground-related sequences. Overall, these findings suggest that the acoustic and temporal structure of titi monkey call sequences discriminate between predator and non-predatory events, fulfilling the production criterion of functional reference. Primate terrestrial alarm calls are at the centre of an ongoing debate about meaning in animal signals. Primates regularly emit one alarm call type to ground predators but often also to various non-predatory events, raising questions about the referential nature of these signals. In this study, we report observational and experimental data from wild titi monkeys and show that terrestrial alarm calls are usually given in sequences of acoustically distinct variants composed in structurally distinct ways depending on the external event. These differences are salient and could help recipients to distinguish the nature of the call eliciting event. Since most previous studies on animal alarm calls have not checked for acoustic variants within different call classes, it may be premature to conclude that primate terrestrial calls do not meet the criteria of functional reference.

Detection and reaction thresholds for reverse alarms in noise with and without passive hearing protection

Objective: To measure masked detection and reaction thresholds for two reverse alarms (tonal and broadband) and compare results to available standards and psychoacoustic criteria for setting alarm levels. Design: Alarm detection and reaction thresholds were adaptively measured in 80-dBA background noises without hearing protection (Experiment 1), and with a passive earmuff-style hearing protection device (HPD) (Experiment 2). Study sample: Twenty-four young adults with normal hearing in each experimental group. Results: Reverse alarms remained audible at levels well-below background noises [thresholds: −11 to −25 dB signal-to-noise ratio (SNR)], with and without the selected HPD. Detection was more influenced by alarm and noise type, while reaction was more susceptible to HPD use. HPD use resulted in lower detection thresholds by up to 2.5 dB compared to unprotected listening but increased reaction thresholds by 5–10 dB depending on the alarm. Conclusions: Since noise type appears to have a more limited effect on reaction thresholds, adjusting alarms based on a global dBA method appears preferable to methods based on masked detection thresholds. However, while the >0 dB SNR recommended in ISO 9533 seems adequate for unprotected listening, an additional 5–10 dB may be warranted to elicit the same reaction when the selected HPD is used.

Visible but wide QRS complexes are associated with false asystole alarms

Alarm fatigue in the ICU setting has been well documented in the literature. The ICU's high-intensity environment requires staff's vigilant attention, and distraction from false and non-actionable alarms pulls staff away from important tasks, creates dissatisfaction, and is a potential patient safety risk if alarms are missed or ignored. This project was intended to improve patient safety by optimizing alarm systems in a cardiovascular surgical intensive care unit (CVSICU). Specific aims were to examine nurses' attitudes toward clinical alarm signals, assess nurses' ability to discriminate audible alarm signals, and implement a bundled set of best practices for monitor alarm reduction without undermining patient safety.CVSICU nurses completed an alarm perception survey and participated in alarm discriminability testing. Nurse survey data and baseline monitor alarm data were used to select targeted alarm reduction interventions, which were progressively phased in. Monitor alarm data and cardiorespiratory event data were trended over one year.Five of the most frequent CVSICU monitor alarm types—pulse oximetry, heart rate, systolic and diastolic blood pressure, pulse oximetry sensor, and ventricular tachycardia > 2—were targeted. After implementation, there was a 61% reduction in average alarms per monitored bed and a downward trend in cardiorespiratory events.To reduce alarm fatigue it is important to decrease alarm burden through targeted interventions. Methods to reduce non-actionable alarms include adding short delays to allow alarm self-correction, adjusting default alarm threshold limits, providing alarm notification through a secondary device, and teaching staff to optimize alarm settings for individual patients.

Frequency, duration and cause of ventilator alarms on a neonatal intensive care unit

ObjectiveTo investigate the frequency and cause of neonatal ventilator alarms. Neonatal ventilators frequently alarm and also disturb babies, parents and nurses. If frequent they may cause alarm fatigue and be...

Effects of directional auditory and visual warnings at intersections on reaction times and speed reduction times

Intersection collision warning systems (ICWSs) have an important impact on driving safety because making the potential collision at intersection predictable, allow reducing the probability and severity of accidents. Among the several types of alarms to alert the driver of an imminent collision, those most used concerning the auditory and the visual stimulus. However, it is unclear whether is more effective an audio or a visual warning. In addition, no study compared the effects on drivers’ behavior induced by an acoustic and a visual directional warning. The main objective of the present study was to assess, in response to a potential conflict event at the intersections, the effects of directional auditory and visual warnings on driving performance.A driving simulator experiment was carried out to collect drivers’ behavior in response to a vehicle that failed to stop at the intersection. The parameters reaction time and speed reduction time were used for the evaluation of the effects on driving performance. These duration variables were modeled following the survival analysis, by the use of the accelerated failure time duration model with a Weibull distribution.Results showed that when the directional warning system (auditory or visual) was present, the drivers were able to detect earlier the violator vehicle. This effect led to a more comfortable braking maneuver and, thus, less possibilities of an unexpected maneuver for the following vehicle, avoiding the car – following collisions. The effectiveness of ICWSs was more evident for the directional auditory speech message; for this condition, in fact, the lower reaction time and the longer speed reduction time were obtained.The outcomes of the present study provide useful suggestions about the most effective collision warning systems that the automotive industry should develop and equip on vehicles.

