Volume Of Alarms Research Articles

Original Research: Alarm Fatigue: Exploring the Adaptive and Maladaptive Coping Strategies of Nurses.

To improve patient safety, hospitals use alarm notification systems to increase nurses' real-time situational awareness of a patient's condition. Such alarms are critical to nurses' clinical decision-making and prioritization, thus helping to improve patient care and care efficiency. But the frequent and often simultaneous ringing of alarms, including many that are false, nonemergent, or nonactionable, has led to overwhelm, alarm distrust, and desensitization, resulting in alarm fatigue. This study aimed to explore oncology nurses' lived experiences with alarms and the adaptive and maladaptive strategies they use to cope with alarm fatigue. This qualitative, phenomenological study was guided by the theoretical framework of the Roy Adaptation Model. A purposive sample of nine nurses was recruited from two oncology units at a large midwestern Magnet hospital in the United States. Qualitative data were collected using a six-question, semistructured interview guide. Interviews were conducted either face-to-face in a private conference room on the unit or via the online videoconferencing platform Zoom. Data analysis yielded five themes, the most prominent being the high volume and frequency of alarms . Nurse participants reported adopting more maladaptive than adaptive coping strategies. Overall, they felt that the high frequency of false, nonemergent, and nonactionable alarms disrupted their workflow and contributed to a general desensitization to alarms. This study's findings offer valuable insight into the problem of alarm fatigue among nurses. Practical measures are urgently needed to reduce nurses' cognitive overload; shift nonnursing responsibilities to other staff; and implement efficiency-focused process changes, such as reengineering workflows to minimize interruptions. Every effort should be made to redesign protocols to reduce alarm fatigue, including by decreasing the number of false, nonemergent, and nonactionable calls and alarms.

Strategies to Improve Sleep Quality in Intensive Care Unit Patients.

Patients in intensive care units are exposed to many factors that can negatively affect the quality of their sleep. To describe the latest findings regarding sleep quality improvement in intensive care unit patients. An integrative literature review was conducted in the CINAHL, PubMed, Cochrane Library, and MEDLINE databases in April and May 2023. The following keywords were used: intensive care units, promotion, sleep quality, and sleep. The Critical Appraisal Skills Programme tool was used to assess the quality of individual studies. Of 159 articles identified, 10 were included in the final analysis. The findings were grouped into 4 thematic categories: consequences of poor sleep quality, factors affecting sleep quality, pharmacologic ways to improve sleep quality, and nonpharmacologic ways to improve sleep quality. Various pharmacologic and nonpharmacologic treatments are used in clinical settings. Nonpharmacologic interventions include sleep masks, earplugs, reductions in alarm volume, and reductions in nighttime interventions. Relaxation techniques include aromatherapy, music therapy, and acupressure. The most effective way to improve sleep for intensive care unit patients is to use a combination of pharmacologic and nonpharmacologic interventions. Among the latter, the use of earplugs and sleep masks is simplest.

Intelligent alarm flood management for power systems

Alarm floods pose a challenge to the successful operation of transmission and distribution systems because the alarm rate is often higher than what operators can effectively manage. Such a high volume of alarms can distract operators from unrelated but relevant alarms that occurred during the flood. To mitigate this situation, we propose a method to group alarm floods into clusters and identify additional alarms that might be lost in the flood and ignored by the operator. To do so, three different clustering approaches are introduced and tested using historical alarm data from a transmission system operator (TSO). Importantly, the results are validated by the end user highlighting the applicability of the proposed alarm flood management tool in real world scenarios.

