Alarming Frequency Research Articles

Inpatient-Derived Vital Sign Parameters Implementation: An Initiative to Decrease Alarm Burden.

To implement data-driven vital sign parameters to reduce bedside monitor alarm burden. Single-center, quality-improvement initiative with historical controls assessing the impact of age-based, inpatient-derived heart rate (HR) and respiratory rate (RR) parameters on a 20-bed acute care ward that serves primarily pediatric cardiology patients. The primary outcome was the number of alarms per monitored bed day (MBD) with the aim to decrease the alarms per MBD. Balancing measures included the frequency of missed rapid response team activations, acute respiratory code events, and cardiorespiratory arrest events in the unit with the new vital sign parameters. The median number of all cardiorespiratory monitor alarms per MBD decreased by 21% from 52 (baseline period) to 41 (postintervention period) (P < .001). This included a 17% decrease in the median HR alarms (9-7.5 per MBD) and a 53% drop in RR alarms (16.8-8.0 per MBD). There were 57 rapid response team activations, 8 acute respiratory code events, and no cardiorespiratory arrest events after the implementation of the new parameters. An evaluation of HRs and RRs recorded at the time of the event revealed that all patients with HRs and/or RRs out of range per former default parameters would also be out of range with the new parameters. Implementation of data-driven HR and iteratively derived RR parameters safely decreased the total alarm frequency by 21% in a pediatric acute care unit.

How Much Alarm Can the Human Being Tolerate?

Due to growing technisation of intensive care the number of devices with integrated alarm systems is steadily increasing. However, most of the sounding alarms are false alarms causing high levels of frustration, aggression and inappropriate behaviour amongst the medical personnel. All this jeopardises patient care. The high number of alarms also disturb the patients interrupting their sleep and provokes anxiety, and also increases the already high noise level in intensive care units and the operating theatre alike. In the interest of the medical staff and our patients, we should reduce the high frequency of false alarms by using modern alarm algorithms techniques, lower both noise exposure and stress load with the help of modern individualized alarm systems and by increasing awareness on the dangers of alarm fatigue through training and by using individualized patient-related alarm limits. Despite economic challenges hospitals and intensive care units should optimize staffing, thereby lowering the risk to patients and improving employee satisfaction.

Effects of online synchronous instruction with an attention monitoring and alarm mechanism on sustained attention and learning performance

ABSTRACTMany studies have shown that learners’ sustained attention strongly affects e-learning performance, particularly during online synchronous instruction. This work thus develops a novel attention monitoring and alarm mechanism (AMAM) based on brainwave signals to improve learning performance via monitoring the attention state of individual learners and helping online instructors or teaching assistants to improve the sustained attention levels of learners with low-attention states as they perform online synchronous instruction activities. Totally, 83 and 65 Grade 7 students were randomly assigned to the experimental and control groups that respectively underwent online synchronous instruction with and without AMAM support. Analytical results reveal that the experimental group of learners exhibited significantly better learning performance and sustained attention than those in the control group, verifying that the AMAM efficiently promotes the learning performance and sustained attention of learners. Moreover, the proposed AMAM was more helpful in improving the learning performance of female learners than those of male learners and improved the sustained attention of both male and female learners. Furthermore, the sustained attention, frequency of attention alarms, and learning performance of the learners in the experimental group were strongly correlated, and the sustained attention and frequency of attention alarms strongly predicted learning performance.

Temporal development of collar necroses and butt rot in association with ash dieback

Abstract: In recent years collar necroses and butt rot associated with the ash dieback disease occurred with alarming frequency in Fraxinus excelsior. We analysed tree ring structures to identify the year of necrosis initiation on a set of 507 necroses on 155 stem discs from nine severely diseased south-western German stands. The number of first-time infections of trees was highest from 2010 to 2012 and slightly decreased in 2013 and 2014, whereas the total number of newly emerging individual necroses remained high. Logistic modelling of disease progression suggests that collar rot infection has almost reached its maximum incidence and that a fraction of trees will remain healthy at the root collar. On average, Hymenoscyphus fraxineus was isolated more frequently from younger collar necroses, whereas older necroses were more often colonized by Armillaria spp. Advanced stages of rot that may pose a risk to forest workers, visitors and traffic were observed already in two years-old necroses infected by Armillaria spp.

