The triage protocol creates an objective process to guide healthcare professionals in making the difficult determination of how to allocate resources to critically ill adult and pediatric patients when there are not enough critical care resources for everyone.
The presentation describes in brief the patients need, expectations and how to develop the patient care and feedback system to obtain maximum patient satisfaction.
abscess advanced trauma life support anterio advanced trauma life support antibiotics apically repositioned flap dental diseases dr dr shabeel drshabeel’s face eye trauma lidocaine anodontia management medical medicine misuse and abuse orthodontics teeth braces pharmacy pn preparation dental students for community based ed presentations s abscess abscess tooth active orthodonti shabeel shabeel"s shabeel’s shabeelpn trends of antimicrobial usage in dental practice View all
’s abscess abscess advanced trauma life support anterio abscess tooth active orthodontics adolescent advanced trauma life support aesthetic dentistry airway management alignment of teeth amalgam anesthesia in dentistry anesthetics in dentistry anterior open bite antibiotic resistanace antibiotics antibiotics and leukopenia aphthous ulcers apically repositioned flap apicoectomy appliances arch dental arch form orthodontics braces arch length orthodontics braces arch wire orthodontist braces ayurvedha baby teeth bloger boil books braces braces teeth cancer canker sore pain cavity preparation children community based learning congenitally missing teeth cosmetic dentistry csf leaks dental dental anesthetics dental restorations dental teeth dento alveolar fractures disease
Tubing misconnections in critical set up is often a grave error which needs to be addressed well with policies and standard operating procedures. A good understanding of the problem by the team will go a long way in preventing this mishap to ever happen in your team.
PHEM - Pre Hospital Emergency Medicine Guidelines for TrainersEmergency Live
This Guide describes the curriculum, training and assessment processes for Pre-hospital Emergency
Medicine (PHEM) sub-specialty training. It reflects the General Medical Council (GMC) standards and the
uK wide regulations for specialty training (the Gold Guide).1,2 Where there are differences between the four
uK national agencies, the parts of the Gold Guide applicable to these agencies should be regarded as the
definitive guidance.
The triage protocol creates an objective process to guide healthcare professionals in making the difficult determination of how to allocate resources to critically ill adult and pediatric patients when there are not enough critical care resources for everyone.
The presentation describes in brief the patients need, expectations and how to develop the patient care and feedback system to obtain maximum patient satisfaction.
abscess advanced trauma life support anterio advanced trauma life support antibiotics apically repositioned flap dental diseases dr dr shabeel drshabeel’s face eye trauma lidocaine anodontia management medical medicine misuse and abuse orthodontics teeth braces pharmacy pn preparation dental students for community based ed presentations s abscess abscess tooth active orthodonti shabeel shabeel"s shabeel’s shabeelpn trends of antimicrobial usage in dental practice View all
’s abscess abscess advanced trauma life support anterio abscess tooth active orthodontics adolescent advanced trauma life support aesthetic dentistry airway management alignment of teeth amalgam anesthesia in dentistry anesthetics in dentistry anterior open bite antibiotic resistanace antibiotics antibiotics and leukopenia aphthous ulcers apically repositioned flap apicoectomy appliances arch dental arch form orthodontics braces arch length orthodontics braces arch wire orthodontist braces ayurvedha baby teeth bloger boil books braces braces teeth cancer canker sore pain cavity preparation children community based learning congenitally missing teeth cosmetic dentistry csf leaks dental dental anesthetics dental restorations dental teeth dento alveolar fractures disease
Tubing misconnections in critical set up is often a grave error which needs to be addressed well with policies and standard operating procedures. A good understanding of the problem by the team will go a long way in preventing this mishap to ever happen in your team.
