A Complex Phenomenon in Complex Adaptive Health Care Systems—Alarm Fatigue

Sowan, Azizeh K.; Reed, Charles C.

doi:10.1001/jamapediatrics.2016.5137

Cited by 12 publications

(7 citation statements)

References 8 publications

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“…Although these efforts led to a significant reduction in the number of nuisance alarms, the reduction was insufficient to improve nurses’ attitudes toward alarms or their perceptions of alarm fatigue in ICUs [ 10 ]. The complexity of modern alarm devices requires usability testing for a safe and efficient operation of medical devices [ 24 ]. To our knowledge, this is the first study to examine the usability of physiologic monitors, the number one device associated with sentinel events in the FDA database, and the one with the highest number of nonactionable alarms [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Improving the Safety, Effectiveness, and Efficiency of Clinical Alarm Systems: Simulation-Based Usability Testing of Physiologic Monitors

Sowan¹,

Staggers²,

Berndt³

et al. 2021

JMIR Nursing

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Background Clinical alarm system safety is a national patient safety goal in the United States. Physiologic monitors are associated with the highest number of device alarms and alarm-related deaths. However, research involving nurses’ use of physiologic monitors is rare. Hence, the identification of critical usability issues for monitors, especially those related to patient safety, is a nursing imperative. Objective This study examined nurses’ usability of physiologic monitors in intensive care units with respect to the effectiveness and efficiency of monitor use. Methods In total, 30 nurses from 4 adult intensive care units completed 40 tasks in a simulation environment. The tasks were common monitoring tasks that were crucial for appropriate monitoring and safe alarm management across four categories of competencies: admitting, transferring, and discharging patients using the monitors (7 tasks); managing measurements and monitor settings (23 tasks); performing electrocardiogram (ECG) analysis (7 tasks); and troubleshooting alarm conditions (3 tasks). The nurse-monitor interaction was video-recorded. The principal investigator and two expert intensive care units nurse educators identified, classified, and validated task success (effectiveness) and the time of task completion (efficiency). Results Among the 40 tasks, only 2 (5%) were successfully completed by all the nurses. At least 1-27 (3%-90%) nurses abandoned or did not correctly perform 38 tasks. The task with the shortest completion time was “take monitor out of standby” (mean 0:02, SD 0:01 min:s), whereas the task “record a 25 mm/s ECG strip of any of the ECG leads” had the longest completion time (mean 1:14, SD 0:32 min:s). The total time to complete 37 navigation-related tasks ranged from a minimum of 3 min 57 s to a maximum of 32 min 42 s. Regression analysis showed that it took 6 s per click or step to successfully complete a task. To understand the nurses’ thought processes during monitor navigation, the authors analyzed the paths of the 2 tasks with the lowest successful completion rates, where only 13% (4/30) of the nurses correctly completed these 2 tasks. Although 30% (9/30) of the nurses accessed the correct screen first for task 1 and task 2, they could not find their way easily from there to successfully complete the 2 tasks. Conclusions Usability testing of physiologic monitors revealed major ineffectiveness and inefficiencies in the current nurse-monitor interactions. The results indicate the potential for safety and productivity issues in completing routine tasks. Training on monitor use should include critical monitoring functions that are necessary for safe, effective, efficient, and appropriate monitoring to include knowledge of the shortest navigation path. It is imperative that vendors’ future monitor designs mimic clinicians’ thought processes for successful, safe, and efficient monitor navigation.

