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[PMID]:28448390
[Au] Autor:Patino M; Kalin M; Griffin A; Minhajuddin A; Ding L; Williams T; Ishman S; Mahmoud M; Kurth CD; Szmuk P
[Ad] Endereço:From the *Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Departments of †Anesthesiology and ‡Clinical Sciences, UT Southwestern and Children's Medical Center, Dallas, Texas; §Division of Biostatistics and Epidemiology, Cincinnati, Ohio; ‖University of Texas Southwestern and Children's Medical Center, Dallas, Texas; ¶Division of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; #Department of Anesthesia and Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; **Department of Anesthesiology, University of Texas Southwestern and Children's Medical Center, Dallas, Texas; and ††Dallas and Outcome Research Consortium, Cleveland, Ohio.
[Ti] Título:Comparison of Postoperative Respiratory Monitoring by Acoustic and Transthoracic Impedance Technologies in Pediatric Patients at Risk of Respiratory Depression.
[So] Source:Anesth Analg;124(6):1937-1942, 2017 06.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In children, postoperative respiratory rate (RR) monitoring by transthoracic impedance (TI), capnography, and manual counting has limitations. The rainbow acoustic monitor (RAM) measures continuous RR noninvasively by a different methodology. Our primary aim was to compare the degree of agreement and accuracy of RR measurements as determined by RAM and TI to that of manual counting. Secondary aims include tolerance and analysis of alarm events. METHODS: Sixty-two children (2-16 years old) were admitted after tonsillectomy or receiving postoperative patient/parental-controlled analgesia. RR was measured at regular intervals by RAM, TI, and manual count. Each TI or RAM alarm resulted in a clinical evaluation to categorize as a true or false alarm. To assess accuracy and degree of agreement of RR measured by RAM or TI compared with manual counting, a Bland-Altman analysis was utilized showing the average difference and the limits of agreement. Sensitivity and specificity of RR alarms by TI and RAM are presented. RESULTS: Fifty-eight posttonsillectomy children and 4 patient/parental-controlled analgesia users aged 6.5 ± 3.4 years and weighting 35.3 ± 22.7 kg (body mass index percentile 76.6 ± 30.8) were included. The average monitoring time per patient was 15.9 ± 4.8 hours. RAM was tolerated 87% of the total monitoring time. The manual RR count was significantly different from TI (P = .007) with an average difference ± SD of 1.39 ± 10.6 but were not significantly different from RAM (P = .81) with an average difference ± SD of 0.17 ± 6.8. The proportion of time when RR measurements differed by ≥4 breaths was 22% by TI and was 11% by RAM. Overall, 276 alarms were detected (mean alarms/patient = 4.5). The mean number of alarms per patient were 1.58 ± 2.49 and 2.87 ± 4.32 for RAM and TI, respectively. The mean number of false alarms was 0.18 ± 0.71 for RAM and 1.00 ± 2.78 for TI. The RAM was found to have 46.6% sensitivity (95% confidence interval [CI], 0.29-0.64), 95.9% specificity (95% CI, 0.90-1.00), 88.9% positive predictive value (95% CI, 0.73-1.00), and 72.1% negative predictive value (95% CI, 0.61-0.84), whereas the TI monitor had 68.5% sensitivity (95% CI, 0.53-0.84), 72.0% specificity (95% CI, 0.60-0.84), 59.0% positive (95% CI, 0.44-0.74), and 79.5% negative predictive value (95% CI, 0.69-0.90). CONCLUSIONS: In children at risk of postoperative respiratory depression, RR assessment by RAM was not different to manual counting. RAM was well tolerated, had a lower incidence of false alarms, and had better specificity and positive predictive value than TI. Rigorous evaluation of the negative predictive value is essential to determine the role of postoperative respiratory monitoring with RAM.
