呼吸机假阳性报警的现状与应对策略探讨
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摘要
目的:提高对呼吸机假阳性报警的响应与处置能力,减少医护人员报警疲劳,保障呼吸机的安全使用。方法:从呼吸机报警等级的分类、假阳性报警及其危害等方面对呼吸机报警现状进行现状分析,以提出应对策略。结果:提出了通过规范应用呼吸机、技术创新等方式减少呼吸机假阳性报警的临床处置策略。结论:加强对呼吸机报警的理解与响应、完善设备报警系统、优化呼吸机报警层级、剔除假阳性报警等对提高呼吸机的临床诊疗效果均具有重要意义。
Objective To improve the stimulus-responses to the false positive alarms of the ventilator, reduce alarm fatigue of the clinician, and assure clinical safety for ventilator use. Method The current situation of the ventilator alarm was analyzed from the classification of ventilator alarms, false positive alarm and its harm. Results The countermeasures of improving the utilizing of ventilator and technical innovation for ventilator alarm system were proposed. Conclusion To understand the alarms and respond properly to the alarms of ventilator, to improve the alarm system of ventilator and optimize the alarm system, and to get rid of false positive alarms are important for the clinical use of ventilator. [Chinese Medical Equipment Journal,2019,40(5):61-65]
Objective To improve the stimulus-responses to the false positive alarms of the ventilator, reduce alarm fatigue of the clinician, and assure clinical safety for ventilator use. Method The current situation of the ventilator alarm was analyzed from the classification of ventilator alarms, false positive alarm and its harm. Results The countermeasures of improving the utilizing of ventilator and technical innovation for ventilator alarm system were proposed. Conclusion To understand the alarms and respond properly to the alarms of ventilator, to improve the alarm system of ventilator and optimize the alarm system, and to get rid of false positive alarms are important for the clinical use of ventilator. [Chinese Medical Equipment Journal,2019,40(5):61-65]
引文
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[27]钱正瑛,金伟,杨俊,等.基于多模式数据采集的医疗设备实时监管平台构建[J].中华医院管理杂志,2017,33(8):608-610.
[28]龚海英,张广,顾彪,等.呼吸机及其远程控制系统技术进展[J].医疗卫生装备,2016,37(4):123-127.
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[30]庞剑飞,蒋俊成,乔梁.呼吸机质控管理系统的设计与实现[J].中国医疗设备,2015,30(2):90-93.
[31]郭丽叶,叶国玲,冯洁慧.ICU仪器报警的干预研究进展[J].护理与康复,2015,14(6):531-533.
[32]俞刚.医疗设备无线数据传感模块的设计与开发[J].中华医院管理杂志,2015,31(10):783-784.
[33]洪范宗,蔡雅玲,田君鹏,等.呼吸机数据采集监控系统设计[J].医疗卫生装备,2017,38(7):20-23.
[2]LEWIS S C,LI L,MURPHY M V,et al.Risk factors for ventilator-associated events:a case-control multivariable analysis[J].Crit Care Med,2014,42(8):1 839-1 848.
[3]医疗器械风险管理对医疗器械的应用:YY/T 0316-2008/ISO 14971:2007[S].
[4]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 electri-cal systems:IEC 60601-1-8:2006[S].
[5]TANNER T.The problem of alarm fatigue[J].Nurs Womens Health,2013,17(2):153-157.
[6]POOLE S,SHAH N.Addressing vital sign alarm fatigue using personalized alarm thresholds[J].Pac Symp Biocomput,2018,23:472-483.
[7]医用电气设备第1-8部分:安全通用要求并列标准:通用要求,医用电气设备和医用电气系统中报警系统的测试和指南:YY 0709-2009/IEC 60601-1-8:2009[S].
[8]JONES K.Alarm fatigue a top patient safety hazard[J].CMAJ,2014,186(3):178.
[9]KOWALCZYK L.Alarm fatigue linked to patient death[N/OL].The boston globe,2010-04-03[2018-11-06].www.boston.com/news/local/massachusetts/articles/2010/04/03/ala-rm_fatigue_linked_to_heart_patients_death_at_mass_general.
[10]BELTEKI G,MORLEY C J.Frequency,duration and cause of ventilator alarms on a neonatal intensive care unit[J].Arch Dis Child Fetal Neonatal Ed,2018,103(4):307-311.