PHEM - Pre Hospital Emergency Medicine Guidelines for TrainersEmergency Live
This Guide describes the curriculum, training and assessment processes for Pre-hospital Emergency
Medicine (PHEM) sub-specialty training. It reflects the General Medical Council (GMC) standards and the
uK wide regulations for specialty training (the Gold Guide).1,2 Where there are differences between the four
uK national agencies, the parts of the Gold Guide applicable to these agencies should be regarded as the
definitive guidance.
Prehospital Sepsis Research Update 2024 Rom DuckworthRommie Duckworth
Recently published papers have given us new insights into the next steps for prehospital care for sepsis patients. By looking at both macro and micro views of patient management this program presents our new understanding of the role of antibiotics, fluid administration, and coordination of clinical care as well as future tools, including advanced biomarkers and the application of antimicrobial nanotechnology. Arm yourself with indispensable knowledge to elevate your prehospital practice and make a real difference in patient outcomes.
Rommie L. Duckworth is a dedicated emergency responder, author, and educator from the United States with more than thirty years of experience working in fire departments, hospital healthcare systems, and private emergency medical services. Rom is a career fire captain and paramedic EMS Coordinator for Ridgefield (CT) Fire Department and director of the New England Center for Rescue and Emergency Medicine. Rom holds a master’s degree in public administration, is a graduate of the US National Fire Academy’s Executive Fire Officer program, and is the recipient of the NAEMT Presidential Award, American Red Cross Hero Award, Sepsis Alliance Sepsis Hero Award, and the EMS 10 Innovators Award for Sepsis Education. Rom is the author of "Duckworth on Education," as well as chapters in more than a dozen EMS, fire, rescue, and medical textbooks and over 100 published articles in fire and EMS magazines. A member of the NAEMT Board of Directors and the Sepsis Alliance Advisory Board Rom continues to work for the advancement of emergency services.
www.RomDuck.com
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Современное лечение ВИЧ: лечение ВИЧ у женщин.2017/Contemporary Management of...hivlifeinfo
In this downloadable slideset, Kathleen E. Squires, MD, and Program Director Joseph J. Eron, Jr., MD, review key data and optimal strategies in caring for HIV-infected women, including ART safety and efficacy in women, reproductive health management, ART and pregnancy, and preventing HIV infection in women.
Format: Microsoft PowerPoint (.ppt)
File size: 1.59 MB
Date posted: 4/25/2017
Telehealth and Geriatrics How telehealth improves medicati.docxAASTHA76
Telehealth and Geriatrics:
How telehealth improves medication management
and patient safety in the geriatric patient
Avrakham Rubinov
Adelphi University
College of Nursing and Public Health
December 3rd, 2018
What is Geriatrics?
Geriatrics is a subspecialty of internal medicine and primary care that was named in 1909 by Ignatz Leo Nascher.
Geriatrics is that specialty of medicine that addresses the health needs of the elderly.
Gellis, Z. D., Kenaley, B., McGinty, J., Bardelli, E., Davitt, J., & Ten Have, T. (2012).
2
Telemedicine is a highly effective
and necessary tool in geriatrics.
The global population of elderly people is increasing at a remarkable rate,
This is expected to continue for some time.
Older patients require more care.
The current model of care delivery indicated costs are expected to rise.
Telemedicine is a great opportunity for medical practice to evolve to cost effective and new levels of engagement with patients
Chang, W., Homer, M., & Rossi, M. (2018).
3
Geriatics, HIT and Patient Safety
CONCERNS:
SOLUTIONS:
Patient safety is a concern.
Telehealth: Difficult to monitor conditions in a patient’s home.
Safety risks such as falls and inability to get in and out of the tub or shower.
Fewer In-Person Consultations
Doctors worry about technical problems associated with telemedicine. poor broadband connections could lead to “possible patient mismanagement.”
Many physicians and patients alike still like a “personal touch,” and not all procedures – even simple checkups – can be performed digitally.
Difficult to monitor depression or other emotional issues.
Health information technology (HIT) is the future of improving care and outcomes for older adults.