Automated control of mechanical ventilation during general anaesthesia: study protocol of a bicentric observational study (AVAS)

IntroductionAutomated control of mechanical ventilation during general anaesthesia is not common. A novel system for automated control of most of the ventilator settings was designed and is available on an...

Implementing monitoring technologies in care homes for people with dementia: A qualitative exploration using Normalization Process Theory

BackgroundAgeing societies and a rising prevalence of dementia are associated with increasing demand for care home places. Monitoring technologies (e.g. bed-monitoring systems; wearable location-tracking devices) are appealing to care homes as they may enhance safety, increase resident freedom, and reduce staff burden. However, there are ethical concerns about the use of such technologies, and it is unclear how they might be implemented to deliver their full range of potential benefits. ObjectiveThis study explored facilitators and barriers to the implementation of monitoring technologies in care homes. DesignEmbedded multiple-case study with qualitative methods. SettingThree dementia-specialist care homes in North-West England. ParticipantsPurposive sample of 24 staff (including registered nurses, clinical specialists, senior managers and care workers), 9 relatives and 9 residents. Methods36 semi-structured interviews with staff, relatives and residents; 175h of observation; resident care record review. Data collection informed by Normalization Process Theory, which seeks to account for how novel interventions become routine practice. Data analysed using Framework Analysis. ResultsFindings are presented under three main themes: 1. Reasons for using technologies: The primary reason for using monitoring technologies was to enhance safety. This often seemed to override consideration of other potential benefits (e.g. increased resident freedom) or ethical concerns (e.g. resident privacy); 2. Ways in which technologies were implemented: Some staff, relatives and residents were not involved in discussions and decision-making, which seemed to limit understandings of the potential benefits and challenges from the technologies. Involvement of residents appeared particularly challenging. Staff highlighted the importance of training, but staff training appeared mainly informal which did not seem sufficient to ensure that staff fully understood the technologies; 3. Use of technologies in practice: Technologies generated frequent alarms that placed a burden upon staff, but staff were able to use their contextual knowledge to help to counter some of this burden. Some technologies offered a range of data-gathering capabilities, but were not always perceived as useful complements to practice. ConclusionImplementation of monitoring technologies may be facilitated by the extent to which the technologies are perceived to enhance safety. Implementation may be further facilitated through greater involvement of all stakeholders in discussions and decision-making in order to deepen understandings about the range of potential benefits and challenges from the use of monitoring technologies. Staff training might need to move beyond functional instruction to include deeper exploration of anticipated benefits and the underlying rationale for using monitoring technologies.

뉴로-퍼지 기반의 선박 충돌 회피 조치 분석 시스템 설계

선박 충돌 사고를 예방하기 위해 충돌위험도를 미리 추정하여 알려주는 다양한 연구들이 꾸준히 소개되고 있고, 일부 항해장비에 적용되고 있다. 하지만, 충돌위험을 미리 알려주었을 때, 실제 운항자는 충분히 피항 가능한 상황인데 위험성을 알린다고 판단하여 위험 경고를 무시하거나 장비의 알람 기능을 꺼놓는 경우도 많은 것으로 알려져 있다. 선박 충돌 위험 예측이 운항자들에게 좀 더 유용해지기 위해서는 실제 선박들의 습관화된 충돌 회피 동작을 고려할 필요가 있다. 이 연구는 선박에서의 충돌 회피 조치가 어떻게 이루어지고 있는지 조우 유형별로 분석하고 이력을 관리하기 위한 시스템을 제안한다. 특히, 충돌회피를 위한 초기대응에 대한 적절성을 판단하는 핵심 모듈을 뉴로-퍼지 기반 추론 형태로 상세히 설계하고 테스트함으로써 제안하는 시스템의 타당성을 보인다. Various studies on the method of ship collision risk assessment for alarm have been reported constantly, and the result of the studies is applied to navigation devices. However, it is known that navigators ignore or turn off frequent alarms from the devices of predicting collision risk, because they may avoid collisions in the most of situations. In oder to make the prediction of ship collision risk more useful, it is necessary to consider the customary actions of ship collision avoidance. This paper proposes a system of analyzing collision avoidance measures of ships according to the types of encounter and managing the avoidance history of each ship. The core module of the system is designed as a neuro-fuzzy based inference system, and the test of the module validates the proposed system.