[Mh] Termos MeSH primário: Acústica
Pulmão/fisiopatologia
Monitorização Fisiológica/métodos
Insuficiência Respiratória/diagnóstico
Taxa Respiratória
Tonsilectomia/efeitos adversos
[Mh] Termos MeSH secundário: Acústica/instrumentação
Adolescente
Criança
Pré-Escolar
Alarmes Clínicos
Impedância Elétrica
Reações Falso-Negativas
Reações Falso-Positivas
Feminino
Seres Humanos
Masculino
Monitorização Fisiológica/instrumentação
Ohio
Projetos Piloto
Pletismografia de Impedância
Valor Preditivo dos Testes
Estudos Prospectivos
Reprodutibilidade dos Testes
Insuficiência Respiratória/etiologia
Insuficiência Respiratória/fisiopatologia
Texas
Fatores de Tempo
Transdutores
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002062


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[PMID]:27775995
[Au] Autor:McCormick PJ; Levin MA; Lin HM; Sessler DI; Reich DL
[Ad] Endereço:Departments of Anesthesiology (P.J.M., M.A.L., D.L.R.), Genetics and Genomic Sciences (M.A.L.), and Population Health Science and Policy (H.-M.L.), Icahn School of Medicine at Mount Sinai, New York, New York; and Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (D.I.S.).
[Ti] Título:Effectiveness of an Electronic Alert for Hypotension and Low Bispectral Index on 90-day Postoperative Mortality: A Prospective, Randomized Trial.
[So] Source:Anesthesiology;125(6):1113-1120, 2016 12.
[Is] ISSN:1528-1175
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: We tested the hypothesis that an electronic alert for a "double low" of mean arterial pressure less than 75 mmHg and a bispectral index less than 45 reduces the primary outcome of 90-day mortality. METHODS: Adults having noncardiac surgery were randomized to receive either intraoperative alerts for double-low events or no alerts. Anesthesiologists were not blinded and not required to alter care based upon the alerts. The primary outcome was all-cause 90-day mortality. RESULTS: Patients (20,239) were randomized over 33 months, and 19,092 were analyzed. After adjusting for age, comorbidities, and perioperative factors, patients with more than 60 min of cumulative double-low time were twice as likely to die (hazard ratio, 1.99; 95% CI, 1.2 to 3.2; P = 0.005). The median number of double-low minutes (quartiles) was only slightly lower in the alert arm: 10 (2 to 30) versus 12 (2 to 34) min. Ninety-day mortality was 135 (1.4%) in the alert arm and 123 (1.3%) in the control arm. The difference in percent mortality was 0.18% (99% CI, -0.25 to 0.61). CONCLUSIONS: Ninety-day mortality was not significantly lower in patients cared for by anesthesiologists who received automated alerts to double-low states. Prolonged cumulative double-low conditions were strongly associated with mortality.
[Mh] Termos MeSH primário: Alarmes Clínicos/estatística & dados numéricos
Monitores de Consciência/estatística & dados numéricos
Hipotensão/diagnóstico
Hipotensão/mortalidade
Monitorização Intraoperatória/instrumentação
Complicações Pós-Operatórias/mortalidade
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Masculino
Monitorização Intraoperatória/métodos
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1706
[Cu] Atualização por classe:180102
[Lr] Data última revisão:
180102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161025
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE


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[PMID]:29176776
[Au] Autor:Fidler RL; Pelter MM; Drew BJ; Palacios JA; Bai Y; Stannard D; Aldrich JM; Hu X
[Ad] Endereço:University of California San Francisco, School of Nursing, San Francisco, CA, United States of America.
[Ti] Título:Understanding heart rate alarm adjustment in the intensive care units through an analytical approach.