There is a growing program of research. HIT are solutions to improving the safety, quality and efficiency of care.
Gerontological nurse scientists are at the forefront of advancing this work.
Electronic health records (EHRs)and telehealth will blend care of older adults.
Multimedia/advanced directives from HIT provided to patients recovering from critical illness have increased the intent to sign an advanced directive by 25 times
Liu, L., Stroulia, E., Nikolaidis, I., Miguel-Cruz, A., Rincon, A. R. (2016).
4
The HITECH Act resulted growth in the development and implementation of the EHR.
The impact of an integrated EHR in 29 Kaiser Permanente hospitals was significant on process and outcome indicators for patient falls and hospital acquired pressure ulcers and other measures of patient safety.
The EHR system was associated with improved documentation of falls/pressure ulcers and significant improvements for pressure ulcer risk assessment documentation.
Bowles, K. H., Dykes, P., & Demiris, G. (2015).
5
NICHE
(Nurses Improving Care for Healthsystem Elders)
NICHE builds decision support within the workflow of nurses caring for old.
ReferencesFouka, G. & Mantzorou, M. (2011). What are the Major kailynochseu
References:
Fouka, G. & Mantzorou, M. (2011). What are the Major Ethical Issues in Conducting Research?
Is there a Conflict between the Research Ethics and the Nature of Nursing? Health Science Journal, 5(1), 3-14.
Furuya, Y., Dick, A., Perencevich, E., Pogorzelska, M., Goldman, D., & Stone, P. (2011). Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS ONE, 6(1), 1-6.
Graling, P., & Vasaly, F. (2013). The effectiveness of 2% CHG Cloth Bathing for Reducing Surgical Site Infections. AORN Journal, 97(5): 547-551.
Jeanes, A., & Bitmead, J. (2015) Reducing bloodstream infection with a chlorhexidine gel IV dressing. British Journal of Nursing, 24, S14-S19.
Kim, J., Holtom, P., & Vigen, C. (2011). Reduction of catheter-related bloodstream infections through the use of a central venous line bundle: Epidemiologic and economic consequences. American Journal of Infection Control, 39(8), 640-646.
Klinworth, G., Stafford, J., O’Connor, M., Leong, T., Hamley, L., Watson, K., Kennon, J., Bass, P., Cheng, A. C., & Worth, L. (2014). Implementation of a successful hospital-wide initiative to reduce central line–associated bloodstream infections. American Journal of Infection Control, 42(6), 685-687.
Kramer, N. (2016). Monitoring Central Line-Associated Bloodstream Infections [CLABSI] in Home Infusion. Infusion, 22(4), 35-44.
McAlearney, A., Hefner, J., Robbins, J., Harrison, M., & Garman, A. (2013). Preventing central line-associated bloodstream infections: A Qualitative Study of Management Practices. Infection Control & Hospital Epidemiology, 36(5), 557-563.
Mermel, L. (2014). MRSA and CLABSI Compendium updates offer additional focus on implementation. Patient Safety Monitor Journal, 15(9), 1-4.
Power, J., Peed, J., Burns, L., & Davis, M. (2012). Chlorhexidine bathing and microbial contamination in patients’ basin. American Journal of Critical Care, 21(5), 338-342.
Pyrek, K. (2015). Experts Address the Promise and Challenges of CHG Bathing Interventions. Infection Control Today, 19(1), 32-36.
Quach, C., Milstone, A, Perpe, C., Bonenfant, M., Moore, D., & Perreault, T. (2014). Chlorhexidine Bathing in a tertiary care neonatal intensive care unit: Impact on central line–associated bloodstream infections. Infection Control & Hospital Epidemiology, 35(2), 158-163.
Richardson, J., & Tjoelker, R. (2012). Beyond the central line-associated bloodstream infection bundle: the value of the clinical nurse specialist in continuing evidence-based practice changes. The Journal of Advanced Nursing Practice, 26(4), 205-211.