[11]RUPPEL H,FUNK M,WHITTEMORE R.Measurement of physiological monitor alarm accuracy and clinical relevance in intensive care units[J].Am J Crit Care,2018,27(1):11-21.
[12]JOSHI R,MORTEL H V,FEIJS L,et al.The heuristics of nurse responsiveness to critical patient monitor and ventilator alarms in a private room neonatal intensive care unit[J].PLoSOne,2017,12(10):e0184567.
[13]PAINE C W,GOEL V V,ELY E,et al.Systematic review of physiologic monitor alarm characteristics and pragmatic interventions to reduce alarm frequency[J].J Hosp Med,2016,11(2):136-144.
[14]JOHNSON K R,HAGADORN J I,SINK D W.Alarm safety and alarm fatigue[J].Clin Perinatol,2017,44(3):713-728.
[15]WILKEN M,H譈SKE-KRAUS D,KLAUSEN A,et al.Alarm fatigue:causes and effects[J].Stud Health Technol Inform,2017,243:107-111.
[16]SOWAN A K,VERA A G,FONSECA E I,et al.Nurse competence on physiologic monitors use:toward eliminating alarm fatigue in intensive care units[J].Open Med Inform J,2017,11:1-11.
[17]ECRI.Top 10 health technology hazards for 2017[R/OL].(2017-09-06)[2019-01-25].http://www.jdsupra.com/legalnews/top-10-health-technology-hazards-for-94718.
[18]CRISCITELLI T.Alarm management:promoting safety and establishing guidelines[J].AORNJ,2016,103(5):518-521.
[19]Association for the Advancement of Medical Instrumentation.Alarms Pose Challenges to Healthcare Facilities[J].Biomed Instrum Technol,2011,45(1):39-43.
[20]G魻RGES M,MARKEWITZ B A,WESTENSKOW D R.Improving alarm performance in the medical intensive care unit using delays and clinical context[J].Anesth Analg,2009,108(5):1 546-1 552.
[21]WELCH J.An evidence-based approach to reduce nuisance alarms and alarm fatigue[J].Biomed Instrum Technol,2011,45(1):46-52.
[22]WINTERS B D,CVACH M M,BONAFIDE C P,et al.Technological distractions(part 2):a summary of approaches to manage clinical alarms with intent to reduce alarm fatigue[J].Crit Care Med,2018,46(1):130-137.
[23]PELTER M M,XU Y,FIDLER R,et al.Evaluation of ECGalgorithms designed to improve detect of transient myocardial ischemia to minimize false alarms in patients with suspected acute coronary[J].J Electrocardiol,2018,51(2):288-295.
[24]SOLVOLL T,ARNTSEN H,HARTVIGSEN G.Alarm fatigue vs user expectations regarding context-aware alarm handling in hospital environments using CallMeSmart[J].Stud Health Technol Inform,2017,241:159-164.
[25]PEDERSEN N E,RASMUSSEN L S,PETERSEN J A,et al.Modifications of the National Early Warning Score for patients with chronic respiratory disease[J].Acta Anaesthesiol Scand,2018,62(2):242-252.
[26]RAHMAN M M,CHAROEN C,SUKSOMPONG P,et al.Afalse alarm reduction method for a gas sensor based electronic nose[J].Sensors(Basel),2017,17(9):E2089.
[27]钱正瑛,金伟,杨俊,等.基于多模式数据采集的医疗设备实时监管平台构建[J].中华医院管理杂志,2017,33(8):608-610.
[28]龚海英,张广,顾彪,等.呼吸机及其远程控制系统技术进展[J].医疗卫生装备,2016,37(4):123-127.
[29]庞兴梅,李桥,陈红.应用基于数据融合的心率估计抑制监护仪错误报警[J].中国医学物理学杂志,2008,25(3):676-678.
[30]庞剑飞,蒋俊成,乔梁.呼吸机质控管理系统的设计与实现[J].中国医疗设备,2015,30(2):90-93.
[31]郭丽叶,叶国玲,冯洁慧.ICU仪器报警的干预研究进展[J].护理与康复,2015,14(6):531-533.
[32]俞刚.医疗设备无线数据传感模块的设计与开发[J].中华医院管理杂志,2015,31(10):783-784.
[33]洪范宗,蔡雅玲,田君鹏,等.呼吸机数据采集监控系统设计[J].医疗卫生装备,2017,38(7):20-23.