[So] Source:PLoS One;12(11):e0187855, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Heart rate (HR) alarms are prevalent in ICU, and these parameters are configurable. Not much is known about nursing behavior associated with tailoring HR alarm parameters to individual patients to reduce clinical alarm fatigue. OBJECTIVES: To understand the relationship between heart rate (HR) alarms and adjustments to reduce unnecessary heart rate alarms. METHODS: Retrospective, quantitative analysis of an adjudicated database using analytical approaches to understand behaviors surrounding parameter HR alarm adjustments. Patients were sampled from five adult ICUs (77 beds) over one month at a quaternary care university medical center. A total of 337 of 461 ICU patients had HR alarms with 53.7% male, mean age 60.3 years, and 39% non-Caucasian. Default HR alarm parameters were 50 and 130 beats per minute (bpm). The occurrence of each alarm, vital signs, and physiologic waveforms was stored in a relational database (SQL server). RESULTS: There were 23,624 HR alarms for analysis, with 65.4% exceeding the upper heart rate limit. Only 51% of patients with HR alarms had parameters adjusted, with a median upper limit change of +5 bpm and -1 bpm lower limit. The median time to first HR parameter adjustment was 17.9 hours, without reduction in alarms occurrence (p = 0.57). CONCLUSIONS: HR alarms are prevalent in ICU, and half of HR alarm settings remain at default. There is a long delay between HR alarms and parameters changes, with insufficient changes to decrease HR alarms. Increasing frequency of HR alarms shortens the time to first adjustment. Best practice guidelines for HR alarm limits are needed to reduce alarm fatigue and improve monitoring precision.
[Mh] Termos MeSH primário: Alarmes Clínicos
Frequência Cardíaca/fisiologia
Unidades de Terapia Intensiva
[Mh] Termos MeSH secundário: Seres Humanos
Software
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171219
[Lr] Data última revisão:
171219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0187855


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[PMID]:28455284
[Au] Autor:Alsaad AA; Alman CR; Thompson KM; Park SH; Monteau RE; Maniaci MJ
[Ad] Endereço:Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA.
[Ti] Título:A multidisciplinary approach to reducing alarm fatigue and cost through appropriate use of cardiac telemetry.
[So] Source:Postgrad Med J;93(1101):430-435, 2017 Jul.
[Is] ISSN:1469-0756
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Alarm fatigue (AF) is a distressing factor for staff and patients in the hospital. Using cardiac telemetry (CT) without clinical indications can create unnecessary alarms, and increase AF and cost of healthcare. We sought to reduce AF and cost associated with CT monitoring. METHODS: After implementing a new protocol for CT placement, data were collected on telemetry orders, alarms and bed cost for 13 weeks from 1 January 2015 through 31 March 2015. We also retrospectively collected data on the same variables for the 13 weeks prior to the intervention. A survey was administered to nurses to assess past and present perceptions of AF. Interventions included protocol creation and education for participants. RESULTS: At baseline, 77% of patients were monitored with CT. A total of 145 (31%) order discrepancies were discovered during data collection, of which 72% had no indication for CT, so CT was discontinued. The other 28% had indications, so orders were placed. A total of 8336 alarms were recorded during 4 weeks of data collection, of which 333 (4%) were classified as true actionable alarms. Postintervention data showed 67% CT assignment with 10% reduction in CT usage, with no increase in mortality (p<0.001 and >0.05, respectively). A 42% cost reduction was achieved after adjusting the patient status. Nurses reported 27% perceived reduction in AF. One-year follow-up revealed that 69% of patients were being monitored by CT, and the rate of order discrepancies due to lack of indication was 9%. CONCLUSION: All hospital units may benefit from the protocols created during this study. If applied appropriately, these protocols can lead to reduced AF and cost per episode of care.
[Mh] Termos MeSH primário: Esgotamento Profissional/prevenção & controle
Cardiologia/instrumentação
Alarmes Clínicos
Fadiga/prevenção & controle
Melhoria de Qualidade
Telemetria
[Mh] Termos MeSH secundário: Seres Humanos
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE
[do] DOI:10.1136/postgradmedj-2016-134764


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[PMID]:28981515
[Au] Autor:Joshi R; Mortel HV; Feijs L; Andriessen P; Pul CV
[Ad] Endereço:Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.