Sandoval, C. (2015). Three practice bundles to reduce CLABSIs. American Nurse Today, 10(11), 37-38.
Scheithauer, S., Lewalter, K., Schroder, J., Koch, A., Hafner, H., Krizanovic, V., Nowicki, K., Hilgers, R.-D., & Lemmen, S. (2014). Reduction of central venous line-associated bloodstream infection rates by using a chlorhexidine-containing dressing. Infect ...
5The Application of Clinical Systems to the Stud.docxblondellchancy
5
The Application of Clinical Systems to the Study of Traumatic Brain Injury
G.G.
Walden University
NURS 6051, Section 49, Transforming Nursing and Healthcare
April 25, 2019
The Application of Clinical Systems to the Study of Traumatic Brain Injury
An area of research that has always sparked a keen interest in me revolves around rehabilitation medicine. I used to volunteer at TIRR Memorial Hermann, a nationally known rehab facility that deals with patients in recovery from significant injuries. Their patient population includes persons recovering from a stroke, spinal cord injury, traumatic brain injury, and a multitude of other less common illnesses. Because of that passion, I am interested in how nursing technology has evolved to help patients recovering from traumatic brain injuries (TBI). This paper will summarize a brief literature search of five articles that apply clinical systems to TBI recovery.
Informatics Database
Caban and associates (2016) studied whether building a large-scale informatics database would facilitate collection of standardized clinical data and obtain trends of the longitudinal outcomes of service members diagnosed with mild TBI. The article written as a result of this study mentioned how the detailed clinical guidelines for treating mild TBI rely too heavily on behavior observations and subjective recollections (Caban et. al., 2016). Knowing there was a need for an informatics database, these researchers created one using a combination of several other electronic health records systems. This database will improve outcomes in TBI because it will provide immediate concrete information that is objective and can be used to determine treatment paths for new TBI patients.
Prognosis Calculator
In the article “The Aggressiveness of Neurotrauma Practitioners and the Influence of the IMPACT Prognostic Calculator,” researchers investigated how effective a prognosis calculator is improving outcomes for TBI patients. 154 medical professionals responded to a survey that specifically questioned them regarding the usefulness and effectiveness of the IMPACT prognosis calculator. The prognosis calculator is a clinical system that was created to assist with care planning for TBI patients. The calculator is supposed to provide an accurate estimate of the future prognosis of the patient so that doctors can know whether to use aggressive treatment strategies or not. Survey responses were collected using a research electronic data capture system and the responses were statistically analyzed using SPSS software (Letsinger, Rommel, Hirschi, Nirula, & Hawryluk, 2017). Although the IMPACT system is the most significant technological advances in modern TBI care, the results of this article reveal that physicians are not properly aware of the capabilities of this software (Lestinger et. al., 2017). Unfortunately, more medical professionals use it as a communication tool more than anything else.
Assistive Technology for Cognition
A ...
Reply 1Why we need 15 minutes Patient Safety ChecksThis felipaser7p
Reply 1
Why we need 15 minutes Patient Safety Checks
This article discusses how in mental facilities, lowering the risk of suicide and other sentinel occurrences is a major concern (Invisalert, 2020). The weakness of this article is doubting the effectiveness of this 15 minutes patient rounding.
Patient Safety and Suicide Prevention in Mental Health Services: time for a new paradigm?
Quinlivan et,al. (2020), this article talks about combining mental health, public health, and patient safety research paradigms will open up new avenues and treatments to bridge the gap between evidence, policy, and practice, and eventually reduce suicide fatalities. The weakness of this article is that there are significant disparities in the quality of treatment provided to those who have come into contact with mental health services or who have self-harmed.
Patient safety in inpatient mental health settings: a systematic review
Bethan et.al, (2019), this is the first study to look at patient safety in inpatient mental health facilities using a systematic approach, which is the strength of this study and the weakness being only peer-reviewed papers with primary data were considered in this analysis.
