Monocle Smart Glass for Nurses
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monocle Smart glass for nurses Final report - Advanced Concept Design Jan Frielingsdorf 4542592 | TU Delft coach: Erik van Kuijk | Company coach: Dr. Elif Ozcan | Group 5B | 03-02-2017 PROJECT: NOISE FREE INTENSIVE CARE UNIT 1 2 FINAL REPORT ReportContent Structure Introduction 4 Problem definition 5 Assignment 5 Approach 5 Solution 5 Initial design vision: Silent guidance 6 Research and relevant conclusions 8 Benchmarking: Existing and emerging solutions 9 Technology research: bone conduction 10 Benchmarking: Smart glasses 12 Monocle: Concept explanation 14 Details: Components and costs 21 Easy tilting mechanism 24 Costs 24 Evaluation: User interview and client feedback 25 References 30 Appendices 32 Appendix 1: User evaluation questions Appendix 2: Report: The use of smartglasses in healthcare PROJECT: NOISE FREE INTENSIVE CARE UNIT 3 Introduction 4 FINAL REPORT Problem definition Approach One of the most prominent problems of Intensive In the first half (team-based), an analysis of ICU Care Units for staff and patients (ICUs) is the technology development and hospital culture, noise caused by excessive occurrence of alarm researching multi-sensory information design sounds from machines that constantly have to followed by research into wearable devices monitor and support the patient. and emerging technologies helped to create individual design visions. The main cause for the high frequency of alarms The second half (individual) consisted of solution are false alarm rates that can be as high as benchmarking, choosing a final design concept 70% [1] and in some cases even 99% [2]. This followed by an extended technology research causes the hospital staff to become desensitized and a final user evaluation. to alarms that can be critical. This behaviour is the typical definition for a phenomenon known as alarm fatigue [3], which was the number one health technology hazard in 2015 for the fourth Solution consecutive time [4]. “Monocle” is a smart glass for nurses that provides Furthermore, hospital device manufacturers quicker access to information, transmitting any are obliged by law to equip their products with device sound only to the responsible nurse - to auditory alarms [5] - exposing everybody in an reduce the noise in ICU’s. Quicker and mobile ICU to the noise instead of only alerting the access to information prevents stress, facilitates responsible staff. work-flow and enables nurses to spend more valuable time at the patient’s bedside. Compared to existing smart-glasses, monocle Assignment is specifically designed for the unique context of a hospital environment, taking into account Erasmus MC hospital asked for concepts for a hygiene, ergonomics, durability and useful more silent ICU by optimizing monitoring and features such as voice dictation and barcode signalling from the perspective of the nursing scanning. staff and looking at wearable technologies. PROJECT: NOISE FREE INTENSIVE CARE UNIT 5 Initial design vision: Silent guidance The initial vision was to create an ideal work are promising solutions but rather belong to the This device was aimed to be designed for a future environment for nurses by turning a noisy, thus field of management and IT. context where ICU equipment regulations don’t stressful, environment into a calm and relaxing require open auditory alarms anymore to give one that increases the patient’s well-being and With nurses being the main target group for this a glimpse of how a worthwhile future can look chance for recovery as well. An environment with project, one of the solutions, however, stuck out like and to trigger ideas about which steps are no auditory alarms at all - at least none that can by suggesting silent alarms that selectively notify necessary to get there. be heard by everyone. single nurses only, thus reducing the overall noise level. The initial idea was a future pager in the form A report by Philips [6] on how to tackle noisy of a head worn device which should contain a ICU`s states the main problem being the many This approach sounded reasonable and suitable component that notifies the nurse and some false alarms and also suggests a combination of for Industrial Design and was hence turned into kind of display which lists and ranks tasks and approaches as there is no single solution to this the concepts main goals: designing a nurse- alarms. issue. wearable device for silent alarms to prevent desensitization, using clearly recognizable However, many of these solutions can‘t be related and distinguishable signals. Furthermore the directly to industrial design. Staff and patient device should facilitate nurses workflow and education or filtering algorithms, for example, provide guidance after alarms are triggered. Desensitization