Effect of a Nurse-Managed Telemetry Discontinuation Protocol on Monitoring Duration, Alarm Frequency, and Adverse Patient Events.

Telemetry monitoring is a limited resource. This quality improvement project describes a nurse-managed telemetry discontinuation protocol aimed at stopping telemetry monitoring when it is no longer indicated. After implementing the protocol, data were collected for 6 months and compared with a preintervention time frame. There was a mean decrease in telemetry monitor usage and a decreased likelihood of remaining on a telemetry monitor until discharge. A nurse-managed telemetry discontinuation protocol was effective in decreasing overmonitoring and ensuring telemetry availability.

Integrating Quality and Safety Competencies to Improve Outcomes: Application in Infusion Therapy Practice.

Despite intense scrutiny and process improvement initiatives, patient harm continues to occur in health care with alarming frequency. The Quality and Safety Education for Nursing (QSEN) project provides a roadmap to transform nursing by integrating 6 competencies: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. As front-line caregivers, nurses encounter inherent risks in their daily work. Infusion therapy is high risk with multiple potential risks for patient harm. This study examines individual and system application of the QSEN competencies and the Infusion Nurses Society's 2016 Infusion Therapy Standards of Practice in the improvement of patient outcomes.

Application of cluster nursing intervention based on quality control circle in reducing the alarming frequency of dialysis machine

Objective To investigate the occurrence of alarm of dialysis machine, and analyze the cause of alarm, so as to reduce the frequency of alarm. Methods The quality control circle (QCC) was established in March 2015 and then we managed alarm events of dialysis machine effectively according to the steps of QCC with professional tools and methods. The intangible and tangibleoutcomes before and after activities were compared. Results The frequency of alarm reduced from 0.249 times per hour to 0.120 times per hour after QCC, the alarming frequency of pressure alarm and balance alarming before and after the implementation of intervention were significantly different (χ2= 4.898, 7.339; P<0.05) . Conclusions The alarming frequency of dialysis machine can be effectively reduced by cluster intervention measures. The team cohesive force and the ability of team members with scientific methods to solve practical problems can be improved by QCC management. Key words: Continuous blood purification; Dialysis machine; Cluster nursing intervention; Quality control circle

Consequences of increasing convection onto patient care and protein removal in hemodialysis.

IntroductionRecent randomised controlled trials suggest that on-line hemodiafiltration (OL-HDF) improves survival, provided that it reaches high convective volumes. However, there is scant information on the feasibility and the consequences of modifying convection volumes in clinics.MethodsTwelve stable dialysis patients were treated with high-flux 1.8 m2 polysulphone dialyzers and 4 levels of convection flows (QUF) based on GKD-UF monitoring of the system, for 1 week each. The consequences on dialysis delivery (transmembrane pressure (TMP), number of alarms, % of achieved prescribed convection) and efficacy (mass removal of low and high molecular weight compounds) were analysed.ResultsTMP increased exponentially with QUF (p<0.001 for N >56,000 monitoring values). Beyond 21 L/session, this resulted into frequent TMP alarms requiring nursing staff interventions (mean ± SEM: 10.3 ± 2.2 alarms per session, p<0.001 compared to lower convection volumes). Optimal convection volumes as assessed by GKD-UF-max were 20.6 ± 0.4 L/session, whilst 4 supplementary litres were obtained in the maximum situation (24.5 ± 0.6 L/session) but the proportion of sessions achieving the prescribed convection volume decreased from 94% to only 33% (p<0.001). Convection increased high molecular weight compound removal and shifted the membrane cut-off towards the higher molecular weight range.ConclusionsReaching high convection volumes as recommended by the recent RCTs (> 20L) is feasible by setting an HDF system at its optimal conditions based upon the GKD-UF monitoring. Prescribing higher convection volumes resulted in instability of the system, provoked alarms, was bothersome for the nursing staff and the patients, rarely achieved the prescribed convection volumes and increased removal of high molecular weight compounds, notably albumin.