Patient safety in inpatient mental health settings: a systematic review
This article concluded with a weakness that compared to other non-mental health inpatient settings, patient safety in inpatient mental health facilities is under-researched. Strength of this article is data was retrieved and organized into groups based on the study's topic and result. Wherever possible, a random-effects model was used to meta-analyze safety occurrences (Thibaut, 2019).
Patient Safety in Inpatient Psychiatry: A Remaining Frontier for Health Policy
Morgan et, al. (2018), discusses that few health-care researchers focus on inpatient psychiatry, the topic isn't a top priority for research funders, and data on inpatient psychiatry isn't included in national quality-of-care surveys, which is the weakness of the study and the strength being organizations' ability to adequately assist front-line workers and participate in strong measures to avert psychological and physical damage is influenced in part by system-level issues.
Article: Patient safety and quality of care in mental health: a world of its own?
According to Dlima et. al, (2017), strength of this article is that it talks about changing trends of focusing on patient safety of metal health patient and the weakness is rather then considering patient safety as a one factor to be focused on it is discussing about making strategies for patient safety in mental health separately.
References
Invisalert (2020),
Why we need 15 minutes Patient Safety Checks
. Retrieved from
https://www.invisalertsolutions.com/why-we-need-15-minute-patient-safety-checks/
Quinlivan. L, Littlewood. D, Webb. R and Kapur. N (2020), Patient Safety and Suicide Prevention in Mental Health Services: time for a new paradigm? Retrieved from
http ...
NEUROLOGICAL MANIFESTATIONS OF HIV/AIDS: A CLINICAL PROSPECTIVE STUDYEarthjournal Publisher
&Objectives: To study the clinical profile of neurological manifestations of Human immunodeficiency
virus(HIV)/Acquired immunodeficiency syndrome(AIDS) and to correlate with the CD4+T lymphocyte
count.Material & Methods : 50 patients who were in the age goup18-55 years, had HIV infection and history
suggestive of Nervous system manifestations were included. The HIV patients with past/present history of
other immunocompromised conditions ( cytotoxic drugs for malignancies, Post organ transplant patients,
Patients using steroids for long term), previous history of epilepsy, focal neurological deficit and head injury
were excluded from the study. All the patients were examined in detail by history and clinical neurological
examination. For all the patients have done routine investigations, and specific investigations like CT/MRI
Brain, Nerve Conduction Studies, CSF Analysis,EEG and Specific antibodies for organisms or parasite done
only wherever it is required. All the patients were correlated with the CD4 T cell count.Results:: Among 50
patients, Commonest age group affected was 26-35 yrs with male predominance(62%). Most common symptom
was non specific headache(38%).Most common opportunistic infetction was Tuberculous meningitis(34%).
Toxoplasmsa encephalitis was the most common space occupying lesion(20%).More number of patients were
seen in the CD4 range in between 51-200 cells/mic.L(72%) with all the diseases had correlation with CD4 T cell
activityCONCLUSION: In the present study, Opportunistic infections were the leading cause in patients
infected with HIV having Neurological manifestastions, usually occurs when the patients had severe
immunosuppresion (CD4 count< 200 cells/μL).
Key words: HIV Positive patients, CD4 T cell count, Neurological manifestation
Quilture: Transforming the Boundries in Clothing bBetween CulturesRojinMoghadam
Design Goal: Transforming the boundary of differences in women's clothing and style preferences into a place of common understanding values between Iranian and Dutch cultures.
Result: The outcome of quilting could be any piece of clothing; but we chose a "robe", as an icon of comfort at home, that every woman would use no matter what culture she comes from.
Every piece of fabric comes with a story, a metaphor for different experiences and values.
The "Quilture Robe" is a symbol of shared culture and stories which unites and empowers women.
Towards Happiness: Possiblity-Driven DesignRojinMoghadam
A presentation on possibility-driven design as an alternative to the common problem-driven approach, based on a chapter of the book "Human-Computer Interaction: The Agency Perspective".