[Ti] Título:The heuristics of nurse responsiveness to critical patient monitor and ventilator alarms in a private room neonatal intensive care unit.
[So] Source:PLoS One;12(10):e0184567, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:AIM: Alarm fatigue is a well-recognized patient safety concern in intensive care settings. Decreased nurse responsiveness and slow response times to alarms are the potentially dangerous consequences of alarm fatigue. The aim of this study was to determine the factors that modulate nurse responsiveness to critical patient monitor and ventilator alarms in the context of a private room neonatal intensive care setting. METHODS: The study design comprised of both a questionnaire and video monitoring of nurse-responsiveness to critical alarms. The Likert scale questionnaire, comprising of 50 questions across thematic clusters (critical alarms, yellow alarms, perception, design, nursing action, and context) was administered to 56 nurses (90% response rate). Nearly 6000 critical alarms were recorded from 10 infants in approximately 2400 hours of video monitoring. Logistic regression was used to identify patient and alarm-level factors that modulate nurse-responsiveness to critical alarms, with a response being defined as a nurse entering the patient's room within the 90s of the alarm being generated. RESULTS: Based on the questionnaire, the majority of nurses found critical alarms to be clinically relevant even though the alarms did not always mandate clinical action. Based on video observations, for a median of 34% (IQR, 20-52) of critical alarms, the nurse was already present in the room. For the remaining alarms, the response rate within 90s was 26%. The median response time was 55s (IQR, 37-70s). Desaturation alarms were the most prevalent and accounted for more than 50% of all alarms. The odds of responding to bradycardia alarms, compared to desaturation alarms, were 1.47 (95% CI = 1.21-1.78; <0.001) while that of responding to a ventilator alarm was lower at 0.35 (95% CI = 0.27-0.46; p <0.001). For every 20s increase in the duration of an alarm, the odds of responding to the alarm (within 90s) increased to 1.15 (95% CI = 1.1-1.2; p <0.001). The random effect per infant improved the fit of the model to the data with the response times being slower for infants suffering from chronic illnesses while being faster for infants who were clinically unstable. DISCUSSION: Even though nurses respond to only a fraction of all critical alarms, they consider the vast majority of critical and yellow alarms as useful and relevant. When notified of a critical alarm, they seek waveform information and employ heuristics in determining whether or not to respond to the alarm. CONCLUSION: Amongst other factors, the category and duration of critical alarms along with the clinical status of the patient determine nurse-responsiveness to alarms.
[Mh] Termos MeSH primário: Alarmes Clínicos
Unidades de Terapia Intensiva Neonatal
Monitorização Fisiológica/enfermagem
Segurança do Paciente
Quartos de Pacientes
Respiração Artificial/enfermagem
[Mh] Termos MeSH secundário: Heurística
Seres Humanos
Lactente
Recém-Nascido
Terapia Intensiva Neonatal
Tempo de Reação
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171022
[Lr] Data última revisão:
171022
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171006
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184567


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[PMID]:28974521
[Au] Autor:Sandau KE; Funk M; Auerbach A; Barsness GW; Blum K; Cvach M; Lampert R; May JL; McDaniel GM; Perez MV; Sendelbach S; Sommargren CE; Wang PJ; American Heart Association Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Council on Cardiovascular Disease in the Young
[Ti] Título:Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association.
[So] Source:Circulation;136(19):e273-e344, 2017 Nov 07.
