Testing of Auditory Clinical Alarms in ICU/CCU
Article Sidebar
Main Article Content
Abstract
Almost all medical devices in ICU/CCU have a built-in clinical alarm system to alert when there are changes in a patient’s condition. The objective of this study is to investigate the effectiveness of the existing alarm system in ICU/CCU. Two summative usability tests were conducted to test the effectiveness of existing and new alarm signals based on IEC 60601-1-8:2006 standard. Further formative test was conducted to study perception of urgency associated with number of tones in the alarm signals. The findings indicate that the existing auditory alarm signal in ICU/CCU do not indicate the urgency of the alarm conditions. The simulation test indicates that the respondents preferred 282Hz, 500Hz and 800Hz for low, medium and high-risk alarm respectively. The one-sample proportion z test on urgency mapping indicates that the proportion of responses for highest risk is more than 50% for single tone test signal. These results show that single tone test signal being perceived as highest risk regardless of frequency. It can be concluded the auditory alarm designed based on this IEC 60608-1-8:2006 standard is not effective. As such it is proposed that incorporation of the new alarm frequencies and tones will improve the effectiveness of the alarm signal.
[Manuscript received: 1 Nov 2018 | Accepted: 23 April 2019 | Published: 30 Oct 2020]
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
C. Meredith, and J. Edworthy, “Are there too many alarms in the intensive care unit? An overview of the problems,” Journal of Advanced Nursing, vol. 21, no. 1, Jan 1995, pp. 15-20.
International Electrotechnical Commission, “Medical electrical equipment -- Part 1-8: General requirements for safety -- Collateral standard: General requirements, tests and guidance for alarm systems in medical electrical equipment and medical electrical systems,” IEC std 60601-1-8:2003, 2003.
International Electrotechnical Commission, “Medical electrical equipment -- Part 1-8: General requirements for basic safety and essential performance -- Collateral standard: General requirements, tests and guidance for alarm systems in medical electrical equipment and medical electrical systems,” IEC std 60601-1-8:2006, 2006.
International Electrotechnical Commission, “Medical electrical equipment - Part 1: General requirements for basic safety and essential performance,” IEC std 60601-1:2005, 2005.
F. E. Block, J. D. Rouse, M. Hakala, and C. L. Thompson, “A proposed new set of alarm sounds which satisfy standards and rationale to encode source information,” Journal of Clinical Monitoring and Computing, vol. 16, no. 7, Sep 2000, pp. 541-546.
P. M. Sanderson, A. Wee, and P. Lacherez, “Learnability and discriminability of melodic medical equipment alarms,” Anaesthesia, vol. 61, no. 2, Feb 2006, pp. 142-147.
A. N. Wee, and P. M. Sanderson, “Do mnemonics help nurses learn melodic medical equipment alarms?,” Proceedings of the Human Factors and Ergonomics Society Annual Meeting, vol. 50, no. 10, Oct 2006, pp. 1039-1043.
P. Lacherez, E. Limin Seah, and P. Sanderson, “Overlapping melodic alarms are almost indiscriminable” Human Factors, vol. 49, no. 4, Aug 2007, pp. 637-645.
S. Williams, and P. C. Beatty, “Measuring the performance of audible alarms for anaesthesia,” Physiological Measurement, vol. 26, no. 4, May 24, 2005, pp. 571.
J. Edworthy, and E. Hellier, “Fewer but better auditory alarms will improve patient safety,” BMJ Quality & Safety, vol. 14, no. 3, Jun 1, 2005, pp. 212-215.
J. Edworthy, and E. Hellier, “Alarms and human behaviour: implications for medical alarms,” BJA: British Journal of Anaesthesia, vol. 97, no. 1, May 12, 2006, pp. 12-17.
J. R. Edworthy, R. McNeer, C. Bennett, and R. Dudaryk, “Updating an International Medical Device Standard: A Process for Audible Alarms,” Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care, vol. 7, no. 1, Jun 2018, pp. 11-16.
R. R. McNeer, J. Bohórquez, Ö. Özdamar, A. J. Varon, and P. Barach, “A new paradigm for the design of audible alarms that convey urgency information,” Journal of Clinical Monitoring and Computing, vol. 21, no. 6, Dec 2007, pp. 353-363.