The impact of an intervention to improve intrapartum maternal vital sign monitoring and reduce alarm fatigue

The infrastructure of many labor and delivery units in the United States may dispose clinicians to overuse continuous and automated maternal physiological monitors. Overmonitoring low-risk patients can negatively affect patient care, primarily through generating alarm fatigue. Given the national attention to reducing alarm fatigue across healthcare settings and the concern for vital sign monitoring overuse on our labor and delivery unit, this quality improvement study aimed to evaluate vital sign monitoring patterns and alarm rates, and nursing experiences of alarm fatigue, before and after implementing a vital sign monitoring guideline for low-risk obstetrical patients. This was a quality improvement study conducted on the labor and delivery unit of an urban, academic, tertiary hospital. The lack of guidance for maternal vital sign assessment in low-risk patients was identified as a potential safety challenge. A vital sign guideline was developed with multidisciplinary input, followed by a pre-post-implementation study evaluating vital sign volume and alarm rates. Total vital signs and alarm rates for all patients delivered during designated calendar days were assessed as a rate of vital signs per patient and compared across baseline, peri-intervention, and follow-up periods. Data were examined in p-type statistical process control charts and with time-series analysis. Patient characteristics and severe maternal morbidity, as a balancing metric, were compared across periods. Nursing perceptions of vital sign monitoring and experience of alarm fatigue were assessed via survey before and after implementation of the guideline. A total of 35 individual 24-hour periods were evaluated with regard to vital sign and alarm volume. There was a decrease in vital signs per patient from a mean of 208.34 to 135.46 (incidence rate ratio, 0.65) and in alarms per patient from a mean of 14.31 to 10.51 (incidence rate ratio, 0.73) after implementation, with no difference in severe maternal morbidity. There were 85 total respondents to the nursing surveys, and comparison of modified task-load index scores before and after implementation demonstrated overall lower scores in the postperiod, although these were not statistically significant. Introducing a maternal vital sign guideline for low-risk patients on the labor and delivery unit decreased vital signs measured as well as alarms, which may ultimately reduce alarm fatigue. This strategy should be considered on labor and delivery units widely to improve patient safety and optimize outcomes.

De-implementing intrapartum maternal vitals monitoring to reduce alarm fatigue: an L&D quality and safety initiative

Many L&D units likely overuse continuous and automated maternal physiologic monitors. Given national attention to reducing alarm fatigue in healthcare, which adversely impacts response times and patient outcomes, this study evaluates vital sign monitoring and alarm patterns before and after implementing a vital sign protocol to reduce overmonitoring in low-risk obstetric patients. This is a quality improvement study conducted at an academic, tertiary hospital (4200 deliveries/year). The lack of guidance for maternal vital sign assessment in low-risk patients was identified as a safety challenge. A vital sign protocol was developed with multidisciplinary input and implemented. Total vital signs and alarm rates for all patients delivered during designated calendar days were assessed and compared across baseline, peri-intervention, and follow-up periods. Data were examined in p-type statistical process control charts as well as with time-series analysis. Patient characteristics and severe maternal morbidity (SMM, defined according to the CDC), used as a balancing metric, were compared peri-intervention. 35 individual 24-hour periods of vital sign and alarm volume were evaluated surrounding implementation of the protocol (10 baseline, 20 peri-intervention, 5 delayed follow-up). There was a decrease from a mean of 208.3 to 135.5 vitals/patient after implementation (incidence rate ratio [IRR] 0.65, p < 0.01) and in alarms/patient from a mean of 14.3 to 10.5 (IRR 0.73, p = 0.045) [Figures]. There were no significant differences in patient characteristics aggregated over the 2 calendar months of the immediate pre/post implementation periods (6-7/2021, 8-9/2021), or in SMM with and without transfusion (p = 0.34, 0.45). Introducing a maternal vital sign protocol for low-risk patients on L&D decreased vital signs measured as well as alarms, which may ultimately reduce alarm fatigue. This strategy should be considered on L&D units widely to improve patient safety and optimize outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

APGNN : Alarm Propagation Graph Neural Network for fault detection and alarm root cause analysis

Telecommunication network plays an important role in our daily life. Fault detection and alarm root cause analysis are the keys to ensure the normal operation of the network. To reduce the burden on operators, numerous methods are employed to analyse root cause of faults. However, there still remain a large amount of non-essential or transient alarms after root cause analysis. A simple Rule-based method may help ease the problems. But it needs prior expert knowledge and the diversity of alarm pattern makes the rules redundant and complicated. Moreover, it cannot accurately cover all true faults and need manual methods as complement. In this work, we propose Alarm Propagation Graph Neural Network(APGNN), a novel data-driven propagation-based root cause analysis and fault detection approach.It first associates alarms and extracts root-derived graph based on Bayesian Network. Then it constructs alarm propagation graphs(APG). We refine the repair orders to obtain actual fault information. At last, Graph Neural Network is used to extract features and learn the mapping from APG to the true fault. Our method not only detects the true fault from large volume of original alarms, but also analyses the root cause alarms. We evaluate our approach both on the offline and online environment of the real-world IP Radio Access Network. Experiments show that our model outperforms the state-of-art approach by 4.6% in F1-score on average.