Quickest detection in the Wiener disorder problem with post-change uncertainty

We consider the problem of quickest detection of an abrupt change when there is uncertainty about the post-change distribution. In particular, we examine this problem in the continuous-time Wiener model where the drift of observations changes from zero to a random drift with a prescribed discrete distribution. We set up the problem as a stochastic optimization in which the objective is to minimize a measure of detection delay subject to a constraint on frequency of false alarms. We design a novel composite stopping rule and prove that it is asymptotically optimal of third order under a weighted Lorden’s criterion for detection delay. We also develop the strategy to identify the post-change drift and analyze the conditional identification error asymptotically. Our composite rules are based on CUSUM stopping times, as well as their reaction periods, namely the times between the last reset of the CUSUM statistic process and the CUSUM alarm. The established results shed new light on the performance of CUSUM strategies under model uncertainty and offer strong asymptotic optimality results in this framework.

Consideration about the blood vacuum pressure and the alarm frequency of occurrence by the difference in the vascular access hemodialysis catheters

Consideration about the blood vacuum pressure and the alarm frequency of occurrence by the difference in the vascular access hemodialysis catheters

Editors' Choice—Field Trials Testing of Mixed Potential Electrochemical Hydrogen Safety Sensors at Commercial California Hydrogen Filling Stations

Hydrogen safety sensors must meet specific performance requirements, mandated by the U.S. Department of Energy, for hydrogen fueling station monitoring. Here, we describe the long-term performance of two zirconia-based mixed potential electrochemical hydrogen gas sensors, developed specifically with a high sensitivity to hydrogen, low cross-sensitivity, and fast response time. Over a two-year period, sensors with tin-doped indium oxide and strontium doped lanthanum chromite electrodes were deployed at two stations in four field trials tests conducted in Los Angeles. The sensors documented the existence of hydrogen plumes ranging in concentration from 100 to as high as 2700 ppm in the area surrounding the dispenser, consistent with depressurization from 700 bar following vehicle refueling. As expected, the hydrogen concentration reported by the mixed potential sensors was influenced by wind direction. Baseline stability testing at a Chino, CA station showed no measureable baseline drift throughout 206 days of uninterrupted data acquisition. The high baseline stability, excellent correlation with logged fueling/depressurization events, and absence of false alarms suggest that the zirconia-based mixed potential sensor platform is a good candidate for protecting hydrogen infrastructure where frequent calibrations or sensor replacement to reduce the false alarm frequency have been shown to be cost prohibitive.

