Alarm Fatigue Research Articles

Polish Adaptation of the Alarm Fatigue Assessment Questionnaire as an Element of Improving Patient Safety.

Medical personnel, working in medical intensive care units, are exposed to fatigue associated with alarms emitted by numerous medical devices used for diagnosing, treating, and monitoring patients. Alarm fatigue is a safety and quality problem in patient care and actions should be taken to reduce this by, among other measures, building an effective safety culture. In the present study, an adaptation of a questionnaire to assess alarm fatigue was carried out. The study obtained good reliability of the questionnaire at Cronbach's alpha level of 0.88. The Polish research team has successfully adapted the Alarm Fatigue Assessment Questionnaire so that it can be used in healthcare settings as a tool to improve patient safety.

Smart care for dealing with nurses' alarm fatigue in the intensive care unit.

Alarm fatigue is a condition in which a person experiences sensory overload or desensitization in exposure to frequent non-actionable alarms. Nurses are the main users of alarms in health care and their behaviors for alarm management influence the occurrence of alarm fatigue. This qualitative research aimed to explore strategies used by nurses in dealing with nurses' alarm fatigue in the intensive care unit (ICU). Qualitative research was carried out. Eighteen nurses working in ICUs were selected purposefully and were invited to take part in individual semi-structured interviews. Collected data were analyzed using content analysis for developing categories and subcategories. Twelve ICUs in ten hospitals in four urban areas of Iran. The research's main category was "smart care" consisting of two categories of "technologic actions" and "non-technologic actions." Also, six subcategories were developed: "identifying the cause and taking timely actions", "personalized alarm settings", "reducing the number of unnecessary alarms", "effective teamwork", "improving the physical environment and ward arrangement", and "self-calmness". Smart care by nurses included a set of active and proactive interventions developed through thinking and reflection and the use of information, skills, and experiences in order to manage exposure to alarm fatigue. Strategies used by nurses to prevent alarm fatigue can reduce the physical and psychological burden caused by frequent exposure to alarms in the ICU and consequently can have direct impacts on the quality and safety of nursing care. Nurses in the healthcare process often experience alarm fatigue that is influenced by the cultural-contextual aspect of care and the care environment. Smart care in terms of technologic and non-technologic actions helps with the prevention of alarm fatigue.

Assessment of Alarm Fatigue Risk Among Oncology Nurses in Jordan.

Using technology in the clinical setting where clinical alarms frequently occur, resulting in many false alarms, which is called alarm fatigue, alarm fatigue may increase nurses' distraction, and that might negatively affect patient safety. This study aimed to assess alarm fatigue among oncology nurses in Jordan. A descriptive cross-sectional design was used in a non-profit specialized cancer center. A self-reported questionnaire was answered by nurses who participated in the study. A total of 222 questionnaires were analyzed with a more than 95% response rate. More than half of the sample (60.4%) were females. The participants were young nurses with a mean age of 25.18 ± 3.33 years. The total mean score of alarm fatigue was 31.62 ± 7.14 on a scale ranging from zero to 52. Post-hoc analysis showed that the palliative unit (25.73 ± 7.22) and emergency room (28.73 ± 6.62) had low scores of total mean alarm fatigue than remaining area of practice, such as the ICU (33.92 ± 6.99); p-value: .004. Alarm fatigue is a global issue affecting many practice areas. An educational program is recommended for nurses to learn how to deal with alarm fatigue. In order to effectively manage alarms, nurses' education and individual training are crucial.

Determinants of Medical Equipment Alarm Fatigue in Practicing Nurses: A Systematic Review

Objective This study aimed to systematically evaluate the level of medical equipment alarm fatigue and its influencing factors among clinical nurses. Methods PubMed, Embase, CNKI, and Wanfang databases were systematically searched to identify articles on alarm fatigue of clinical nurses published before September 25, 2022. According to the evaluation criteria of prevalence studies recommended by JBI Evidence-Based Health Care Center, the quality of the literature meeting the inclusion criteria was evaluated, and Stata MP17 software was used for meta-analysis. Results A total of 14 cross-sectional studies were included, with a total sample of 2,848 nurses. The results showed that the alarm fatigue score of clinical nurses was 21.76 (95% CI [20.27, 23.25]). Subgroup analysis showed that the nurses who worked night shift and had lower professional title had higher alarm fatigue. Conclusion The alarm fatigue of clinical nurses was at a moderate level. To reduce the alarm fatigue level of clinical nurses, nursing managers should strengthen the alarm safety awareness of nurses, rationally arrange nurse manpower, carry out training to actively improve the alarm management ability of nurses, and optimize the alarm level and frequency of alarm equipment.