T. A. Mondor, and G. A. Finley, “The perceived urgency of auditory warning alarms used in the hospital operating room is inappropriate,” Canadian Journal of Anaesthesia, vol. 50, no. 3, Mar 1, 2003, pp. 221-228.
A. N. Wee, and P.M. Sanderson, “Are melodic medical equipment alarms easily learned?,” Anesthesia & Analgesia, vol. 106, no. 2, Feb 1, 2008, pp. 501-508.
P. C. Beatty, and S. F. Beatty, “Anaesthetists' intentions to violate safety guidelines” Anaesthesia, vol. 59, no. 6, Jun 2004, pp. 528-540.
K. J. Ruskin, and D. Hueske-Kraus, “Alarm fatigue: impacts on patient safety,” Current Opinion in Anesthesiology, vol. 28, no. 6, Dec 1, 2015, pp. 685-690.
K. R. Johnson, J. I. Hagadorn, and D. W. Sink, “Alarm safety and alarm fatigue,” Clinics in Perinatology, vol. 44, no. 3, Sep 1, 2017, pp. 713-728.
J. Edworthy J, and C. Baldwin, “Medical Audible Alarms and IEC 60601-1-8,” Proceedings of the Human Factors and Ergonomics Society Annual Meeting, vol. 60, no. 1, Sep 2016, pp. 634-635.
S. Thangavelu, J. Yunus, E. Ifeachor, and J. Edworthy, “Improving Alarm Response in ICU/CCU,” International Journal of Simulation -- Systems, Science & Technology, vol. 16, no. 4, Aug 2015, pp. 1.1-1.9.
J. R. Edworthy, R. R. McNeer, C. L. Bennett, R. Dudaryk, S. J. McDougall, J. J. Schlesinger, M. L. Bolton, J. D. Edworthy, E. Özcan, A. D. Boyd, and S. K. Reid, “Getting Better Hospital Alarm Sounds Into a Global Standard,” Ergonomics in Design, vol. 26, no. 4, Oct 2018, pp. 4-13.
J. Edworthy, “Designing effective alarm sounds,” Biomedical Instrumentation & Technology, vol. 45, no. 4, Jul 2011, pp. 290-294.
G. A. Finley, and A. J. Cohen, “Perceived urgency and the anaesthetist: responses to common operating room monitor alarms,” Canadian Journal of Anaesthesia, vol. 38, no. 8, Nov 1, 1991, pp. 958-964.
F. E. Block, ““For if the trumpet give an uncertain sound, who shall prepare himself to the battle?”(I Corinthians 14: 8, KJV),” Anesthesia & Analgesia, vol. 106, no. 2, Feb 2008, pp. 357-359.
J. Edworthy, “Medical audible alarms: a review,” Journal of the American Medical Informatics Association, vol. 20, no. 3, Oct 25, 2012, pp. 584-589.
S. Siebig, S. Kuhls, M. Imhoff, J. Langgartner, M. Reng, J. Schölmerich, U. Gather, and C. E. Wrede, “Collection of annotated data in a clinical validation study for alarm algorithms in intensive care—a methodologic framework,” Journal of Critical Care, vol. 25, no. 1, Mar 2010, pp. 128-135.
J. Bliss, M. Dunn, and B. S. Fuller, “Reversal of the cry-wolf effect: An investigation of two methods to increase alarm response rates,” Perceptual and Motor Skills, vol. 80, no. 3_suppl, Jun 1995, pp. 1231-1242.
F. E. Block, L. Nuutinen, and B. Ballast, “Optimization of alarms: a study on alarm limits, alarm sounds, and false alarms, intended to reduce annoyance,” Journal of Clinical Monitoring and Computing, vol. 15, no. 2, Feb 1999, pp. 75-83.
J. Edworthy, S. Loxley, and I. Dennis, “Improving auditory warning design: Relationship between warning sound parameters and perceived urgency,” Human Factors, vol. 33, no. 2, Apr 1991, pp. 205-231.
E. J. Hellier, J. Edworthy, and I. A. Dennis, “Improving auditory warning design: Quantifying and predicting the effects of different warning parameters on perceived urgency,” Human Factors, vol. 35, no. 4, Dec 1993, pp. 693-706.
W. M. Hartmann, “Signals, sound, and sensation,” Springer Science & Business Media, Sep 14, 2004.
Y. Yuki, “Alarm system optimization for increasing operations productivity,” ISA Transactions, vol. 41, no. 3, Jul 2002, pp. 383-387.