Open Archive of Hate: Terrorism and Violent Extremism on Internet Archive

The recognized correlation between the growing spread of violent extremist and terrorist content on the Internet and online platforms and the significant increase of attacks inspired by these postings caused governments and security agencies to launch various countermeasures. These measures included removal of terrorist and violent extremist online content (or “deplatforming”), suspension of their social media accounts, hacking websites and pressuring social media companies to remove terrorist propaganda. Struggling to adjust to these countermeasures and sustain their online presence, terrorist and violent extremists moved from mainstream online platforms to alternative online channels including anonymous sharing portals and cloud services. The most popular archiving service used by various extremist and terrorist group is the Internet Archive. While the few studies on hate speech and violent contents on Internet Archive focused only on a certain type of content or a specific group, this study attempts to reveal a wider range of contents, groups and organizations who use this archive for sharing and promoting such contents. To examine the use of Internet Archive by various groups and organizations involved in violence, terrorism, hate speech, racism and neo-Nazism we applied several stages of data collection and analysis. The findings highlight an alarming volume of terrorist, extremist, and racist material on the Internet Archive. These findings are discussed in terms of ethical and practical implications.

AESTHETIC VALUE OF RE-USE WASTE MATERIALS AS A PANACEA FOR ENVIRONMENTAL PROTECTION (An Appraisal of Oligbinde's Creative Works)

Discarded plastic and bottle tops are unwanted and seen as unusable materials that the initial user has no further use for or no longer considers of any significant value to retain. They are considered waste, thus, discarded after primary use. The indiscriminate disposal of such waste amounts to an alarming volume of them, however, wastes can be managed through recycling, repurposing and if well managed, a man stands at a vantage point economically, socially, and more importantly aesthetically – which affects our health on short and long terms. This paper examines the plastic sculptures of Oligbinde Rotimi with the concept of turning plastic waste into objects of aesthetic made from discarded plastics that are purposively selected for formal and contextual analysis. These works were produced as a source of inspiration for others to gainfully redeploy any plastic they see within their enabling environment to lay their hands on and thereby save the planet committed to us. Photographs of works are taken and the procedures involved in executing the works were highlighted. KEYWORDS: Aesthetic, Discarded plastic, Repurposing, Waste, Recycling, Environment.

Evaluation of a Medication Robot Through Participatory Design Methods - A Case Study in Denmark.

The demographics in Denmark are changing. People's life expectancy is increasing, which puts a strain on the home care resources. The aim of this article is to get a deeper insight to how a specific medication robot in elders' homes can be further developed and modified to create more independence. An insight to the end users is created through the use of participatory design methods. The methods illuminate the fact that the medication robots design is gawky, its alarm volume is too low, the robot itself is too big and that it lacks the functionality of being transportable.

An incremental intrusion detection model using alarms correlation

Today, intrusion detection systems are extremely important in securing computers and computer networks. Correlated systems are next to intrusion detection systems by analyzing and combining the alarms received from them, appropriate reports for review and producing security measures. One of the problems face by intrusion detection systems is generating a large volume of false alarms, so one of the most important issues in correlated systems is to check the alerts received by the intrusion detection system to distinguish true-positive alarms from false-positive alarms. The main focus of this research is on the applied optimization of classification methods to reduce the cost of organizations and security expert time in alert checking. The proposed intrusion detection model using correlation(IIDMC) is tested on a valid test dataset and the results show the efficiency of the proposed model and consequently its high accuracy.