퍼지와 DEVS를 이용한 선박 충돌 위험 예측 모델 설계

선박에 현대화된 다양한 항해장비들이 설치됨에도 불구하고 여전히 해양사고가 자주 일어나는데, 이런 사고의 주요 형태 중 하나가 충돌 사고이다. 우리나라 해양사고의 약 1/4이 충돌에 의한 사고이고, 이 중 대부분이 인적오류가 원인인 것으로 알려져 있다. 따라서, 항해사의 의사결정을 도울 수 있는 지능적인 지원 도구가 필요한데, 이와 관련하여 충돌위험을 추정하는 다양한 방식들이 꾸준히 소개되어 왔으며 충돌위험 상황에 대해 사람에게 친숙한 언어적 표현을 반영하여 추론하기 위해 퍼지를 활용한 연구 결과들이 많다. 이런 기존 연구들의 충돌위험도는 현재시점에서 선박들의 속도나 방향 상태가 유지되는 것을 기준으로 충돌위험도를 추정한다. 그러나, 실제 선박에서는 충분히 피항 가능 상황임에도 불구하고 충돌 위험으로 판단되어 잦은 경고를 울리는 시스템들에 대해 항해사들이 느끼는 불편함이 적지 않아 보조 장치들의 알람 기능을 꺼놓은 경우도 많은 것으로 알려져 있다. 이 연구는 선박들의 일반적인 피항 패턴을 반영한 가까운 미래 시점의 충돌위험도 예측에 관한 것으로서, 퍼지추론과 DEVS 형식론에 기반한 충돌 위험 예측 모델을 제안한다. Even thought modernized marine navigation devices help navigators, marine accidents has been often occurred and ship collision is one of the main types of the accidents. Various studies on the assessment method of collision risk have been reported, and studies using fuzzy theory are remarkable for the reason that reflect linguistic and ambiguous criteria for real situations. In these studies, collision risks were assessed on the assumption that the current state of navigation ship would be maintained. However, navigators ignore or turn off frequent alarms caused by the devices predicting collision risk, because they think that they can avoid the collisions in the most of situations. This paper proposes a model of predicting ship collision risk considering the general patterns of collision avoidance, and the approach is based on fuzzy inference and discrete event system specification (DEVS) formalism.

Data-Driven Implementation of Alarm Reduction Interventions in a Cardiovascular Surgical ICU

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.

Long-term monitoring of cardiorespiratory patterns in drug-resistant epilepsy.

Sudden unexplained death in epilepsy (SUDEP) during inpatient electroencephalography (EEG) monitoring has been a rare but potentially preventable event, with associated cardiopulmonary markers. To date, no systematic evaluation of alarm settings for a continuous pulse oximeter (SpO2 ) has been performed. In addition, evaluation of the interrelationship between the ictal and interictal states for cardiopulmonary measures has not been reported. Patients with epilepsy were monitored using video-EEG, SpO2 , and electrocardiography (ECG). Alarm thresholds were tested systematically, balancing the number of false alarms with true seizure detections. Additional cardiopulmonary patterns were explored using automated ECG analysis software. One hundred ninety-three seizures (32 generalized) were evaluated from 45 patients (7,104 h recorded). Alarm thresholds of 80-86% SpO2 detected 63-73% of all generalized convulsions and 20-28% of all focal seizures (81-94% of generalized and 25-36% of focal seizures when considering only evaluable data). These same thresholds resulted in 25-146 min between false alarms. The sequential probability of ictal SpO2 revealed a potential common seizure termination pathway of desaturation. A statistical model of corrected QT intervals (QTc), heart rate (HR), and SpO2 revealed close cardiopulmonary coupling ictally. Joint probability maps of QTc and SpO2 demonstrated that many patients had baseline dysfunction in either cardiac, pulmonary, or both domains, and that ictally there was dissociation-some patients exhibited further dysfunction in one or both domains. Optimal selection of continuous pulse oximetry thresholds involves a tradeoff between seizure detection accuracy and false alarm frequency. Alarming at 86% for patients that tend to have fewer false alarms and at 80% for those who have more, would likely result in a reasonable tradeoff. The cardiopulmonary findings may lead to SUDEP biomarkers and early seizure termination therapies.

Psychological outcomes of evening and night closed-loop insulin delivery under free living conditions in people with Type 1 diabetes: a 2-month randomized crossover trial.