Alarm fatigue: Can Indian intensive care unit nurses keep up with the noise and maintain their edge?

ABSTRACT Alarm fatigue has become a significant concern for intensive care unit (ICU) nurses. The incessant flood of alarms can result in desensitization, negatively affecting both nurses and consequently, patient care. This article delves into the struggles ICU nurses encounter due to alarm fatigue, its repercussions, and potential strategies to tackle the problem. By comprehending and addressing alarm fatigue, healthcare professionals can foster a safer and more efficient work environment for ICU nurses.

The Affects of False Alarms on Alarm Fatigue in the ICU

Objective: Analyze the effect of false alarms on alarm fatigue in ICU nursesDesign: Quasi-Experimental, Mixed Method, ComparativeSetting: Intensive Care Unit of Hays Medical Center Participants: Intensive Care Unit Nurses Results/Conclusions: Pending Results and Data Collection

Clinician Perspectives on Specifications for Metrics to Inform Pediatric Alarm Management.

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.

Technological Intervention to Improve Alarm Management in Acute Care Telemetry Units.

Background: Telemetry monitoring is intended to improve patient safety and reduce harm. However, excessive monitor alarms may have the undesired effect of staff ignoring, silencing, or delaying a response due to alarm fatigue. Outlier patients, or those patients who are responsible for generating the most monitor alarms, contribute to excessive monitor alarms. Methods: Daily alarm data reports at a large academic medical center indicated that one or two patient outliers generated the most alarms daily. A technological intervention aimed at reminding registered nurses (RNs) to adjust alarm thresholds for patients who triggered excessive alarms was implemented. The notification was sent to the assigned RN's mobile phone when a patient exceeded the unit's seven-day average of alarms per day by greater than 400%. Results: A reduction in average alarm duration was observed across the four acute care telemetry units (P < 0.001), with an overall decrease of 8.07 seconds in the postintervention versus preintervention period. However, alarm frequency increased significantly (χ23 = 34.83, P < 0.001). Conclusion: Implementing a technological intervention to notify RNs to adjust alarm parameters may reduce alarm duration. Reducing alarm duration may improve RN telemetry management, alarm fatigue, and awareness. More research is needed to support this conclusion, as well as to determine the cause of the observed increase in alarm frequency.

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)

Combating Alert Fatigue in the Security Operations Centre

Combating Alert Fatigue in the Security Operations Centre

The influence of patient characteristics on the alarm rate in intensive care units: a retrospective cohort study

Intensive care units (ICU) are often overflooded with alarms from monitoring devices which constitutes a hazard to both staff and patients. To date, the suggested solutions to excessive monitoring alarms have remained on a research level. We aimed to identify patient characteristics that affect the ICU alarm rate with the goal of proposing a straightforward solution that can easily be implemented in ICUs. Alarm logs from eight adult ICUs of a tertiary care university-hospital in Berlin, Germany were retrospectively collected between September 2019 and March 2021. Adult patients admitted to the ICU with at least 24 h of continuous alarm logs were included in the study. The sum of alarms per patient per day was calculated. The median was 119. A total of 26,890 observations from 3205 patients were included. 23 variables were extracted from patients' electronic health records (EHR) and a multivariable logistic regression was performed to evaluate the association of patient characteristics and alarm rates. Invasive blood pressure monitoring (adjusted odds ratio (aOR) 4.68, 95%CI 4.15–5.29, p < 0.001), invasive mechanical ventilation (aOR 1.24, 95%CI 1.16–1.32, p < 0.001), heart failure (aOR 1.26, 95%CI 1.19–1.35, p < 0.001), chronic renal failure (aOR 1.18, 95%CI 1.10–1.27, p < 0.001), hypertension (aOR 1.19, 95%CI 1.13–1.26, p < 0.001), high RASS (aOR 1.22, 95%CI 1.18–1.25, p < 0.001) and scheduled surgical admission (aOR 1.22, 95%CI 1.13–1.32, p < 0.001) were significantly associated with a high alarm rate. Our study suggests that patient-specific alarm management should be integrated in the clinical routine of ICUs. To reduce the overall alarm load, particular attention regarding alarm management should be paid to patients with invasive blood pressure monitoring, invasive mechanical ventilation, heart failure, chronic renal failure, hypertension, high RASS or scheduled surgical admission since they are more likely to have a high contribution to noise pollution, alarm fatigue and hence compromised patient safety in ICUs.

ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes.

ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes.

The Overriding of Computerized Physician Order Entry (CPOE) Drug Safety Alerts Fired by the Clinical Decision Support (CDS) Tool: Evaluation of Appropriate Responses and Alert Fatigue Solutions.

Introduction Most computerized physician order entry (CPOE) software come with clinical decision-support components (CDS) that provide prescribers assistance and notify them about adverse drug reactions. An excessive number of alerts in a repeated and non-relevant manner leads to alert fatigue and enforces physicians and pharmacists to alert overrides. King Abdulaziz Medical City (KAMC) in Jeddah still reports a higher percentage of drug alerts overridden by clinicians and pharmacists. Thus, this study was conducted to evaluate CDS alerts overriding and to determine which alerts are clinically irrelevant and need modifications. Methods The study was carried out in the inpatient setting at KAMC in Jeddah, from September 1, 2020, to December 31, 2020. It was designed as a retrospective chart review study that included all red alerts that required comments and were overridden by a physician and pharmacist. Results Among 11350 red alerts, potential drug-drug interaction (pDDI), dose, and allergy alerts represent 57%, 41%, and 2%, respectively, of the total alerts. The most common drug-drug interactions (DDIs) in category X were proton pump inhibitors and clopidogrel (9.9%). The appropriate response by prescribers and pharmacists toward allergy alerts was associated with the highest odds compared with the other alerts (p < 0.05) while there is a significant decrease in the odds of appropriate action being taken by both prescribers and pharmacists in the dose screen alerts (p < 0.05).Among all clinical specialties, there is an increased odds of appropriate action being taken by residents and fellows for allergy and dose alerts, respectively, compared to other groups (p < 0.05). For diminishing the unnecessary alerts, we provided 14 alert refinements strategies andadvised turning off four alerts. Applying this will terminate 32% of irrelevant alerts. Conclusion Our study's findings indicated that a substantial number of alerts are ignored, and the rate of appropriateness varies significantly by alert type and prescriber level.

Abstract 13205: Mitigating Alarm Fatigue and Improving the Care Provider, Patient, and Family Experience Through Reduction in Non-Actionable Bedside Alarms

Introduction: The burden of bedside alarms is a well-established patient safety hazard with &gt;85% of alarms in ICU settings considered non-actionable or “false alarms”. Healthcare providers risk developing alarm fatigue with potential for prolonged response times and silencing of clinically meaningful alarms. Additionally, alarms disrupt care and cause stress for patients and families. Hypothesis: Creating conditional alarm triggers for bedside monitors can decrease the frequency of non-actionable alarms without compromising safety. The decreased burden of alarms on nurses, patients, and families may promote increased satisfaction. Methods: Single center, quality improvement initiative in a 26-bed cardiac acute care unit and 36-bed pediatric ICU, modeled after successful iterative effort at another tertiary children’s hospital. After 1 month pre-intervention observation of bedside monitor alarm burden, monitors were programmed with hierarchical time delay and conditional pulse oximetry, respiratory rate, and premature ventricular contractions alarm triggers. Bedside alarms were tallied for 1-month follow-up. The primary outcome was alarms per monitored patient day (MPD). Results: A total of 1394 and 776 MPD were evaluated in the pre- and post-intervention periods, respectively. The median number of cardiorespiratory monitor alarms per MPD decreased by 73% (15 to 4, p &lt; 0.001) in both acute care and ICU. Alarm burden in RR, SpO2, and PVC categories also decreased. No increase in frequency of rapid response or code events occurred in either unit. Nursing surveys (n=253) reported positive trends of more manageable alarm burden and decreased perceived number of alarms. Family surveys (n=160), however, reported decreased sleep quality and increased perceived alarms. Conclusions: Implemented changes to bedside monitor alarm conditions decreased total alarm frequency in both cardiac acute care and pediatric ICU without compromising safety.