[Is] ISSN:1524-4539
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: This scientific statement provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration, and implementation of continuous electro cardiographic monitoring of hospitalized patients. Since the original practice standards were published in 2004, new issues have emerged that need to be addressed: overuse of arrhythmia monitoring among a variety of patient populations, appropriate use of ischemia and QT-interval monitoring among select populations, alarm management, and documentation in electronic health records. METHODS: Authors were commissioned by the American Heart Association and included experts from general cardiology, electrophysiology (adult and pediatric), and interventional cardiology, as well as a hospitalist and experts in alarm management. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Authors were assigned topics relevant to their areas of expertise, reviewed the literature with an emphasis on publications since the prior practice standards, and drafted recommendations on indications and duration for electrocardiographic monitoring in accordance with the American Heart Association Level of Evidence grading algorithm that was in place at the time of commissioning. RESULTS: The comprehensive document is grouped into 5 sections: (1) Overview of Arrhythmia, Ischemia, and QTc Monitoring; (2) Recommendations for Indication and Duration of Electrocardiographic Monitoring presented by patient population; (3) Organizational Aspects: Alarm Management, Education of Staff, and Documentation; (4) Implementation of Practice Standards; and (5) Call for Research. CONCLUSIONS: Many of the recommendations are based on limited data, so authors conclude with specific questions for further research.
[Mh] Termos MeSH primário: American Heart Association
Arritmias Cardíacas/diagnóstico
Serviço Hospitalar de Cardiologia/normas
Eletrocardiografia/normas
Hospitalização
[Mh] Termos MeSH secundário: Arritmias Cardíacas/fisiopatologia
Arritmias Cardíacas/terapia
Alarmes Clínicos/normas
Consenso
Documentação/normas
Eletrocardiografia Ambulatorial/normas
Registros Eletrônicos de Saúde/normas
Medicina Baseada em Evidências/normas
Teste de Esforço/normas
Controle de Formulários e Registros/normas
Seres Humanos
Valor Preditivo dos Testes
Prognóstico
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE; REVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171005
[St] Status:MEDLINE
[do] DOI:10.1161/CIR.0000000000000527


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[PMID]:28759483
[Au] Autor:Berman MF; Iyer N; Freudzon L; Wang S; Freundlich RE; Housey M; Kheterpal S; Multicenter Perioperative Outcomes Group (MPOG) Perioperative Clinical Research Committee
[Ad] Endereço:From the *Department of Anesthesiology, Columbia University Medical Center, New York, New York; †Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan; ‡Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut; §Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York; and ‖Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
[Ti] Título:Alarm Limits for Intraoperative Drug Infusions: A Report From the Multicenter Perioperative Outcomes Group.
[So] Source:Anesth Analg;125(4):1203-1211, 2017 Oct.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Continuous medication infusions are commonly used during surgical procedures. Alarm settings for infusion pumps are considered important for patient safety, but limits are not created in a standardized manner from actual usage data. We estimated 90th and 95th percentile infusion rates from a national database for potential use as upper limit alarm settings. METHODS: We extracted infusion rate data from 17 major hospitals using intraoperative records provided by Multicenter Perioperative Outcomes Group for adult surgery between 2008 and 2014. Seven infusions were selected for study: propofol, remifentanil, dexmedetomidine, norepinephrine, phenylephrine, nitroglycerin, and esmolol. Each dosage entry for an infusion during a procedure was included. We estimated the 50th, 90th, and 95th percentile levels for each infusion across institutions, and performed quantile regression to examine factors that might affect the percentiles rates, such as use in general anesthesia versus sedation. RESULTS: The median 90th and 95th percentile infusion rates (with interquartile range) for propofol were 150 (140-150) and 170 (150-200) µg/kg/min. Quantile regression demonstrated higher 90th and 95th percentile rates during sedation for gastrointestinal endoscopy than for all surgical procedures performed under general anesthesia. For selected vasoactive medications, the corresponding median 90th and 95th percentile rates (with interquartile range) were norepinephrine 14.0 (9.8-18.1) and 18.3 (12.6-23.9) µg/min, and phenylephrine 60 (55-80) and 80 (75-100) µg/min. CONCLUSIONS: Alarm settings based on infusion rate percentile limits would be triggered at predictable rates; ie, the 95th percentile would be exceeded and an alarm sounded during 1 in 20 infusion rate entries. As a result, institutions could establish pump alarm settings consistent with desired alarm frequency using their own or externally validated usage data. Further study will be needed to determine the optimal percentile for infusion alarm settings.