AimTo assess the impact on fear of hypoglycaemia and treatment satisfaction with an artificial pancreas system used for 2 consecutive months, as well as participant acceptance of the artificial pancreas system.MethodsIn a randomized crossover trial patient‐related outcomes associated with an evening‐and‐night artificial pancreas and sensor‐augmented pump therapy were compared. Both intervention periods lasted 8 weeks. The artificial pancreas acceptance questionnaire (range 0–90, higher scores better), Hypoglycaemia Fear Survey II (range 0–72, higher scores worse) and Diabetes Treatment Satisfaction Questionnaire (range 0–36, higher scores better) were completed by 32 participants. Semi‐structured interviews were conducted after study completion in a subset of six participants. Outcomes were compared using a repeated‐measures anova model or paired t‐test when appropriate.ResultsThe total artificial pancreas acceptance questionnaire score at the end of the artificial pancreas period was 69.1 (sd 14.7; 95% CI 63.5, 74.7), indicating a positive attitude towards the artificial pancreas. No significant differences were found among the scores at baseline, end of sensor‐augmented pump therapy period or end of the artificial pancreas period with regard to fear of hypoglycaemia [28.2 (sd 17.5), 23.5 (sd 16.6) and 23.5 (sd 16.7), respectively; P = 0.099] or diabetes treatment satisfaction [29.0 (sd 3.9), 28.2 (sd 5.2) and 28.0 (sd 7.1), respectively; P = 0.43]. Themes frequently mentioned in the interviews were ‘positive effects at work’, ‘improved blood glucose’, ‘fewer worries about blood glucose’, but also ‘frequent alarms’, ‘technological issues’ and ‘demand for an all‐in‐one device’.ConclusionsThe psychological outcomes of artificial pancreas and sensor‐augmented pump therapy were similar. Current artificial pancreas technology is promising but user concerns should be taken into account to ensure utility of these systems.

Associations Between the Self-Reported Frequency of Hearing Chemical Alarms in Theater and Visuospatial Function in Gulf War Veterans.

The aim of this study was to examine the relationship between the self-reported frequencies of hearing chemical alarms during deployment and visuospatial function in Gulf War (GW) veterans. The relationship between the self-reported frequency of hearing chemical alarms, neurobehavioral, and volumetric brain imaging data was examined with correlational, regression, and mediation analyses. The self-reported frequency of hearing chemical alarms was inversely associated with and significantly predicted performance on a visuospatial task (ie, Block Design) over and above potentially confounding variables, including concurrent, correlated GW-related exposures. This effect was partially mediated by the relationship between hearing chemical alarms and lateral occipital cortex volume. Exposure to substances that triggered chemical alarms during GW deployment likely had adverse effects on veterans' brain structure and function, warranting further investigation of whether these GW veterans are at an increased risk for dementia.

Cooperative warning systems: The impact of false and unnecessary alarms on drivers’ compliance

Cooperative warning systems have a great potential to prevent traffic accidents. However, because of their predictive nature, they might also go along with an increased frequency of incorrect alarms that could limit their effectiveness. To better understand the consequences associated with incorrect alarms, a driving simulator study with N=80 drivers was conducted to investigate how situational context and warning urgency jointly influence drivers’ compliance with an unreliable advisory warning system (AWS). The participants encountered several critical urban driving situations and were either assisted by a 100% reliable AWS, a 60% reliable AWS that generated false alarms (without obvious reason) or a 60% reliable AWS that generated unnecessary alarms (with plausible reason). A baseline drive without any assistance was also introduced to the study. The warnings were presented either only visually or visual-auditory. In line with previous research, drivers’ compliance and effectiveness of the AWS was reduced by false alarms but not by unnecessary alarms. However, this so-called cry wolf effect (Breznitz, 1984) was only found in the visual-auditory condition, whereas there was no effect of warning reliability in the condition with visual AWS. Furthermore, false but not unnecessary alarms caused the participants to rate the AWS less favourably during a follow-up interview. In spite of these negative effects of false alarms, a reduction in the frequency of safety-critical events (SCEs) and an earlier braking onset were evident in all assisted drives compared with that of non-assisted driving, even when the AWS was unreliable. The results may thus lower concerns about the negative consequences of warning drivers unnecessarily about upcoming traffic conflicts if the reasons of these alarms are comprehensible. From a perspective of designing AWS, we recommend to use less urgent warnings to prevent the cry wolf effect.