Insights into the problem of alarm fatigue with physiologic monitor devices: a comprehensive observational study of consecutive intensive care unit patients.
Insights into the problem of alarm fatigue with physiologic monitor devices: a comprehensive observational study of consecutive intensive care unit patients.
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DOI：
10.1371/journal.pone.0110274
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Hu X
中科院分区：
文献类型：
--
作者：
Drew BJ;Harris P;Zègre-Hemsey JK;Mammone T;Schindler D;Salas-Boni R;Bai Y;Tinoco A;Ding Q;Hu X
生理监测仪受到警报的困扰，这些警报会产生刺耳的声音和视觉警报，导致“警报疲劳”，从而造成不安全的患者环境，因为在这种感官超负荷的环境中可能会错过危及生命的事件。使用最先进的技术采集基础设施，所有监测数据（包括7个ECG导联、所有压力、SpO 2和呼吸波形以及用户设置和警报）均存储在重症监护室治疗的461名成人中。使用定义良好的报警注释协议，护士科学家以95%的评分员间可靠性注释了12，671个心律失常报警。在31天研究期间，共发生2，558，760次独特报警：心律失常，1，154，201次;参数，612，927次;技术，791，632次。有381，560个声音报警，声音报警负担为187个/床/天。12，671个注释的心律失常警报中有88.8%为假阳性。导致过度报警的条件包括不适当的报警设置、持续性房颤和不可操作事件，如PVC和ST段中的短暂尖峰。某些但并非所有可用心电图导联中的低振幅QRS复合波会导致计数不足和错误心律失常警报。由于束分支阻滞或心室起搏器节律引起的宽QRS波群引起假警报。168个真实室性心动过速报警中有93%的报警持续时间不足以保证治疗。过多的生理监护仪报警是不适当的用户设置、患者状况和算法缺陷的复杂相互作用。器械解决方案应侧重于使用所有可用的ECG导联，以识别非伪影导联和具有足够QRS振幅的导联。器械应提供提示，以帮助更适当地定制个体患者的报警设置。房颤报警应限于心律失常的新发和终止，ST段和其他参数报警的延迟应可配置。由于计算机设备比人类更可靠，因此存在改善生理监测和减少警报疲劳的机会。
Physiologic monitors are plagued with alarms that create a cacophony of sounds and visual alerts causing “alarm fatigue” which creates an unsafe patient environment because a life-threatening event may be missed in this milieu of sensory overload. Using a state-of-the-art technology acquisition infrastructure, all monitor data including 7 ECG leads, all pressure, SpO2, and respiration waveforms as well as user settings and alarms were stored on 461 adults treated in intensive care units. Using a well-defined alarm annotation protocol, nurse scientists with 95% inter-rater reliability annotated 12,671 arrhythmia alarms. A total of 2,558,760 unique alarms occurred in the 31-day study period: arrhythmia, 1,154,201; parameter, 612,927; technical, 791,632. There were 381,560 audible alarms for an audible alarm burden of 187/bed/day. 88.8% of the 12,671 annotated arrhythmia alarms were false positives. Conditions causing excessive alarms included inappropriate alarm settings, persistent atrial fibrillation, and non-actionable events such as PVC's and brief spikes in ST segments. Low amplitude QRS complexes in some, but not all available ECG leads caused undercounting and false arrhythmia alarms. Wide QRS complexes due to bundle branch block or ventricular pacemaker rhythm caused false alarms. 93% of the 168 true ventricular tachycardia alarms were not sustained long enough to warrant treatment. The excessive number of physiologic monitor alarms is a complex interplay of inappropriate user settings, patient conditions, and algorithm deficiencies. Device solutions should focus on use of all available ECG leads to identify non-artifact leads and leads with adequate QRS amplitude. Devices should provide prompts to aide in more appropriate tailoring of alarm settings to individual patients. Atrial fibrillation alarms should be limited to new onset and termination of the arrhythmia and delays for ST-segment and other parameter alarms should be configurable. Because computer devices are more reliable than humans, an opportunity exists to improve physiologic monitoring and reduce alarm fatigue.
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影响因子：
8.8
作者：
Siebig, Sylvia;Kuhls, Silvia;Wrede, Christian E.
通讯作者：
Wrede, Christian E.
影响因子：
4.5
作者：
Aboukhalil, Anton;Nielsen, Larry;Clifford, Gari D.
通讯作者：
Clifford, Gari D.
影响因子：
1.3
作者：
Sgarbossa, EB;Barold, SS;Pahlm, O
通讯作者：
Pahlm, O
影响因子：
37.8
作者：
Drew BJ;Ackerman MJ;Funk M;Gibler WB;Kligfield P;Menon V;Philippides GJ;Roden DM;Zareba W;American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology, the Council on Cardiovascular Nursing, and the American College of Cardiology Foundation
通讯作者：
American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology, the Council on Cardiovascular Nursing, and the American College of Cardiology Foundation
影响因子：
1.3
作者：
Keller, James P., Jr.
通讯作者：
Keller, James P., Jr.