Challenges and recommendation of clinical alarm system in intensive care units from user perspective

Abstract

There are too many problems associated with clinical alarm system in Intensive Care Unit. This study was undertaken to identify and propose rectification to these problems to optimise alarm system performance. The objective of the study is to identify the problems associated with clinical alarm system in Intensive Care Units (ICU), determine the contributing factors and propose ways to improve clinical alarm. In conducting the study it would also be interesting to explore the difference in the way doctors and nurses respond towards alarm system problems. A survey was conducted with 161 clinicians, 137(85%) were registered nurses and medical assistants (MA) and 24(15%) were medical doctors from ICU. Prospective observation study was carried out for a total of 120hrs. Thereon interview sessions with focus group were conducted followed with task analysis to identify the root cause of alarm problems in ICU. In this survey, responses to triggered alarm show that there is no significant difference in the response to clinical alarm system by doctors and nurses. Findings show that 14% of the respondent ignored or switched off the alarm. Outcome of the survey and observation study show that too many alarms is the main problem identified by 78% (n=161, p<0.001) of the respondent. The task analysis indicates this problem is due to lack of integration and harmonisation, improper limit setting, lack of physiological information, no prioritisation of alarms and lack of consideration of human factor in alarm design. Incorporation of these factors in the design can minimise the frequency of alarm triggered thereby improving the performance of the alarm system.)

A formal approach to discovering simultaneous additive masking between auditory medical alarms

“…First, most medical alarms are represented as melodies (patterns) of tonal sounds, which are particularly susceptible to simultaneous masking. Second, the number of alarms in modern medical environments (Thangavelu et al, 2014), given that the likelihood of masking increases with the frequency and number of concurrently sounding alarms (Humes & Jesteadt, 1989;Bosi & Goldberg, 2003).…”

A computationally efficient formal method for discovering simultaneous masking in medical alarms

“…These are particularly susceptible to simultaneous masking [12,30]. Given that the probability of masking increases with the number of concurrently sounding alarms [12,39,65], the sheer number of alarms in modern medical environments [56] practically assures that masking is occurring.…”