Authors: Pieter Desmet, Marc Hassenzahl
Publisher: Springer, Berlin, Heidelberg, 2012
Presntation by Rojin Moghadam at the University of Tehran, 2019
Designing an interactive smart product concept in order to improve subjective well-being in lonely elderly based on Positive Design
Bachelor's final project presentation - Industrial Design - Tehran University of Art - Supervisor: Mr Nader Shayegh - July 2019
[Description of each page is available in the "note" part]
White wonder, Work developed by Eva TschoppMansi Shah
White Wonder by Eva Tschopp
A tale about our culture around the use of fertilizers and pesticides visiting small farms around Ahmedabad in Matar and Shilaj.
Can AI do good? at 'offtheCanvas' India HCI preludeAlan Dix
Invited talk at 'offtheCanvas' IndiaHCI prelude, 29th June 2024.
https://www.alandix.com/academic/talks/offtheCanvas-IndiaHCI2024/
The world is being changed fundamentally by AI and we are constantly faced with newspaper headlines about its harmful effects. However, there is also the potential to both ameliorate theses harms and use the new abilities of AI to transform society for the good. Can you make the difference?
Unleash Your Inner Demon with the "Let's Summon Demons" T-Shirt. Calling all fans of dark humor and edgy fashion! The "Let's Summon Demons" t-shirt is a unique way to express yourself and turn heads.
https://dribbble.com/shots/24253051-Let-s-Summon-Demons-Shirt
3. Follow up of Patients After a Visit to Tourcoing Emergency Department for an Ankle Sprain. (2019). Case Medical Research. Published. https://doi.org/10.31525/ct1-
nct04114552
Philips Case Study
4. Philips Case Study
Follow up of Patients After a Visit to Tourcoing Emergency Department for an Ankle Sprain. (2019). Case Medical Research. Published. https://doi.org/10.31525/ct1-
nct04114552
7. Hravnak, M., Pellathy, T., Chen, L., Dubrawski, A., Wertz, A., Clermont, G., & Pinsky, M. R. (2018). A call to alarms: Current state and future directions in the battle
against alarm fatigue. Journal of Electrocardiology, 51(6), S44–S48. https://doi.org/10.1016/j.jelectrocard.2018.07.024
8. Automation in the ICU
Reference
Gholami, B., Haddad, W. M., & Bailey, J. M. (2018). AI in the ICU: In the intensive care unit, artificial intelligence can keep watch. IEEE Spectrum, 55(10), 31–35.
https://doi.org/10.1109/mspec.2018.8482421
37. Conclusions
● When critical alarm goes on, non-critical alarms are still there but softer
(prioritization).
● AI changes the alarm from Harmonic to Minor (more sad) when criticality level is
increasing.
A case study from phillips that was done over the course of a week found that there are 237 alarms sounded per day per bed. This mean that there is an alarm every 5 minutes for one bed.
This many alarms can become dangerous, as they can overwhelm the clinicians and even desensitize them and have them ignore important alarms. They can also prevent patients from resting.
In response to this, the study tried to reduce inconsequential alarms, which included pausing the alarms when performing bedside procedures such as drawing blood and reducing the sensitivity of some of the monitors.They used prioritisation to choose which alarms to mute and which to play.
After 6 months they found that 39% of the non - consequential alarms were reduced (making the alarms go from 237 - 173).
Link:
https://www.philips.com/c-dam/corporate/newscenter/global/case-studies/tourcoing/tourcoing-general-hospital-customer-partnership.pdf
The nurses and doctors agreed that this helped them with doing their work more efficiently and it positively affected their wellbeing.
