Degree

Doctor of Philosophy (PhD)

Department

Mechanical and Industrial Engineering

Document Type

Dissertation

Abstract

Alarm fatigue has been a consistent problem nurses have experienced for decades. The effects of excessive nuisance alarms leads to adverse effects such as desensitization, missed alarms, frustration, and increased risk to patient safety. Other research has provided explanations on alarm fatigue causes and developed solutions for reducing nuisance alarms or minimizing effects, but few have examined the problem from a sociotechnical systems perspective. This study applied the Systems Engineering Initiative for Patient Safety (SEIPS) framework to define, design, and test an alarm management intervention compatible with a Progressive Care Unit (PCU)’s sociotechnical subsystems. The SEIPS application is unique from previous research in that the framework examines the complex alarm system to find the root cause and provide solutions that minimize interfering with patient care. The research utilized a multi-step approach following the SEIPS framework. The first step involved studying the sociotechnical system of the PCU and describing nurses’ perceptions of alarms through a Cognitive Task Analysis (CTA). The second step used the Plan-Do-Check-ACT (PDCA) cycle to identify leading issues of nuisance alarms and feasible improvement options to design an intervention model. The third step tested the intervention in a controlled simulation where nurses and nursing students updated fabricated medical records while responding to audible alarms. The CTA findings showed that alarm related stress and boredom increase during the shift and effort and mental demand had the most significant effect on alarm related workload. The SEIPS framework identified sociotechnical systems compatible solutions through additional telemetry monitor and reduced volume of low priority alarms to the address alarm fatigue and reduce overall workload. The results of the intervention testing showed a 62% increase in work performance, an average 37% increase in alarm response accuracy, and decreased emotional stress (23%), frustration (42%), and confusion (31%). This research provides evidence that the SEIPS framework can effectively address nuisance alarm problems by describing the PCU’s sociotechnical system, nurse’s perception of alarms, and systematically identifying problems and creating solutions compatible with the sociotechnical system. The findings contribute to the main commission of addressing hospital alarm fatigue and improving alarm related workflow while reducing adverse effects.

Date

7-15-2025

Committee Chair

Ikuma, Laura

DOI

10.31390/gradschool_dissertations.6881

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