SOURCES OF SOUND LEVELS IN NICU AND INCUBATOR

Introduction: Currently there is limited research regarding estimated intrauterine sound levels. Benzaquen, Gagnon, Hunse&amp; Foreman (1990) suggest however that intrauterine noise consists predominantly of low-frequency noise with sound levels being 40 dB above 500 Hz. Ideally, to promote healthy auditory development, sound levels in the NICU should be consistent with intrauterine environment. Each part has two sections A and B, the section A Methodology: is from more sick babies requiring Level 3 NICU care, whereas the section B is for babies requiring Level 2 NICU care. Our unit is 20 beded NICU with 15 beds level III and 5 beds level II unit, the study was conducted in level III unit. All sources of noise levels higher than 55 dBA in the NICU n Results: eed to be eliminated or mitigated. Since the alarms of equipments were important sources of noise in the NICU, eliminating or decreasing volume of alarms will reduce sound level. Every NICU requires a sound level assessment system in order to achieve environmental noise limiting guidelines and to get closer to the standard sound levels. Conclusion:By evaluating sound levels, the sources of noise can be identied and their effects on sound levels can be studied.

Application of geocell reinforced coal mine overburden waste as subballast in railway tracks on weak subgrade

An alarming volume of coal mining by-product in the form of waste rock, referred to as overburden (OB), is being dumped over vast areas of useful ground, leading to an ever-increasing demand for land space worldwide. Reusing this material in the form of industrial applications can provide an effective and environmentally sound solution for disposal of the unsightly and polluted stockpiles. The present study focuses on recycling the coal mine OB as an alternative to conventional subballast material in railways. A series of model tests have been conducted with the OB material as subballast layers of different thicknesses overlying a weak subgrade. Further, geocells of varying geometries have been used for additional performance improvement. The results portrayed that coal OB had the potential to be recycled as a subballast material in railways. Additionally, with geocell reinforced OB, the magnitude of vertical settlement and stresses in the track bed can be reduced significantly. Experimentally validated finite element models (FEM) were used to predict the lateral deformations and subgrade stresses in the track bed, which were also found to have exhibited substantial reductions with geocell reinforcement.

Alarm Sound Propagation Characteristics of Gas Extinguishing System Installed in Computer Server Room

Gas extinguishing systems are used for fire protection in server rooms and data centers. In the fire safety standards (NFSC 106, 107) of gas extinguishing systems (carbon dioxide, halon, and clean agent extinguishing system), sound alarm devices are installed in each protected area to provide an effective warning to personnel in the protected area or areas with objects to be protected. By measuring the noise level generated in a small server room, it was found that more than 70 dB of noise was generated. Therefore, to effectively transmit alarm sound to workers in all areas within the protection area, such as a server room, an acoustic alarm device must be designed and installed so that an alarm sound is transmitted at a level of 15 dB or higher than the noise level generated by equipment installed in the facility. As a result of predicting the alarm sound through the room acoustic simulation for a small server room equipped with an acoustic alarm system in a cabinet-type gas extinguishing system, it was found that it was insufficient in effectively delivering an alarm sound to the entire protection area. To effectively transmit an alarm sound inside the protection area where a gas extinguishing system is installed, the output of the alarm device needs to be increased and the room acoustic parameters should be predicted in advance using room acoustic prediction techniques and actively adjusting the acoustics according to the noise generated inside the protection area. Additionally, the distance between alarm devices needs to be shortened to deliver sufficient alarm volume throughout the protection area, and it is necessary to establish specific standards for this.

The intersection of hand hygiene, infusion pump contamination, and high alarm volume in the health care environment

Researchers have found that lack of hand hygiene and environmental contamination are sources of infection transmission in the health care environment. One factor that may lead to lack of hand hygiene is alarm fatigue, the sensory overload that results when clinicians are exposed to an excessive number of alarms, causing them to silence alarms without taking proper precautions. In this study, we report hand hygiene compliance and infusion pump contamination in the context of infusion pump alarm prevalence. Health care worker hand hygiene audits were conducted to determine percent compliance. Cultures were obtained from infusion pumps to determine environmental contamination. The frequency of alarms from August 4, 2019 to September 7, 2019 was determined. Hand hygiene compliance ranged from 50% to 87%. Pump contamination ranged from 20% to 70% per unit. A total of 116, 872 infusion pump alarms sounded in the hospital. Pumps were contaminated primarily with skin flora. This was demonstrated in the context of poor hand hygiene compliance and a high number of alarms, indicative of alarm fatigue. The intersection of a high prevalence of infusion pump alarms and poor hand hygiene resulting in bacterial contamination of pumps could be a source of health care-associated infection transmission for patients.