[Mh] Termos MeSH primário: Anestésicos Intravenosos/administração & dosagem
Alarmes Clínicos/normas
Falha de Equipamento
Bombas de Infusão/normas
Relatório de Pesquisa
[Mh] Termos MeSH secundário: Idoso
Anestésicos Intravenosos/efeitos adversos
Feminino
Seres Humanos
Bombas de Infusão/efeitos adversos
Infusões Intravenosas
Complicações Intraoperatórias/prevenção & controle
Masculino
Meia-Idade
Propofol/administração & dosagem
Propofol/efeitos adversos
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Anesthetics, Intravenous); YI7VU623SF (Propofol)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170801
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002305


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[PMID]:28687637
[Au] Autor:Kipps AK; Poole SF; Slaney C; Feehan S; Longhurst CA; Sharek PJ; Goel VV
[Ad] Endereço:Department of Pediatrics, Stanford Children's Health, Palo Alto, California; akipps@stanford.edu.
[Ti] Título:Inpatient-Derived Vital Sign Parameters Implementation: An Initiative to Decrease Alarm Burden.
[So] Source:Pediatrics;140(2), 2017 Aug.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To implement data-driven vital sign parameters to reduce bedside monitor alarm burden. METHODS: Single-center, quality-improvement initiative with historical controls assessing the impact of age-based, inpatient-derived heart rate (HR) and respiratory rate (RR) parameters on a 20-bed acute care ward that serves primarily pediatric cardiology patients. The primary outcome was the number of alarms per monitored bed day (MBD) with the aim to decrease the alarms per MBD. Balancing measures included the frequency of missed rapid response team activations, acute respiratory code events, and cardiorespiratory arrest events in the unit with the new vital sign parameters. RESULTS: The median number of all cardiorespiratory monitor alarms per MBD decreased by 21% from 52 (baseline period) to 41 (postintervention period) ( < .001). This included a 17% decrease in the median HR alarms (9-7.5 per MBD) and a 53% drop in RR alarms (16.8-8.0 per MBD). There were 57 rapid response team activations, 8 acute respiratory code events, and no cardiorespiratory arrest events after the implementation of the new parameters. An evaluation of HRs and RRs recorded at the time of the event revealed that all patients with HRs and/or RRs out of range per former default parameters would also be out of range with the new parameters. CONCLUSIONS: Implementation of data-driven HR and iteratively derived RR parameters safely decreased the total alarm frequency by 21% in a pediatric acute care unit.
[Mh] Termos MeSH primário: Alarmes Clínicos
Parada Cardíaca/enfermagem
Cardiopatias/enfermagem
Admissão do Paciente
Melhoria de Qualidade/organização & administração
Processamento de Sinais Assistido por Computador
Sinais Vitais
[Mh] Termos MeSH secundário: Adolescente
Esgotamento Profissional/enfermagem
Esgotamento Profissional/prevenção & controle
Serviço Hospitalar de Cardiologia/organização & administração
Criança
Pré-Escolar
Feminino
Implementação de Plano de Saúde
Frequência Cardíaca
Seres Humanos
Lactente
Masculino
Segurança do Paciente
Taxa Respiratória
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170828
[Lr] Data última revisão:
170828
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170709
[St] Status:MEDLINE


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[PMID]:28682835
[Au] Autor:Kane-Gill SL; O'Connor MF; Rothschild JM; Selby NM; McLean B; Bonafide CP; Cvach MM; Hu X; Konkani A; Pelter MM; Winters BD
[Ad] Endereço:1Department of Pharmacy, Critical Care Medicine, Biomedical Informatics and Clinical Translational Science Institute, University of Pittsburgh, Pittsburgh, PA. 2Department of Pharmacy, UPMC, Pittsburgh, PA. 3Department of Anesthesia and Critical Care Section of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, IL. 4Department of Medicine, The University of Chicago, Chicago, IL. 5Division of General Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. 6Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, United Kingdom. 7Critical Care Division, Grady Health Systems, Atlanta, GA. 8Division of General Pediatrics, Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA. 9Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 10John Hopkins Health System, Baltimore, MD. 11Department of Physiological Nursing, University of California, San Francisco, CA. 12Clinical Engineering Professional Services, University of Virginia Health System, Charlottesville, VA. 13Department of Anesthesiology, Critical Care Medicine, Surgery and Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD.
