Receiving false and nuisance alarms is a well known problem in industrial alarm systems. The main cause of this problem is poor alarm design which is the result of huge number of configured alarms and lack of automatic and analytical design methods. This study targets deriving analytical methods for designing alarm parameters such as alarm limits, alarm deadbands and delay timers. The relation between false and missed alarm rates along with chattering is investigated with alarm limits and deadbands. There are two equations presented to estimate the optimal alarm limit with respect to deadbands and statistical characteristics of the process data. Since reduction of alarm chattering is a primary goal in redesigning the alarm parameters, the analytical relation between chattering with alarm parameters and process data is also investigated. The alarm chattering index is derived as a mathematical function of alarm limits, deadbands, time delays and statistical characteristics of the process data. / Control Systems

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Within the healthcare system, nurses, are involved in many critical steps of the patient care process such as surgery triaging, post-procedure recovery monitoring and handoff release to a caregiver. A significant portion of their time is spent on the hospital floors where patients recover from their medical procedures. In today’s healthcare environments, multiple devices – typically monitors, ventilators, and infusion pumps – are used during said patient recovery process. Health equipment manufacturers often add alarms to medical devices, which serve a variety of purposes, ranging from simple notifications to warnings and alerts about potential hazards that require rapid action. In typical hospital units, several types of medical devices that monitor a variety of parameters based on patient and nurses/assistants needs. Many devices have similar alarm tones, regardless of risk levels. A typical nurse will attend to multiple patients, and the number of alarms that require attention place tremendous demands on nurses’ cognition, which causes enormous alarm fatigue. Alarm fatigue is not a new phenomenon and is very common in other industries, such as chemical processing, and nuclear power. The additional stress and burden of false alarms and non-actionable alarms is also troublesome. Many for-profit companies have developed commercial alarm management tools and aids to combat these problems and the rapid adoption of smart phones and tablets in healthcare has made alarm management more mobile and visual. However, even after these advances, the number of deaths and adverse events are still at an unacceptable level. The purpose of this study to establish that the current training methods used by various hospitals are inadequate and to explore the effects of rigorous one-on-one training and metacognitive intervention in managing alarm related adverse events. This study also identifies deficiencies in the current training methods and assesses the impact of individualizing alarm threshold settings on alarm workload, response and error rates.

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A lack of alarm management for industrial control rooms has led to frequent alarm floods that have the potential to overwhelm operators within minutes. One approach to managing alarm floods would be altering the salience of alarms that operators might already notice, thereby reducing the disruption on workflow and attention for managing uninformative alarms. This research investigated the central hypothesis that eye fixations could supply passive input to acknowledge alarms anticipated by the operators and thereby improve their overall task performance. A dual-task experiment recruiting 24 participants was conducted to compare three gaze-based alarm acknowledgement methods –Proximity, Prediction, and Entropy- against no acknowledgement across three types of scenarios – Near-threshold, Trending, and Fluctuation. The gaze-based acknowledgement methods reduced visual and auditory salience of alarms as a function of the number of fixations on parameters as well as characteristics of the parameter known to influence operator monitoring behaviors. The participants performed an alarm monitoring task while controlling a continuous parameter within an acceptable range. While participants showed a preference for all of three gaze-based acknowledgment methods, performance of the parameter control task did not improve with gaze-based acknowledgement. Scenario types, as defined by the behavior of the parameters, exhibited a significant effect on the performance of the parameter control task, suggesting a greater influence on participant attention than the reduced salience associated with the gaze-based acknowledgments. Additional analysis revealed that gaze-acknowledgements are higher in scenarios with the most suitable for the gaze-based acknowledgement methods, although the participants did not show any gaze-based acknowledgements and did not make a prediction of an alarm for a significant portion of the trials, suggesting a lack of resource allocation to the alarm monitoring task. This result suggests that the effectiveness of gaze-based acknowledgement may depend on the combination of on-going tasks. Taken together, the experimental results showed some utility of user gaze in managing alarms given how acknowledgement occurred more often when the acknowledgement methods and parameters matched; however, further design research is necessary to translate the utility into clear performance or productivity benefits. / Master of Science / Industrial control rooms are notorious for having too many alarms triggered within minutes and operators are hindered by responding to these alarms as opposed to the actual process faults. Existing alarm management research and applications have already reduced nuisance alarms by filtering out those correlated to one another according to historical data or plant models. However, existing approaches have not eliminated the process parameters that operators already expect to reach alarm thresholds. In other words, current alarm management has not adapted for operator awareness of impending alarms. This study explored how eye-tracking might be used to acknowledge alarms anticipated by operators, thereby reducing uninformative alarms and interruption to operator work. The participants performed an alarm monitoring task while trying to maintain a fluctuating parameter within an acceptable range. While participants liked the gaze-based acknowledgement methods, their performance on the parameter control task did not improve over conditions without any alarm acknowledgement. The alarm monitoring task may not have received sufficient attention to induce an observable benefit. The characteristics of the parameter seemed to have a larger effect on participants' attention than the muted alarm presentation associated with the gaze-based acknowledgment. Further research is necessary to refine the current design to induce the postulated attention and performance benefits with gaze-based acknowledgement.