Generalizability of SuperAlarm via Cross-Institutional Performance Evaluation.

Bedside patient monitors are ubiquitous tools in modern critical care units to provide timely patient status. However, current systems suffer from high volume of false alarms leading to alarm fatigue, one of top technical hazards in clinical settings. Many studies are racing to develop improved algorithms towards precision patient monitoring, while little has been done to investigate the aspect of algorithm generalizability across different health institutions. Our group has been developing an evolving framework termed SuperAlarm that extracts multivariate patterns in data streams (monitor alarms, electronic health records and physiologic waveforms) of modern health enterprise to predict patient deterioration and has demonstrated great potential in mitigating alarm fatigue. In this study, we further investigate the generalizability of SuperAlarm by designing a comprehensive approach to achieve performance comparison in predicting in-hospital code blue (CB) events across two health institutions. SuperAlarm model trained with alarm data in one institution is tested on both internal and external test sets. Results show comparable performance with sensitivity up to 80% within one-hour window of events and over 90% in reduction of false alarms in both institutions. Cross-institutional performance agreement can be further improved by predicting a more stringent CB subtype (cardiopulmonary arrest), with internal sensitivity lying within 95% confident interval of external one up to 8-hour before event onset. The cross-institutional performance comparison offers first-hand knowledge on both advantages and challenges in generalizing a prediction algorithm across different institutions, which hold key information to guide the design of model training and deployment strategy.

West Germany and the Iron Curtain: Environment, Economy, and Culture in the Borderlands by Astrid Eckert

Reviewed by: West Germany and the Iron Curtain: Environment, Economy, and Culture in the Borderlands by Astrid Eckert Thomas Lekan West Germany and the Iron Curtain: Environment, Economy, and Culture in the Borderlands. By Astrid Eckert. Oxford: Oxford University Press, 2019. Pp. 444. Cloth $99.00. ISBN 978-0190690052. Astrid Eckert’s innovative and deeply researched monograph reveals the power of borderland studies to shift our historical understanding of West German state formation, tourism development, and environmental policy and to uncover unexpected continuities across the 1989/90 divide. In her deft hands, the forty-kilometer strip known as the “zonal borderlands” (Zonenrandgebiete) moves from the periphery to the center of West German history, transforming the movement of people, animals, plants, and pollutants in ways that defy the static image of an impenetrable Iron Curtain. As she writes, “real borders produce borderlands” (49)—that is, infrastructures do not merely reflect broader political or socioeconomic trends but create them anew. Working thematically rather than chronologically, Eckert begins her study of the inter-German frontier with a historical economic geography of the “East of the West” (chapter 2), noting that the emplacement of the fortified border in the early 1950s created a symbolic and material space for elected officials and chambers of commerce to lobby Bonn for economic subsidies as part of federal efforts to equalize burdens and manage development. They characterized the region as “the last outpost of freedom and yet desolate and underdeveloped—the poorhouse of the otherwise prospering Federal Republic” (13). They were remarkably successful, fending off domestic critics of pork barrel politics and scrutiny by the European Commission to secure funding even as other, more economically marginal regions such as the deindustrializing Rhine-Ruhr corridor stagnated. The portrayal of the borderlands as a neglected victim of Cold War geopolitics nonetheless beckoned curiosity-seekers hoping to glimpse across the “Iron Curtain.” Eckert shows that both residents and state officials tried to cash in on this “creepy tourism” (Gruseltourismus) to stimulate the economy and cultivate anticommunism. Metropolitan West Germans soon delighted in their discovery of “sleepy villages” (118) bypassed by postwar modernization and, sometimes to the chagrin of locals, bought up second homes—setting the stage for urbane environmentalists to join forces with farmers in “agrarian-leftist” (120) alliances against nuclearization in the 1970s and 1980s. Eckert argues convincingly that GDR efforts to block Western visitors’ views led to a more fortified—and deadly—border regimen. Indeed, despite federal lobbyists and tourist promoters’ lamentations over [End Page 642] partition, subsidization, and tourism contributed to a growing acceptance of the border as a permanent fact of life. Such dependencies on federal aid left the borderlands particularly vulnerable in the 1990s as the “new” Federal Republic shifted its aid programs just a few kilometers eastward. The second half of West Germany and the Iron Curtain presents an innovative prehistory of postunification Germany’s much-vaunted ecological “restoration” of the East (chapters 4 and 5) and the antinuclear protests at Gorleben in Lower Saxony that ultimately halted nuclear energy production altogether (chapter 6). In these chapters, the borderlands function as a contact zone, forcing both states to confront transboundary toxins seeping across shared water- and airways, reckon with dynamic “transboundary natures” (chapter 5) emerging along a “no man’s landscape” (159–160) of abandoned agricultural fields, and reconfigure siting protocols for the nuclear industry. Such entanglements shaped the Environmental Accords of 1987 which, though ineffectual at the time, prepared the way for the rapid remediation and renaturing of the East after unification. Chapter 5 takes aim at the “redemptive stories” (162) surrounding the Green Belt project, whose goal of creating blossoming nature reserves out of the defunct “death strip” has missed the deeper history of the border installations and its ecological footprint. Well-intentioned NGOs largely failed to see how militarization actively produced the seemingly intact biotopes they cherished, including the needless deaths of thousands of wild animals in minefields and wanton SED hunting expeditions. Redemptive narratives that take 1990 as their baseline also elided decades of environmental diplomacy between the GDR and the FRG over transboundary pollutants. Eckert argues convincingly that Western negotiators who hoped to stem the alarming volume of industrial toxins...