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Section: Discussionmentioning

confidence: 99%

Improving the Safety, Effectiveness, and Efficiency of Clinical Alarm Systems: Simulation-Based Usability Testing of Physiologic Monitors

Sowan¹,

Staggers²,

Berndt³

et al. 2021

JMIR Nursing

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“…When a sensor-based hazard alarm system is designed, alarm fatigue also needs to be seriously considered. Alarm fatigue has been identified as a major issue in many sensor-based danger alarm systems in construction and other industries, such as health care [56,57]. If a worker keeps receiving alarm notifications that are not relevant to their task or workspace, redundant, or repetitive, it is likely that they will ignore the alarms or even disable the alarm device.…”

Section: Field Experiments 41 Experiments Design Conceptmentioning

confidence: 99%

Beacon-Based Individualized Hazard Alarm System for Construction Sites: An Experimental Study on Sensor Deployment

et al. 2021

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Researchers have proposed several forms of beacon sensor-based hazard alarm systems for increasing construction workers’ awareness of site hazards, but research on how to deploy beacon sensors so that the system is adequate for achieving timely individualized hazard alarms is scarce. Against this background, this research investigates the impact of different beacon sensor locations in a construction site on how quickly a worker can receive the individualized hazard alarms. This research took an experimental study approach to address this objective. After a prototype of a beacon-based hazard alarm system was developed, the system was tested in a concrete structure building under construction. In the experiment, the locations where the experimenter received the first hazard alarm were recorded in repetitive trials while the beacon sensor was located in four different locations, such as (1) at the entrance of the room, (2) behind the front side wall, (3) on the internal wall facing the access point, and (4) on the internal wall not facing the access point and in a partially enclosed room in the concrete structure. The rate of successful alarm notification (i.e., the rate that the person received the hazard alarm before arriving at the target location) was 89%, 68%, 48%, and 19%, respectively, for the four locations of the beacon sensor. Meanwhile, the heat maps indicating where the hazard alarm notification was received show that the “behind the front side wall” setting yielded the most desired pattern of notification reception, wherein the person received the hazard alarm just before arriving at the room. These results show that the hazard alarm function of the system could be severely affected by the beacon sensor’s location and implies that the locations of beacon sensors should be decided carefully based on the type of hazard involved and the workers targeted for receiving the alarms.

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“…Sittig and Singh 6 developed a sociotechnical model for studying health information technology (IT) in complex adaptive healthcare systems. The model identifies eight interdependent and interrelated dimensions: (1) hardware and software computing infrastructure, (2) clinical content, (3) human-computer interface, (4) people, (5) workflow and communication, (6) internal organizational features (e.g., policies, procedures, culture), (7) external rules and regulations, and (8) measurement and monitoring.…”

mentioning

confidence: 99%

State of Science in Alarm System Safety: Implications for Researchers, Vendors, and Clinical Leaders

Sowan

Staggers

Reed

et al. 2022

Biomedical Instrumentation & Technology

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Alarm fatigue is a complex phenomenon that needs to be assessed within the context of the clinical setting. Considering that complexity, the available information on how to address alarm fatigue and improve alarm system safety is relatively scarce. This article summarizes the state of science in alarm system safety based on the eight dimensions of a sociotechnical model for studying health information technology in complex adaptive healthcare systems. The summary and recommendations were guided by available systematic reviews on the topic, interventional studies published between January 2019 and February 2022, and recommendations and evidence-based practice interventions published by professional organizations. The current article suggests implications to help researchers respond to the gap in science related to alarm safety, help vendors design safe monitoring systems, and help clinical leaders apply evidence-based strategies to improve alarm safety in their settings. Physiologic monitors in intensive care units—the devices most commonly used in complex care environments and associated with the highest number of alarms and deaths—are the focus of the current work.

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A Complex Phenomenon in Complex Adaptive Health Care Systems—Alarm Fatigue

Cited by 12 publications

References 8 publications

Improving the Safety, Effectiveness, and Efficiency of Clinical Alarm Systems: Simulation-Based Usability Testing of Physiologic Monitors

Improving the Safety, Effectiveness, and Efficiency of Clinical Alarm Systems: Simulation-Based Usability Testing of Physiologic Monitors

Beacon-Based Individualized Hazard Alarm System for Construction Sites: An Experimental Study on Sensor Deployment

State of Science in Alarm System Safety: Implications for Researchers, Vendors, and Clinical Leaders

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