Alarms Externalisation
Dr Signouret Thomas
Intensive care unit
 Patients
 Vital prognosis committed
 Multiorgan failure
 Cares :
 Invasives, painfull, 24 h/24
 Life support equipment: ventilator, dyalisis, infusion
pumps
 Monitoring: 24 h/24
 Caregivers
 Monitoring device
Noise: World Health Organisation
guidelines: 35→40 dB
 Currently average noise: 60 → 70 dB
 Alarms : 70 → 80 dB !!!
 Staff conversations: 59 → 90 dB
Bush-Vishniac J acoust soc Am 2005
 10 à 25 % of alarms do induce a therapeutic modification
Lawless ST Crit Care Med 1994
 Patients:
 Disturbance
 Tachycardia, hypertension
 Pituitary and adrenal gland stimulation
Xie Crit care 2009
 Nurses: Concentration, stress, Phenomen of alarm fatigue
Morrison Crit Care Med 2003
Chambrin MC crit care 2001
Link between noise and sleep
disturbance ?
 Sleep disturbance:
 Slower healing
 Cognitive function
 Décrease immune response
 ICU delirium : 20 →80 %
 ↗ lenght of stay
 ↗ morbi-mortality
Ely EW JAMA 2004
 Noise is one of many factors of sleep disturbance:
 17→ 56 %
Xie Crit care 2009
Historic
1.
Remove the cardiacs monitor alarms from the room to
the centrale station
2.
Close the patient door’s room
3.
Pb: What about the others devices Alarm’s ?
4.
Need a translation of all the alarm in the same language
(HL7): Capsultech®
5.
Need to bring and allocate the alarm to the caregiver:
Connexall®
Aims of the Externalisation alarms
 Decrease the noise due to the alarms in the patient room.
 Allow the door closing:
 Decrease the noise from the nursing station
- 4 dB: Lawson Am J Crit Care 2010
 Overpressure level respected in the unit
 Aspergillose prevention
R113: Référentiel struct Vdef 2011
 Alarms send to caregivers
 Tracability
Définition of gravity level
 Cardiac arrest(vital priority) : Vital emmergency who need an
immediat respons of all the caregivers( nurses and doctor) of intensive
care unit
 Critical (high priority ) : Urgent situation who require an immediat
response of caregivers
 Grave (medium priority) : Imminent risk who requires a rapid
response of caregivers
 Message (low priority) : Attention of medical staff is require
European standard medical devices.EN 475:1995
Mapping alarms
Cause/message machine
Affichage Connexall
affichage simplifié
Criticité
Changement poche Réinjection
Pression transmembranaire élevée
Gain excessif poids patient
Alerte changement poche
Alerte PTM élevée
Arrêt pompe sang
Changement poche
PTM ↗
↕ pompe sang
Message
Grave
Critique
Arrêt pompe (= Occlusion)
Relais seringue imminent
Bulle d’air (Pompe)
Occlusion Perfusion
Relais seringue imminent
Bulle d'air perfusion
↕ PSE
relais PSE imminent
bulle d'air
Grave
Message
Grave
Fibrillation V
Tachycardie V
Couplet
Fibrillation ventriculaire
Tachycardie Ventriculaire
Couplet
Fibr V
TV
Couplet
Vitale
Critique
Message
Workflow
Primaire
Specification pour
chaque alarme
Secondaire
Interval entre
Delai
Duree
Delai
Duree Nombre de
chaque
Nombre de
Connexall
apres
total(sec)
apres ackw repetitions repetitions
repetitions
(sec)
ackw
(sec)
Backup
Interval
Nombre
Duree
entre
de
Interval
apres
chaque
repetition (sec)
ackw
(sec)
s
Vitale
5
2
90
9999
15
0
0
1
0
0
1
Critique
5
2
90
2
20
90
2
20
60
0
40
Grave
10
7
90
2
30
90
2
30
Message
15
12
9999
0
20
0
0
15
0
0
15
The Daily Job of the Nurse
Hardware connectivity
Check devices connexion
 Specific connection by DIM
Capsultech® on device
RS232 outlet
 Connection IT wires on
DATACAPTOR®module for
sending the information on
the network
Sélect and Assign the patients
 Connexall central station:
 Assignement of each patient on an iPoD which is dedicated to a
nurse
303
304
305
R2.2
301
302
R2.1
Assignment
Connexall Central station
Main Screen
Alarms on mobile Device
Arrêt cardiaque box 1
Acknowledgment
Currently
 Golive on a five beds unit after a training of all nurses
of the unit
 Connection of all devices
 Good expression of the sonor Alarms with right tonality,
gravity and workflow
 Visual alarms: Good rendering
 Doors closed recently
 We left the sound in the box due to an IT server issue
Alarm Externalisation Risk
 Log out the devices from the datacaptor
 4 or 5 network





Drager
Capsultech
Connexall
Hopital européen Marseille
Apple
Regulated Medical Devices Class II FDA
What we expected ? Sécurity
 A visual indicator of log out on connexall central station
 An automatic detection of IT server issue by heart bit then an
alarm message with a workflow to:
 Drager IT engineer
 Biomed
 Doctor
 Chief nurse
 A new device who avoid apple network
 Evaluation the quality of caregivers réaction
And Also…: Dévellopment
 Transitory (2min) Inhibition of the transmission of all alarm
on the Connexall system when the Nurse active “a nursing
function”
 Showing the waves in live in case of alarm: Link patient
watch
 Sending vocal message with:
 1st : the sound characteristic of level of gravity
 2nd : the number of room
 3rd : the message of alarm
Link on patient watch
Evaluation
1. Safety
2. Efficacy
3. Perception
Safety
 Description of differents alarm :
 Number of alarm / hour and /12 h
 Number by device
 Number by nurse
 Number by gravity
 Delay between alarm and acknowledgment
 Delay between alarm and resolution
Efficacy
 Average intensity noise during day and night :
 In the room
 In the nurse station
 Number of Peak level > 80 dB/ h during day and night :
 In the room
 In the nurse station
Perception
 Patient questionnaire :
 Sleep quality : Richards Campbell Sleep Questionnaire
 Noise discomfort
 Care givers quetionnaire :
 Noise discomfort
 Satisfaction
A prospective open interventionnel
study évaluate a reducing stratégy of
noise by an alarm notification system
Primary purpose: réduction of 10 dB by currently average noise
level 60 +/- 10 dB
We need 16 patients in each stategies
Power: 80 %
alpha risk : 5 %
Middle and Long terms Plan
 Extended the externalisation of the alarm to other
medical Device
 ECMO, Bed, Labs, etc…
 Extended the externalisation of the alarm to other
medical specialties
 Anesthesia : An anesthesiologist works on several OR
 Cardiology
 Special device to show the alarm: Samsung gear,
Google Glasses
Thank you for you attention
Functionnal Basics of Third-Party
Alarm Notification Systems
B Moorman Biomed Instrumentation and Technology 2011