Background and Motivation of AlarmRedux
An essential feature of intensive care is the monitoring of patients whose condition requires a close meshed control of vital body functions. With increasing development of biosensorics and associated monitoring options the frequency of acoustical and visual alarms increases on the intensive care station. Since every alarm can be caused by a critical situation or a technical problem, it must be reviewed and acknowledged by an intensive caregiver or a doctor. That noise exposure and frequent interruptions of the work process constitute an in large part avoidable extra load and lead to massive cognitive stress and in the medium term to a desensitization of professional nurses for alarms (“Alarm fatigue”) dangerous for patients. This may lead to the ignoring of alarms or to risky settings at the control monitors. The consequence of these effects are frequent treatment failures with potential patient injury. Each critical situation and especially each patient injury leads to extensive mental stress of the staff and often to doctors withdrawing from their career.
Goals of AlarmRedux
The project aims to develop methodologicial and technical concepts to make the work load and cognitive stress of the nursing staff by alarms measurable and decrease it sustainably. It is expected that this could also reduce the known consequences of this load (stress, irritation, fatigue, job dissatisfaction etc.). Furthermore, we assume that the patient safety and experience will be improved by a reduction of the desensitization effects, the frequent interruptions of nursing activities and the reduction of the noise level.
Essentially for an improvement of the working conditions in intensive care and comparable care contexts are actions which help to reduce the alarm load and especially the number of irrelevant alarms. Until now innovative methodological and technical approaches which achieve reproducible and sustainable results under consideration of the entire socio-technical context of “patient monitoring” in terms of alarm reduction and which assess the effects on work safety and satisfaction are missing. Futhermore, innovative processes have to be considered which lead to a purposeful and safe alarm notification of the responsible nurses and which simultaneously reduce the cognitive load by acoustical alarms. The project will follow the principle of the Human-Centered Design Processes (ISO 9241-210). Both end users, nurses on the intensive care, and doctors as well as medical technology of the participating hospitals are integrated at the stages of project development from the beginning. Together, in iterative cycles new innovative functional models and demonstrators are developed and evaluated. Ethical, legal and socially relevant issues are taken into account. In addition, a complex regulatory framework must be considered (Medicinal Devices Act, EU Medical Devices Ordinance, FDA Requirements).
For the measurable and sustainable reduction of alarm load the following innovations shall be developed in the course of the project:
- Methodological approaches for a secure, data-driven reduction of avoidable alarms
- Decision support in the selection process of strategies for alarm reduction
- Innovative approaches for a secure distribution and signalisation of alarms
- Development of practical metrics and appropriate methods of measuring the load of alarms on nursing staff
- Development of quality metrics to determine the quality of an alarm system
- Development of an alarm datawarehouse for acquisition and analysis