Authenticity and Reliability of the Cardiac Monitor Alarms in the ICU: A Patient Safety Concern Due to Alarm Fatigue

SESSION TITLE: Quality Improvement 1 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: It is desirable for the cardiac monitor (CM) to have a high sensitivity. Frequent alarms may cause alarm fatigue of the medical personnel leading to delayed or no response to the alarms, which could jeopardize patient’s safety. The impact of following standard processes/protocols such as pertinent skin preparation, changing electrocardiogram (EKG) leads daily, customization of alarm parameters, and education of the nursing staff to reduce the false alarms remains unclear. The aim of this study was to analyze the accuracy of the CM alarms in the intensive care unit (ICU) with utilization of the standard protocol. METHODS: This quality improvement project was conducted in the medical ICU of a teaching hospital in the United States from May 2016 to March 2017. Prior to initiation of this study, standard protocols for initial setting and maintenance of monitoring apparatus were taught to the nursing staff and were followed throughout the study. The alarm parameters were customized for each patient. Critical life threating cardiac alarms (red alarms) such as for asystole, tachycardia, bradycardia, ventricular tachycardia (VT) and ventricular fibrillation (VF) were included in the study. All the alarms were studied retrospectively for the occurrence of actual cardiac event suggested by the alarm. Positive predictive value was calculated for each arrhythmia. RESULTS: A total of 2408 alarms were analyzed on 350 patients. Overall, 557 (23.13%) were true positive (TP) and were clinically relevant, while majority (n=1851; 76.87%) were deemed to be false positive (FP). The most common type of alarms were for VT (~42%), followed by asystole (~23%) and tachycardia (20.5%). On detailed analysis, most of the tachycardia alarms (84.4%) were TP. On the contrary, majority of the alarms for VT (96.5%), asystole (~90%), VF (89.9%) and bradycardia (80.6%) were FP. Of 497 FP asystole alarms, 43 (8.6%) were FP due to EKG leads falling off the patient. The positive predictive value (PPV) of the alarm for tachycardia was the highest (84.4%), whereas the PPV of the alarm for VT (3.5%) was the lowest. CONCLUSIONS: This study demonstrated that significant number of alarms in the ICU are false without any clinical significance despite following the standard protocol to reduce the FP alarms. The alarm for tachycardia were more likely to be true in the majority of the patients and their higher accuracy resulted from customization of the alarm parameter settings. Though a higher sensitivity of CM alarms is desirable, false alarms are concerning and further study is warranted to increase the accuracy of CM alarms. CLINICAL IMPLICATIONS: Alarm fatigue ranked first on the list of “Top 10 Health Technology Hazards” released by Emergency Care Research Institute in 2012, 2013 and 2015. With this study, we highlight a pressing need of implementing an intelligent cardiac monitoring system in the ICUs. Besides being highly sensitive, the alarm system should also take into account other parameters before beeping. Reducing the number of FP alarms would lead to increased efficiency of the nursing staff and other medical personnel; hence would improve the patient safety. DISCLOSURE: The following authors have nothing to disclose: Parita Soni, Nidhi Aggarwal, Vivek Kumar, Peter Homel, Yizhak Kupfer No Product/Research Disclosure Information

Impact of targeted education on managing warning and error signals by children and adolescents with type 1 diabetes using the Accu-Chek Combo Insulin Pump System.

PurposeInsulin pumps are widely used in diabetes. They are equipped with safety alarms to alert users. Pump manuals contain alarm codes and how to troubleshoot them. However, these manuals are lengthy and difficult to use, particularly in emergencies. We aim to assess the impact of targeted education on warnings and errors in improving competency to troubleshoot the alarms.MethodsTwenty-one patients, with a median age of 13, were recruited over a 5-month period. Each patient had 2 study visits. The frequencies and types of alarms were recorded, and patients were given a summary sheet that outlined common alarms encountered and troubleshooting tips. In visit 2, the frequencies and types of alarms were compared to those of visit 1. The patients were asked to fill a questionnaire and to rate the education session given in visit 1, their level of competency in decrypting alarm codes, and their promptness in responding to alarms.ResultsLow cartridge (W1), low battery (W2), and bolus cancelled (W8) were the commonest warnings. The most noted errors were occlusion (E4), power interruption (E8), empty battery (E2), set not primed (E11), and cartridge empty (E1). The numbers of warning and error signals markedly decreased after targeted education (P<0.05). The ability in decrypting warning signals significantly improved (P=0.02), and the frequency of response to pump alarms significantly increased (P=0.001).ConclusionsCertain warnings and errors are more common than others in insulin pumps. Targeted education is useful in improving competency and response of patients in managing pump alarms.