[Ti] Título:Technologic Distractions (Part 1): Summary of Approaches to Manage Alert Quantity With Intent to Reduce Alert Fatigue and Suggestions for Alert Fatigue Metrics.
[So] Source:Crit Care Med;45(9):1481-1488, 2017 Sep.
[Is] ISSN:1530-0293
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To provide ICU clinicians with evidence-based guidance on tested interventions that reduce or prevent alert fatigue within clinical decision support systems. DESIGN: Systematic review of PubMed, Embase, SCOPUS, and CINAHL for relevant literature from 1966 to February 2017. PATIENTS: Focus on critically ill patients and included evaluations in other patient care settings, as well. INTERVENTIONS: Identified interventions designed to reduce or prevent alert fatigue within clinical decision support systems. MEASUREMENTS AND MAIN RESULTS: Study selection was based on one primary key question to identify effective interventions that attempted to reduce alert fatigue and three secondary key questions that covered the negative effects of alert fatigue, potential unintended consequences of efforts to reduce alert fatigue, and ideal alert quantity. Data were abstracted by two reviewers independently using a standardized abstraction tool. Surveys, meeting abstracts, "gray" literature, studies not available in English, and studies with non-original data were excluded. For the primary key question, articles were excluded if they did not provide a comparator as key question 1 was designed as a problem, intervention, comparison, and outcome question. We anticipated that reduction in alert fatigue, including the concept of desensitization may not be directly measured and thus considered interventions that reduced alert quantity as a surrogate marker for alert fatigue. Twenty-six articles met the inclusion criteria. CONCLUSION: Approaches for managing alert fatigue in the ICU are provided as a result of reviewing tested interventions that reduced alert quantity with the anticipated effect of reducing fatigue. Suggested alert management strategies include prioritizing alerts, developing sophisticated alerts, customizing commercially available alerts, and including end user opinion in alert selection. Alert fatigue itself is studied less frequently, as an outcome, and there is a need for more precise evaluation. Standardized metrics for alert fatigue is needed to advance the field. Suggestions for standardized metrics are provided in this document.
[Mh] Termos MeSH primário: Alarmes Clínicos/efeitos adversos
Estado Terminal
Sistemas de Apoio a Decisões Clínicas/organização & administração
Unidades de Terapia Intensiva/organização & administração
Fadiga Mental/etiologia
Fadiga Mental/prevenção & controle
[Mh] Termos MeSH secundário: Hipersensibilidade a Drogas/epidemiologia
Interações Medicamentosas
Seres Humanos
Guias de Prática Clínica como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE
[do] DOI:10.1097/CCM.0000000000002580


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[PMID]:28609513
[Au] Autor:Abbasi J
[Ti] Título:In-home, Over-the-counter Sleep Apnea Sensor on the Horizon.
[So] Source:JAMA;317(22):2271, 2017 Jun 13.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Alarmes Clínicos
Difusão de Inovações
Síndromes da Apneia do Sono/diagnóstico
[Mh] Termos MeSH secundário: Ensaios Clínicos Fase II como Assunto
Seres Humanos
Aplicativos Móveis
Projetos Piloto
Sensibilidade e Especificidade
Auxiliares Sensoriais
[Pt] Tipo de publicação:NEWS
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170706
[Lr] Data última revisão:
170706
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170614
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.6928



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