Will not rehash all the articles and buzz around the known, however will give my perspective. This perspective is based upon experience selling/training clinicans/ and providing system reviews in the patient monitoring, holter, EKG, cardiac monitoring space since 1982…a long time.
Not touching on infusion therapy or ventilator alarms, because in this blog I felt that focusing on alarms contributing to fatigue generating by patient monitoring is critical.
Measuring the electrical activity of the heart via the Einthoven triangle 3 lead and 5 lead, and also the 12 lead for interpretive cardiographs has been around for decades. However obtaining a quality signal depends upon several variables. Other than the patient medical conditions, having a quality signal will ensure the fidelity processed by the algorithms for identifying violation of set rate and rhythms values.
It starts out with proper site selection and skin preparations adequate skin preparation, and there are numerous articles surrounding this and why this is absolutely important. It continues with quality electrodes that ensure the conductive interface is optimal and reliable. In my experience there are variability in electrodes manufactures and storage conditions at the point- of-care. For example, electrodes that are left open while stored on shelf somewhere for months where they could be exposed to heat or other factors. Finally, how often are these electrodes changed?
Lead wires and connectors. What about lead wires, they can act as an antenna. Are they quality lead wires, or low cost/quality disposables? Are they short and affixed to the patient? Are they shielded from interferences? Do their connectors mate properly?
The next stage is the quality of the algorithms for arrhythmia processing. Here again, each patient monitoring company has their own that were validated and verified by different databases. Now, enteres the monitor level of processing and how smart the alarm detection is. Can the alarm detect system’s issues (loose lead, electrode off, etc) and physiological issues and prioritize them accordingly? Again, enters into another variability.
But, perhaps highly critical issue is the ability to set and compliance with setting of the alarms limits to match the medical conditions of the individual patient.
So these are the basics behind just setting the stage for obtaining the best signal possible. Not going down this path…well you will more than likely get artifact, lead off alarms, and your arrhythmia processing algorithms will have a hard time to give a quality analysis and interpretation.
Once the aforementioned has been addressed and evaluated…then you can start looking at tailoring alarm profiles for your specific patients. Defaults are defaults. For example if the patient is in chronic atrial fibrillation, how the alarms are adjusted just should be looked at.
While all of the proceeding may not address the entire nature of alarm fatigue, looking at these factors and the ability to educate care givers about it will go a long way to reduce the potential of false alarms from patient monitoring. These will factor into the overall metrics of reducing alarm fatigue.
Thanks goes out to Yadin B. David Ed.D for his professional review and edits.
Yadin B. David
Ed.D., P.E., C.C.E., F.A.I.M.B.E., F.A.C.C.E. Biomedical Engineering Consultants L.L.C. 1111 Hermann Drive, Suite 12B Houston, Texas 77004
Voice: (713) 522-6666 Fax: (713) 522-6686
E-mail: david@BiomedEng.com URL: www.BiomedEng.com