Another quote from the study: “The alarms project has reduced noise pollution and improved patient care within the unit.” -Dr Delannoy, ICU doctor, Tourcoing General Hospital
Link:
https://www.philips.com/c-dam/corporate/newscenter/global/case-studies/tourcoing/tourcoing-general-hospital-customer-partnership.pdf
This is a simplified method to show the process of the alarm, from generating the data (from the patient) to how the clinician receives and interprets the data. Based on this, failures of the systems can be encountered throughout the whole process.
We focused mostly on the the issues starting from the processor (since before that, the system relies on the technical limitations of the devices used), for example calibrating the settings based on the patient case or reducing the sensitivity in the settings, so only meaningful alarms can run. Relevant examples that clinicians could have an effect o is how many alarms can run at ones, as they can turn some off if they need to focus on a specific task (which could potentially become dangerous).
The clinician can choose to pot respond to an alarm at all by ignoring it. When they do not ignore it they have to acknowledge the alarm, investigate the cause (which could be time consuming), interpreting the information and judge is they need to proceed with an action.
Literature review also shows that a large proportion (40-80%) of alarms are not actionable (some not being relevant to the patient case).
Link:
https://www.philips.nl/c-dam/b2bhc/us/whitepapers/alarm-systems-management/Just-a-Nuisance.pdf
The same study interviewed 56 clinician on alarm fatigue. They found that an intense frequency of alarms can have serious consequences ”Consequences include: missing true positive alarms; breach of monitoring protocols; stress to patients, families and caregivers and poor use of nursing time”.
An interesting outcome was that a lot of the machines make similar sounds which can make it difficult for the clinicians to identify the problem(where the alarm is coming from).
Conclusions from the paper:
1. The absolute burden of alarms in the hospital environment is problematic
2. Half of all alarm signals are not clinically relevant
3. Excess alarms, particularly excess ‘nuisance’ alarms, are clinically harmful
4. A large number of false positive alarms is operationally inefficient
5. There is a clear mandate to improve the management of alarms
Regrading conclusion 5, we proposed the centralisation of alarms
Link:
https://www.philips.nl/c-dam/b2bhc/us/whitepapers/alarm-systems-management/Just-a-Nuisance.pdf
There are many cases for alarm fatigue in the system, starting from the patient, monitors and all the way to how the hospital operates (e.g. if they are understaffed and nurses have to take care of multiple patients or what systems they operate)
This slide shows different causes for alarm fatigue and show what are current available solutions and what could be future solutions.
Once again we see that some alarms might be inconsequential for a specific patient case. We can also see that due to understaffing a patient can have multiple clinicians assigned and every time they have to analyse what is going on, where an alarm is coming from.
Current solutions include customizing the threshold settings for the alarms.
One solution is targeting the alarms to who is available or giving the clinicians more resources to faster analyse a situation.
(An example for the organisation: develop safety culture)
Future solutions:
Include more patient information, this can be very useful to avoid inconsequential alams.
(System solutions include: Improving alarm reliability)
The paper mentions that “Alarm suppression can be accomplished with a variety of suppression algorithms, including statistical metrics” Maybe an interesting way to do that would be machine learning.
Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6263784/
Possibilities of automation in the ICU:
The two examples above show different levels of automation for 2 different cases: breathing easier and fluid movements.
This paper talks about the having automation integrated in the medical field on a gradual scale. As a lot of medical professionals might distrust AI and would want just what is best for the user.
Link:
https://ieeexplore.ieee.org/stamp/stamp.jsp?tp=&arnumber=8482421
Other possibilities for automation in the medical field
“Using recurrent neural network models for early detection of heart failure onset”
https://pubmed.ncbi.nlm.nih.gov/27521897/
“Artificial intelligence and machine learning for predicting acute kidney injury in severely burned patients: A proof of concept”
https://pubmed.ncbi.nlm.nih.gov/31230801/
Based on the research we did in the previous page, we started the ideation process.
We generated a lot of ideas that some were out of the box and even out of context. Here we did not refine or eliminate any design possibility.
