Exploring experiences of alarm response and alarm fatigue among nurses working in the ICU of a tertiary care hospital in Karachi, Pakistan: A qualitative study

Background: Alarm fatigue is a significant concern within the healthcare sector, marked by the excessive exposure of healthcare practitioners to clinical alarms. This prolonged exposure can result in desensitization and delay nurse’s responsiveness to vital warnings. The occurrence of inaccurate alarms intensifies desensitization, undermining confidence in alarm systems and potentially leading nurses to ignore alarms. Alarm fatigue is a prevalent issue of worldwide significance, which calls for more investigation to effectively tackle these issues and enhance understanding of alarm systems to get the best possible treatment results. However, there is a lack of study undertaken in Pakistan about the investigation regarding response of intensive care unit (ICU) nurses to clinical alarms and their understanding of alarm fatigue.Purpose: The objectives of this study are to describe the type and criticality of alarms produced by machines at the patient’s bedside and explore the experiences of alarm response and alarm fatigue among nurses working in the ICU of a tertiary care hospital in Karachi, Pakistan.Methodology: This study used an observational descriptive exploratory methodology to investigate the experiences of alarm response and alarm fatigue among nurses working in the ICU. The research was conducted in an 11-bed intensive care unit, with nurses selected through purposive sampling. Data was collected through observations (camera and documentation) and interviews, and the findings were analyzed through content analysis. Moreover, synergy model was used as a theoretical framework for this study.Finding: The study investigated how nurses respond to clinical alerts and their perception of alarm fatigue. The observational findings highlighted a diverse range of alarms and demonstrated variations in nurse responses to these alerts. Additionally, the observations identified discrepancies between the alarms set on monitors and those documented on the flowsheet. The content analysis study identified five key themes: Alarm setting guarantees patient Safety, Alarms response follows standards and patient priority, alarm driven nurse’s actions, alarm fatigue exists and is dangerous, alarm fatigue can be combat. Moreover, the study illuminates the consequences of alarm desensitization and explores methods to alleviate alarm fatigue.Conclusion: The findings of the study offer crucial suggestions for nursing leaders and administrators to enact policies aimed at reducing alarm fatigue among nurses. The recommendations encompass the implementation of procedures aimed at prioritizing alerts according to their level of criticality, the provision of education and training programs focused on the appropriate handling of alarms, and the frequent evaluation of the efficacy of existing alarm systems

Clinical deterioration detection for continuous vital signs monitoring using wearable sensors

Surgical patients are at risk of experiencing clinical deterioration events, especially when transferred to general wards during the postoperative period of their hospital stay. Cur rently, such events are detected by combining Early Warning Scores (EWS) with manual and periodical vital signs measurements, performed by nurses every 4 to 6 hours. Hence, deterioration may remain unnoticed for hours, delaying patient treatment, which might lead to increased morbidity and mortality. Also, EWS are inadequate to predict events so physiologically complex. So that early warning of deterioration could be provided, it was investigated the potential of warning systems that combine machine learning-based prediction models with continuous vital signs monitoring, provided by wearable sensors. This dissertation presents the development of such a warning system, fully indepen dent of manual measurements and based on a logistic regression prediction model with 85% sensitivity, 79% precision and 98% specificity. Additionally, a new personalized ap proach to handle missing data periods in vital signs and a novel variation of a RR-interval preprocessing technique were developed. The results obtained revealed a relevant im provement in the detection of deterioration events and a significant reduction in false alarms, when comparing the warning system with a commonly employed EWS (42% sensitivity, 14% precision and 90% specificity). It was also found that the developed sys tem can assess patient’s condition much more frequently and with timely deterioration detection, without even requiring nurses to interrupt their workflow. These findings sup port the idea that these warning systems are reliable, more practical, more appropriate and produce smarter alarms than current methods, making early deterioration detection possible, thus contributing for better patients outcomes. Nonetheless, the performance achieved may yet reveal insufficient for application in real clinical contexts. Therefore, further work is necessary to improve prediction performance to a greater extent and to confirm these systems reliability

Using mobile phones to improve medication compliance and awareness for cardiac patients

Improving cardiac patients' medication compliance is a major factor in reducing mortality rate and reducing hospitalization rate. This paper describes a novel medication compliance management system. Its novelty lies in the combination of functionalities that helps the patient to comply with their medication regimen, together with a personal health monitoring system that monitors their health and collects vital signs data using a mobile phone and wireless bio sensors. The system is designed to collect and analyse medication compliance, side effects and symptom responses and transfers the collected data in real time to a web based system for remote monitoring by caregivers and health professionals. Health professionals can use the system to assess the effect of the medication regimen on their patients' health and adapt it to reduce side effects and maximise the patient's wellbeing. Copyright © 2010 ACM

Education for LTACH Nurses on Clinical Monitoring Systems

Alarm fatigue is a patient safety issue. The gap identified in practice is that nurses did not know how to navigate the monitoring system properly such that improper use of the alarm system was the result, which compromised patient safety. The goal of this project aimed to fill the gap in knowledge and skill among the staff and improve the confidence level among nurses by providing an educational program. The practice-focused question focused on whether knowledge, skills, and confidence would increase among nurses after receiving education on the clinical monitoring system. The model to facilitate organizing and analyzing this project was Rosswurm and Larrabee\u27s model for evidence-based practice. The sources of evidence were data from pretest and posttest surveys completed by seventeen nursing staff after reviewing the self-guided education. The paired t-tests were used to determine if a statistically significant improvement concluded with return demonstration competency. The results showed a statistically significant increase in confidence for navigating the clinical monitoring systems (p=.012), The competency demonstrated that the staff knew how to navigate the monitoring system with small amount of coaching. This project contributes to positive social change by increasing nurses’ confidence in addressing alarms safely and increasing patient and family satisfaction, which would lead to better scores to support the organization’s quality metrics and thereby impact service reimbursements