Evaluating Alarm Classifiers with High-confidence Data Programming

Classification of clinical alarms is at the heart of prioritization, suppression, integration, postponement, and other methods of mitigating alarm fatigue. Since these methods directly affect clinical care, alarm classifiers, such as intelligent suppression systems, need to be evaluated in terms of their sensitivity and specificity, which is typically calculated on a labeled dataset of alarms. Unfortunately, the collection and particularly labeling of such datasets requires substantial effort and time, thus deterring hospitals from investigating mitigations of alarm fatigue. This article develops a lightweight method for evaluating alarm classifiers without perfect alarm labels. The method relies on probabilistic labels obtained from data programming—a labeling paradigm based on combining noisy and cheap-to-obtain labeling heuristics. Based on these labels, the method produces confidence bounds for the sensitivity/specificity values from a hypothetical evaluation with manual labeling. Our experiments on five alarm datasets collected at Children’s Hospital of Philadelphia show that the proposed method provides accurate bounds on the classifier’s sensitivity/specificity, appropriately reflecting the uncertainty from noisy labeling and limited sample sizes.

76 Understanding practice change around intermittent versus continuous pulse oximetry in infants hospitalized with bronchiolitis: a multi-centre qualitative study

Abstract Background Bronchiolitis is the most common reason for hospitalization in infants and is cumulatively costly for the healthcare system. Trial evidence and national guidelines support the routine use of intermittent pulse oximetry in stabilized (no oxygen supplementation) infants with bronchiolitis. However, continuous pulse oximetry use is common. Objectives To understand the barriers and facilitators important to de-implementing continuous pulse oximetry and implementing intermittent pulse oximetry in stabilized infants hospitalized with bronchiolitis. Design/Methods From December 2018 to January 2020, participants were recruited from six Ontario hospitals (3 community and 3 paediatric hospitals) in a multi-centre qualitative study. Focus groups were conducted with staff paediatricians, paediatric residents, nurses, and respiratory therapists. Interviews were conducted with caregivers of infants recently hospitalized with bronchiolitis. Participants' beliefs, attitudes, and experiences related to pulse oximetry use in bronchiolitis management were explored. Recordings were transcribed and analyzed using thematic analysis via NVivo software to understand barriers and facilitators to practice change. These were then mapped to the domains and the constructs of the Consolidated Framework for Implementation Research (CFIR). Results 67 individuals from six hospitals participated. Themes relevant to understanding barriers and facilitators to de-implementing continuous and implementing intermittent monitoring were identified. Healthcare professionals emphasized the importance of identifying and understanding who is responsible for bedside monitoring practice (physician vs. nurses). Clinical experience, knowledge of guidelines (international and local practice), importance relative to competing priorities, and the tensions amongst team members due to practice variation all influenced monitoring practice. Nurses held beliefs around the advantages of intermittent monitoring (e.g., reduced alarm fatigue, facilitation of timely discharges and reduced workload). Clinicians identified ways to clarify indications for ongoing continuous monitoring (e.g., based on clinical risk factors such as medical complexity, prematurity, and age), vs. indications to transition to intermittent monitoring (e.g., established oral feeding, sleeping without desaturations, and off supplemental oxygen). Caregivers did not express a clear preference for monitoring type, but described the stress of having a child admitted to hospital with an emphasis on the need for clear communication around the interpretation of monitors, management decisions, and care transitions. Conclusion In this multi-centre qualitative study of clinicians and caregivers, we identified barriers and facilitators that are important to de-implementing continuous monitoring and implementing intermittent monitoring. Understanding professional roles, clarity around local practice standards and supporting families' understanding of pulse oximetry monitoring practices are essential for practice change.

DualAC2NN: Revisiting and Alleviating Alert Fatigue from the Detection Perspective

The exponential expansion of Internet interconnectivity has led to a dramatic increase in cyber-attack alerts, which contain a considerable proportion of false positives. The overwhelming number of false positives cause tremendous resource consumption and delay responses to the really severe incidents, namely, alert fatigue. To cope with the challenge from alert fatigue, we focus on enhancing the capability of detectors to reduce the generation of false alerts from the detection perspective. The core idea of our work is to train a machine-learning-based detector to grasp the empirical intelligence of security analysts to estimate the feasibility of an incoming HTTP request to cause substantial threats, and integrate the estimation into the detection stage to reduce false alarms. To this end, we innovatively introduce the concept of attack feasibility to characterize the composition rationality of an inbound HTTP request as a feasible attack under static scrutinization. First, we adopt a fast request-reorganization algorithm to transform an HTTP request into the form of interface:payload pair for further alignment of structural components which can reveal the processing logic of the target program. Then, we build a dual-channel attention-based circulant convolution neural network (DualAC2NN) to integrate the attack feasibility estimation into the alert decision, by comprehensively considering the interface sensitivity, payload maliciousness, and their bipartite compatibility. Experiments on a real-world dataset show that the proposed method significantly reduces invalid alerts by around 86.37% and over 61.64% compared to a rule-based commercial WAF and several state-of-the-art methods, along with retaining a detection rate at 97.89% and a lower time overhead, which indicates that our approach can effectively mitigate alert fatigue from the detection perspective.