Alarm Fatigue NOISY CALM Stress 6 FINAL REPORT SILENT GUIDANCE PROJECT: NOISE FREE INTENSIVE CARE UNIT 7 Research and relevant conclusions 8 FINAL REPORT Benchmarking: Existing and emerging solutions Ascom: Unite Connect [7] Philips: alarm management solution [8] Vocera: Alarm Management System [9] A solution designed for standard patient Designed to complement staff workflow, help Aimed to reduce alarm fatigue and integrates monitoring systems which sends alarm lower the noise level and enhance patient care. with most industry-leading patient monitoring information to several devices (wireless handsets, It optimizes all problem causing points - from systems. It enables prioritization of alarms and pagers, smart devices and text displays.) The patient sensors and monitors over IT to mobile sending only actionable alarms to the right system includes alarm filtering – categorizing solutions, offering reporting and analysis to recipient device of choice, including smartphones, and relevant conclusions and reducing the number of alert messages manage alarms and providing mobile (-phone) tablets and the Vocera Badge. The entire care being received by clinicians. Comes with a secure access to patient data. Software lists the number team can securely text each other in response messaging app and features like automatic and occurrence of alarms, the caregiver response to an event. The system comes with “native escalation and forwarding alarms if a nurse and response times. This data can be used to push technology” for reliable alert delivery and is busy, which contributes to a safer patient adjust alarm parameters, improving protocols, improved security. environment. and balancing the workload among caregivers. Conclusions cancel out false alarms, categorize true alarms Therefore, the to-be designed nurse wearable and notify nurses on their smart devices. should improve upon these aspects. • Promising system and software solutions for reducing noise and facilitating nurses workflow • These devices, however, still produce alarm It was further decided to design the nurse exist and are on the rise but are expensive and sounds that everybody can hear, and at least wearable for and within these solutions, take time to be implemented in the rather slow smartphones require both hands to operate, implementing their features to increase their developing clinical environment. which is impractical for the physical job of efficiency. This was considered suitable since nursing. Moreover, smartphones often don’t it would likely take several years for the above • These solutions come with great features to meet the specific requirements for an ICU, such solutions to become the standard - the same as hygienic and break-proof construction. applying to the developed nurse wearable. PROJECT: NOISE FREE INTENSIVE CARE UNIT 9 Technology research: bone conduction Bone conduction is a rather unknown Bone conduction headphones could also be phenomenon of receiving sounds via vibration used for nurses to differentiate between non- through bones, particularly the skull. urgent notification (vibration only) and urgent alarms (vibration + sound/voice). Bone Conduction bypasses the eardrums and bone conduction devices ,instead, act as the In order to validate and test these features, the eardrum. Such devices decode sound waves and wireless bone conducting headphone “AS600SG Transmitting sound via vibration through bone mass convert them into vibrations that travel to and Trekz Titanium” by Chinese company Aftershokz and skin instead of air. can be received by the Cochlea (inner ear)[10]. was purchased and testes with several people. Bone-conduction headphones exist but never had a successful breakthrough since their audio quality usually never matches conventional headphones. Their biggest advantage, however, lies in the possibility to hear your surroundings since the ear-canals are not covered. This feature was found to be very useful for the ICU context since nurses could be solely exposed to sounds while still being able to listen to patients and co- workers. Furthermore, bone conduction headphones would offer a hygienic solution for swapping devices between nurse shifts. Bone conduction headphones audio quality is sufficient to transmit voices of phone calls and alarm sounds that usually never require the same high audio quality as music. AS600SG Trekz Titanium 10 FINAL REPORT Conclusions • The audio quality was surprisingly good - music as well as phone calls could be understood easily while still listening to you surroundings, thus making it suitable for an ICU environment. • The sound leakage was perceivable but really quiet - presumably no other staff members would be able to hear a personal alarm in an ICU. • The vibrations were noticeable (“tickling”) but not uncomfortable