Optimizing Operations with Perpetual Alarm Management

Alarms universally remain to be a big problem to all Process control systems both in Process Industries and Manufacturing. Despite conducting several Alarm rationalizations and managements there are many poorly performing Alarm systems risking not only to minor trips and upsets contributing to major incidents which will have a significant effect on the plants bottom line. Operators are overwhelmed by the large volume of alarms preventing them to take effective actions to abnormal conditions leading to severe incidents. We do not need more alarms, we need better Alarm management and even better an automated perpetual Alarm management. The aim of this paper is to advance the current Alarm management systems for being further effective and improve operations of Process control systems as a continuous development process instead of it being a discrete activity.

Reducing Alert Fatigue for Comfort Care and Palliative Care Hospital Patients

Hospital nurses are inundated by numerous non-actionable and false telemetry alarms from bedside monitors, central nursing stations, and, in some cases, also from alarms escalated to hospital-provided cellphones after a short time period. There is widespread that patients electing to have DNR/comfort care status do not require telemetry monitoring, and an increasing awareness of the interference of these alarms with valuable end-of-life conversations and interactions with family members. In this project, we instituted policy changes, changes to the electronic health record, and educational interventions for physicians and nurses in order to reduce the proportion of DNR-CC patients with active telemetry monitoring. Overall, we learned that many bedside nurses prefer to turn down the volume or turn off the display inside rooms, which addresses the interference with family interactions but does not reduce the volume of unnecessary alarms and associated documentation requirements and inclusion of alarms in population-based analyses.

Types and Frequency of Infusion Pump Alarms and Infusion-Interruption to Infusion-Recovery Times for Critical Short Half-Life Infusions: Retrospective Data Analysis.