Individualized Dynamic Patient Monitoring Under Alarm Fatigue

Individualized Patient Monitoring Under Alarm Fatigue Hospitals are rife with alarms, many of which are false. This leads to alarm fatigue, in which clinicians become desensitized and may inadvertently ignore real threats. “Individualized Dynamic Patient Monitoring Under Alarm Fatigue” by Piri, Huh, Shechter, and Hudson studies the problem of personalizing alarm thresholds for vital signs at a hospital while considering the ”boy who cried wolf” effect of false alarms. The authors create a model that learns patients’ personal alarm thresholds during their hospital stay and updates their alarm settings dynamically. They formulate the problem as a partially observable Markov decision process. They provide structural properties of the optimal policy and perform a numerical case study based on clinical data from an intensive care unit. They show that dynamic methods of alarm settings that explicitly consider the feedback loop of false positives can significantly reduce patient harm when compared with current methods of alarm settings.

Resident and nurse perspectives on the use of secure text messaging systems.

As hospitals shift away from pagers and towardssecure text messaging systems (STMS), limited research exists on the drawbacks of such systems. Preliminary data show that introduction of STMS can lead to a dramatic increase in interruptions, which may contribute to medical errors. This study aimed to investigate residents' and nurses' experiences with STMS at a quaternary care children's hospital. This was a qualitative study with focus groups. Participants were pediatric residents and nurses at Lucile Packard Children's Hospital. Focus groups were audio recorded, transcribed verbatim, and coded by 2 independent coders. Codes were discussed until consensus was reached. Data was analyzed through a thematic, descriptive content analysis approach. Themes were developed alongside a framework of teamwork, patient safety, and clinician well-being. Three resident focus groups (n = 14) and three nurse focus groups (n = 21) were held. Six themes were identified: (1) STMS can facilitate teamwork through multiple communication modalities and technological features. (2) STMS can negatively impact teamwork by decreasing face-to-face communication and frontline decision-making. (3) STMS can promote patient safety through closed-loop communication and ready access to team members. (4) STMS can negatively impact patient safety through alarm fatigue, interruptions, and miscommunication. (5) STMS can positively impact clinician well-being through satisfaction and relationship building. (6) STMS can negatively impact clinician well-being through increased stress related to communication volume. Use of STMS in the hospital setting has many advantages as well as drawbacks. With appropriate guidelines and training designed to mitigate the drawbacks, STMS have the potential to be valuable means of communication for healthcare team members.

Creating Meaningful Alerts and Reducing Alert Fatigue: Strategies Implemented by Informatics Pharmacists to Optimize Dose Range Checking Alerts in a Multihospital Health System.

Background: Among the many clinical decision support (CDS) mechanisms available in electronic health record (EHR) systems, dose range checking (DRC) is one of the most impactful safeguard tools integrated within most computerized provider order entry (CPOE) workflows. Unfortunately, improper configurations and lack of resources to maintain and monitor CDS systems can hinder and even disrupt daily clinical operations. Objective: This article seeks to highlight the impact that informatics pharmacists can make by implementing different strategies to decrease nuisance alerts and create clinically meaningful DRC alerts that guide clinicians in their practice. Methods: Following the activation of the DRC application for 3623 medication groupers (ie, generic drugs and all their dosage form variations), informatics pharmacists implemented strategies to monitor DRC alert output and decrease the number of inappropriate alerts. Such strategies included weekly monitoring of alerts, modification of order sentences (including dose, route, and age/weight filters), update to the rule triggering the alerts, and modifications of the preference settings. Results: From July to September 2018, an average of 70 DRC tables were reviewed by informatics pharmacists, reducing the number of overridden DRC alerts to 4796 in the first week of September-a 63% decrease in a 3-month period. Conclusions: By reducing the number of DRC nuisance alerts and improving the clinical content of DRC alerts, informatics pharmacists can contribute to lowering alert fatigue and improving providers' trust in CDS alerts.