There is limited clinical research on the effectiveness of alarm management strategies and nursing behaviors related to alarms in clinical settings. As many as 76% of physiological monitor alarms are overlooked as clinically insignificant by nursing staff. Excessive alarms may impact patient outcomes and cause cognitive overload for nurses that can result in medical errors and missed patient resuscitations. The purpose of this systematic review was to rate alarm management studies on level of evidence for interventions, nursing responses to alarms, and impact on alarm fatigue behavior. The nursing role effectiveness model guided this project. Twenty-seven studies were reviewed to analyze outcome effectiveness by addressing structure, process, and outcomes related to how the roles of the nurse affect nurse-sensitive patient outcomes. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and the Cochrane guidelines guided study selection and analysis. A second reviewer collaborated on the search strategy and provided an independent review of the identified literature. The effectiveness of alarm management was difficult to determine because most studies were descriptive, cohort, or nonrandomized trials. Review findings did not support a relationship between the amount of alarms and increased alarm fatigue behaviors. Findings indicated that nurses' attitudes and alarm fatigue behaviors are present globally and have not significantly altered since reduction strategies were implemented. The findings may impact social change by decreasing nurses' stress levels related to cognitive workloads, improving patient outcomes, and supporting increased levels of nurses' workforce satisfaction.

According to The Joint Commission (TJC), 98 unexpected and unacceptable events related to alarm fatigue were reported in United States hospitals between January 2009 and June 2012. There were 80 deaths, 13 permanent loss of function, and 5 extended care stays that occurred during this time period. The problem identified in this quality improvement (QI) initiative was the TJC report that nursing staff in the US was experiencing alarm fatigue due to the overstimulation of senses from continuous beeping from alarms on the unit. Framed within the Iowa model of evidence-based practice to promote quality care, the purpose of the project was to develop a patient care alarm fatigue initiative as mandated by TJC including a policy and procedure for managing alarm fatigue, a curriculum plan for educating the nursing staff on alarm fatigue, and a survey on nurse attitudes toward alarm fatigue to be administered at the beginning of the education. The developed policy and procedure was approved by the committee with the recommendation to revise the policy to involve all ancillary staff in direct contact with clinical alarms. The curriculum objectives were evaluated by 2 content experts using a 4 item met/not met response format. Findings showed that all objectives were met. The content of the nurse survey was reviewed by the experts using a 3 item Likert scale and all the items were deemed relevant. Finally, team members (n = 9) completed a summative evaluation of the project using an 8 item, 5-option Likert scale. All were in agreement that the project met its intent. The implementation of this project after graduation has the potential to bring about social change by increasing patient safety, patient well being and reducing healthcare costs.

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Yes / In large industrial systems, alarm management is one of the most important issues to improve the safety and efficiency of systems in practice. Operators of such systems often have to deal with a numerous number of simultaneous alarms. Different kinds of thresholding or filtration are applied to decrease alarm nuisance and improve performance indices, such as Averaged Alarm Delay (ADD), Missed Alarm and False Alarm Rates (MAR and FAR). Among threshold-based approaches, variable thresholding methods are well-known for reducing the alarm nuisance and improving the performance of the alarm system. However, the literature suffers from the lack of an appropriate method to assess performance parameters of Variable Threshold Alarm Systems (VTASs). This study introduces two types of variable thresholding and proposes a novel approach for performance assessment of VTASs using Priority-AND gate and semi-Markov process. Application of semi-Markov process allows the proposed approach to consider industrial measurements with non-Gaussian distributions. In addition, the paper provides a genetic algorithm based optimized design process for optimal parameter setting to improve performance indices. The effectiveness of the proposed approach is illustrated via three numerical examples and through a comparison with previous studies. / Noavaran Electronic Adar Sameh company [Grant NO: IRAM17S1].