Patient Monitors In Intensive Care: Areas Of Improvement
Detecting, diagnosing, and treating unexpected incidence in an ICU setting is done in many ways, including clinical sign symptoms, and by physical display of a patient’s vital parameters on an ICU monitor. In this article, we will focus on problems related to patient monitoring and needs of ICU nurses and doctors.
The present ICU monitors could be improved with new monitoring tools that fit their specific need and can provide better safety and work efficiency. The physiologic parameters currently displayed on ICU monitors include blood pressure, acquired from an arterial catheter and external pressure cuff; oxygen saturation of the blood, acquired from a pulse oximeter; and heart rate and respiratory rate, acquired from external transducers and the electrocardiogram waveform. Critically-ill patients may also require hemodynamic monitoring using a pulmonary artery (PA) catheter. The parameters obtained from a PA catheter – including central venous pressure, right atrial pressure, PA pressure, cardiac output, and other calculated parameters – are also typically displayed. Monitors currently in use in ICUs provide information in numerical and waveform formats.
ICU nurses monitor physiologic patient parameters on a regular basis to assure the patient’s stability. Among the most common problems they face is detecting changes in one or more physiologic patient parameters. Timely detection of a change becomes a potential problem when detection is viewed in the context of all the patient’s physiologic parameters and disease history and then must be interpreted and compared with parameters stored in the nurse’s recent memory or the patient’s records.
To make matters worse, in the case of an unexpected and potentially life-threatening event, the cognitive demands increase as the clinician must interpret new data for problem detection and rapid intervention. It reduces available cognitive resources for other important tasks (e.g., taking corrective actions, documentation, communicating with physicians and/or other staff). This can lead to other problems or a cascade of errors, such as interrupted tasks or deviations from the treatment plan or necessary interventions.
Current ICU monitor displays are also deficient in their ability to facilitate an integrated assessment of the patient’s status that would enable nurses to develop a high level of situation comprehension. During data collection of patient’s vital parameters, there are high chances of errors as nurses have to rely on monitoring equipment that is optimized for specific tasks they have to perform; the graphic display reduces the time to detect problems and to initiate corrective majors and treatment. It is also observed that there is a high number of false alarms, as alarm settings are not adapted to individual patients and there is a lack of knowledge about how to change alarm settings, among other problems.
Users complained about the presence of clutter on monitors. In terms of software, users mentioned issues related to affordance, visibility of functions, accessibility, discrimination of information, and violations of the consistency principle. Also mentioned were issues with current hardware, including a desire for touch screens, easy-access buttons, and clearly displayed alarm status. Providing nurses with information about the patient’s physiologic status in a manner that is easy and fast to interpret should reduce the time needed to detect changes. However, currently available monitors are not explicitly designed as cognitive aids for facilitating the rapid detection of changes in patient status.
So currently available display technology does not allow to rapidly integrate individual parameters into a coherent, holistic assessment of the patient. Instead, it forces users to process individual parameters in a piecemeal fashion. An integrated information display will be better in overall patient management. So, we need monitors that can provide easy and fast interpretation of physiological changes and have cognitive aids for facilitating the rapid detection of problems.