Human-centred design of clinical auditory alarms

Auditory alarms are commonly badly designed, providing little to no information or guidance. In the healthcare context, the poor acoustics of alarms is one contributor for the noise problem. The goal of this thesis is to propose a human-centred methodology for the design of clinical auditory alarms, by making them less disruptive and more informative, thus improving the healthcare soundscape. It implements this methodology from concept to evaluation and validation, combining psychoacoustics with usability and user experience methods. Another aim of this research consisted in understanding the limitations and possibilities offered by online tools for scientific studies. Thus, different processes and methodologies were implemented, and corresponding results were discussed. To understand the acoustic healthcare environment, field visits, interviews, and surveys were performed with healthcare professionals. Additionally, sound pressure levels and frequency analysis of several surgeries in different hospitals provided specific sound design requirements, which were added to an existent body of knowledge on clinical alarm design. A second stage consisted in prototyping very simple sounds to comprehend which temporal and spectral parameters of sound could be manipulated to communicate clinical information. Parameters such as frequency, speed, onset, and rhythm were studied, and relations between subjective perception and physical parameters were established. In parallel, and heavily influenced by the new IEC 60601-1-8 - General requirements, tests and guidance for alarm systems in medical electrical equipment and medical electrical systems, a design strategy with auditory icons was created. This strategy intended to provide as much information as possible in an auditory alarm. To do so, it involved two main components: a priority pointer indicating the priority of the alarm; an auditory icon indicating the cause of the alarm. A third component indicating increasing or decreasing tendency of the vital sign was designed, but not validated with users. After online validation of the priority pointer and auditory icon for eight categories (cardiac, drug administration, ventilation, blood pressure, perfusion, oxygen, temperature, and power down), a new library of clinical auditory alarms is proposed.Os alarmes auditivos são habitualmente mal concebidos, dando poucas informações ou orientações perante a situação que despoletou o aviso. No contexto da saúde, a má acústica dos alarmes é um dos contribuidores para o problema do ruído. O objetivo desta tese é o de melhorar a paisagem sonora em ambientes clínicos, propondo uma metodologia centrada no Humano para o design de alarmes auditivos clínicos, tornando-os menos disruptivos e mais informativos. Essa metodologia é implementada desde o conceito até a avaliação e validação, combinando métodos da psicoacústica com métodos de usabilidade e experiência do utilizador. Outro objetivo desta investigação é o de compreender as limitações e possibilidades oferecidas pelas ferramentas online para estudos científicos. Assim, diversos processos e metodologias foram implementados, e os respetivos resultados são discutidos. Para compreender o ambiente acústico clínico, foram realizadas visitas de campo, entrevistas e inquéritos com profissionais de saúde. Além disso, avaliou-se o nível de pressão sonora e frequências de várias cirurgias em diferentes hospitais. Esta atividade forneceu requisitos específicos de design de som que foram adicionados a um corpo existente de conhecimento sobre design de alarmes clínicos. Uma segunda etapa consistiu na prototipagem de sons simples para compreender que parâmetros temporais e espectrais do som poderiam ser manipulados para comunicar informações clínicas. Parâmetros como frequência, velocidade, envelope e ritmo foram estudados, e as relações entre a perceção subjetiva e os parâmetros físicos foram estabelecidas. Paralelamente, e fortemente influenciado pela nova norma IEC 60601-1-8 - Requisitos gerais, testes e orientações para sistemas de alarme em equipamentos médicos elétricos e sistemas médicos elétricos, foi criada uma estratégia de design com ícones auditivos. Essa estratégia pretendia incorporar o máximo de informações num alarme auditivo. Para isso, envolveu dois componentes principais: um ponteiro de prioridade que indica a prioridade do alarme; e um ícone auditivo que indica a causa do alarme. Um terceiro componente de tendência (aumento ou diminuição do valor do sinal vital) foi criado, mas não validado com utilizadores. Após a validação do ponteiro de prioridade e ícone auditivo para oito categorias (cardíaco, administração de medicamentos, ventilação, pressão arterial, perfusão, oxigénio, temperatura e falha de equipamento), propõe-se uma nova biblioteca de alarmes auditivos clínicos

eHealth in hypertension and cardiovascular disease:Opportunities and challenges

In this thesis we investigate different aspects of eHealth for hypertension and cardiovascular disease, with a focus on remote monitoring programs for chronic care. We use the Dutch HartWacht program for patients with hypertension, cardiac arrhythmias and heart failure as an example that has been implemented in routine clinical care. We first focus on hypertension and identify areas that are attractive for future implementation of eHealth because of poor hypertension control. In the following chapters we present economical, legal and technical challenges that accompany eHealth implementation, in each chapter followed by potential solutions and opportunities. We identify success factors for cost-effective eHealth, provide a roadmap for GDPR-compliant solutions, present a novel technique for heartbeat detection through a bracelet and describe a protocol for efficient data handling in remote monitoring programs. In the second part of this thesis, we zoom in on the patients participating in eHealth programs. We evaluate the impact on quality of life of patients participating in the HartWacht program for cardiac arrhythmias and demonstrate equivalence compared to usual care. We then describe the feasibility of the HartWacht program for patients with hypertension in reducing blood pressure and present rationale, design and cohort profile of the Effectiveness of home-Monitoring of blood pressure in PAtients with difficult to Treat HYpertension (EMPATHY) trial. We conclude with an evaluation of the impact of the COVID-19 pandemic on the uptake of eHealth in primary care in the Netherlands