After a certain amount of ideas, we started the refinement process of the ideas and categorised them into bigger bubble. The most interesting ones for us were the automize, centralization, and criticality prioritization. With centralisation we mean connecting all the devices to a central hub, as opposed to designing the devices from scratch or proposing that the hospital buys new devices.
From these ideas and our conclusion, we designed our workflow.
The patient is connected to the devices that monitor its vitals. These vitals get send to the central hub which then informs the nurse if needed.
What we call non actionable alarms is called monitoring. Which don't need to be heard until a certain threshold is exceeded.
AI classifies the data to determine if it the situation is critical and how long before actionable tasks become critical.
Here is the decision making algorithm of the AI done on the patient data. Al starts with the analysis and firstly checks of the alarm is actually actionable. If yes, it checks if the alarm is Critical, and if yes again, the alarm would be on. And if not critical, it constantly checks if the certain amount of time needed for this specific non critical alarm to become critical has reached or not. If yes, the alarm would go off. I the alarm is not indeed actionable it checks to see if the nurse is in range if yes, a monitoring sound would be plates, and if not, no sound would be played and the information would be stored in the data added to the checklist for the nurse to check at the end of the day.
As mentioned, the output of the system would be the sounds coming off the speakers, and also being transmitted to the nurse’s personal device.
We have to keep the acceptability of the system in mind.
Gradual change in the ICU (from only feedback from the speaker to the earpiece and other forms of feedback)
That's why we propose to have a step in between where it only uses the speaker system, and not the earpieces.
Now: a lot of mostly unnecessary sounds that they don't know where those sounds are coming from.
Our recommendation: Is to centralise all the devices to a single hub that can manage data and alarms and visualize the data.
Future: personal wearables that guide the nurse.
All the ICU devices connect to the connector which collects the data from the devices.
This data is processed by the AI. The vitals are displayed on the left and the checklist is displayed on the right.
Alarms are then send to the earpiece or the speaker, depending on the type of alarm and if the nurse if close.
This system focuses of solving these three pain points from the paper mentioned before.
Here you can see that there is an actionable task that the patient needs a bath.
You can also see that there are some events that happened that should be reviewed.
Oxygen meter fell off so it gets added to the actionable tasks and should be fixed the next time the nurse comes to check up on the patient.
So when the nurse goes to visit this patient the nurse will get an alert in their earpiece.
A cardiac arrest happened which is a critical actionable event and should be resolved as soon as possible.
The speaker alarm goes of alerting all nearby nurses of this critical event in order to get them to respond.
This scenario focuses on one line of situation as an example.
When there is an actionable but noncritical situation, it goes on until the time limit is reached and becomes critical.
As you know, there are a lot of devices and sounds in an ICU room.
All information is represented in the centralized hub.
At this point the system is only monitors the vitals so it doesn’t make any sound as all the vitals are within a normal range.
The patient wears an oxygen sensor on his finger.
But the oxygen sensor detaches.
Oxygen meter fell off so it gets added to the actionable tasks and should be fixed the next time the nurse comes to check up on the patient.
So now a non-critical alarm will sound if the nurse is closeby to notify them of this task.
However, the nurse did not pass by, but the oxygen sensor had been detached for some time now. Enough time for the patient's oxygen levels to have dropped out of the safe range, potentially having lethal consequences. Therefore the critical alarm is triggered to make sure this task gets done as soon as possible.
After a certain amount of time the non-critical task becomes critical if not yet fixed. For any non-critical task there is a point in time where it becomes critical. For instance after the oxygen sensor falls off, the oxygen level could be slowly decreasing to lethal levels without anyone knowing, but this takes a certain amount of time and it should be critical before that time is reached. This is also to minimise liability.
Also there is a clear auditory distinction between non critical alarms and critical actionable alarms to distinguish between urgent and non urgent response.
After the critical alarm notified the nearby nurses, one of the nurses reattaches the sensor and the critical alarm stops.