BackgroundAlarm fatigue commonly leads to a reduced response to alarms. Appropriate and timely response to intravenous pump alarms is crucial to infusion continuity. The difficulty of filtering out critical short half-life infusion alarms from nonurgent alarms is a key challenge for risk management for clinicians. Critical care areas provide ample opportunities for intravenous medication error with the frequent administration of high-alert, critical short half-life infusions that require rigorous maintenance for continuity of delivery. Most serious medication errors in critical care occur during the execution of treatment, with performance-level failures outweighing rule-based or knowledge-based mistakes.ObjectiveOne objective of this study was to establish baseline data for the types and frequency of alarms that critical care clinicians are exposed to from a variety of infusion devices, including both large volume pumps and syringe drivers. Another objective was to identify the volume of these alarms that specifically relate to critical short half-life infusions and to evaluate user response times to alarms from infusion devices delivering these particular infusions.MethodsThe event logs of 1183 infusion pumps used in critical care environments and in general care areas within the European region were mined for a range of alarm states. The study then focused on a selection of infusion alarms from devices delivering critical short half-life infusions that would warrant rapid attention from clinicians in order to avoid potentially harmful prolonged infusion interruption. The reaction time of clinicians to infusion-interruption states and alarms for the selected critical short half-life infusions was then calculated.ResultsInitial analysis showed a mean average of 4.50 alarms per infusion in the general critical care pump population as opposed to the whole hospital rate of 1.39. In the pediatric intensive care unit (PICU) group, the alarms per infusion value was significantly above the mean average for all critical care areas, with 8.61 alarms per infusion. Infusion-interruption of critical short half-life infusions was found to be a significant problem in all areas of the general critical care pump population, with a significant number of downstream (ie, vein and access) occlusion events noted. While the mean and median response times to critical short half-life infusion interruptions were generally within the half-lives of the selected medications, there was a high prevalence of outliers in terms of reaction times for all the critical short half-life infusions studied.ConclusionsThis study gives an indication of what might be expected in critical care environments in terms of the volume of general infusion alarms and critical short half-life infusion alarms, as well as for clinician reaction times to critical short half-life infusion-interruption events. This study also identifies potentially problematic areas of the hospital for alarm fatigue and for particular issues of infusion and infusion-line management. Application of the proposed protocols can help create benchmarks for pump alarm management and clinician reaction times. These protocols can be applied to studies on the impact of alarm fatigue and for the evaluation of protocols, infusion-monitoring strategies, and infusion pump-based medication safety software aimed at reducing alarm fatigue and ensuring the maintenance of critical short half-life infusions. Given the frequency of infusion alarms seen in this study, the risk of alarm fatigue due to the white noise of pump alarms present in critical care, to which clinicians are constantly exposed, is very high. Furthermore, the added difficulties of maintaining critical short half-life infusions, and other infusions in specialist areas, are made clear by the high ratio of downstream occlusion to infusion starts in the neonatal intensive care unit (NICU). The ability to quantitatively track the volume of alarms and clinician reaction times contributes to a greater understanding of the issues of alarm fatigue in intensive care units. This can be applied to clinical audit, can allow for targeted training to reduce nuisance alarms, and can aid in planning for improvement in the key area of maintenance of steady-state plasma levels of critical short half-life infusions. One clear conclusion is that the medication administration rights should be extended to include right maintenance and ensured delivery continuity of critical short half-life infusions.

Fault diagnosis of wind turbine with SCADA alarms based multidimensional information processing method

This paper presents a first attempt to use Dempster-Shafer (D-S) evidence theory for the fault diagnosis of wind turbine (WT) on SCADA alarm data. As two important elements in D-S evidence theory, identification framework (IF) and Basic Probability Assignment (BPA) are derived from WT maintenance records and SCADA alarm data. A procedure of multi-dimensional information fusion for WT fault diagnosis is presented. The diagnosis accuracy using BPAs obtained from a sample WT and from the wind farm are compared and evaluated. The result shows that D-S evidence theory as a multidimensional information processing method is useful for WT fault diagnosis. Compared to previous SCADA alarms processing methods, the approach proposed predominates at aspects of simple calculation, superior capability on dealing with large volume of alarms through quantifying fault probabilities. It has the advantages of being easy to perform, low cost and explainable, which make it ideal for online application. A self-BPA-generating procedure for future online application with this approach is also provided in this paper. It is concluded that D-S evidence theory applied to SCADA alarm analysis is a valuable approach to intelligent wind farm management.