Balancing the Tension Between Hyperoxia Prevention and Alarm Fatigue in the NICU

Abstract

BACKGROUND: After the implementation of narrowed oxygen saturation alarms, alarm frequency increased in the C.S. Mott Children's Hospital NICU which could have a negative impact on patient safety. The Joint Commission on the Accreditation of Healthcare Organizations issued a Sentinel Event Alert for hospitals in 2013 to improve alarm safety, resulting in a 2014 National Patient Safety Goal requiring institutional policies and procedures to be in place to manage alarms.METHODS: A multidisciplinary improvement team developed an alarm management bundle applying strategies to decrease alarm frequency, which included evaluating existing strategies and developing patient care-based and systems-based interventions. The total number of delivered and detected saturation alarms and high saturation alarms and the total time spent within a targeted saturation range were quantitatively tracked. Nursing morale was assessed qualitatively.RESULTS: SpO 2 alarms per monitored patient-day increased from 78 to 105 after the narrowing of alarm limits. Modification of the high saturation alarm algorithm substantially decreased the delivery and escalation of high pulse oxygen saturation (SpO 2 ) alarms. During a pilot period, using histogram technology to individually customize alarm limits resulted in increased time spent within the targeted saturation range and fewer alarms per day. Qualitatively, nurses reported improved satisfaction when not assigned

Effect of a smaller target range on the compliance in targeting and distribution of oxygen saturation in preterm infants

“…It has been reported that a narrower TR leads to an inevitable increase of SpO 2 alarms 17. These alarms contribute to all other alarms on a NICU where a high number of alarms are false 18.…”

Time series evaluation of improvement interventions to reduce alarm notifications in a paediatric hospital

“…Partnering with stakeholders such as clinical leadership, bedside providers and technical staff was critical. Our approach incorporated many evidence-based interventions previously shown to reduce alarm notifications,19 such as implementing alarm delays,20 changing ECG electrodes daily11 and generating algorithms for alarm notification 21 22. Previously, these strategies successfully decreased the number of alarms per patient-day over fourfold without compromising patient safety 11 23.…”

“…Nursing staff satisfaction was prioritised as an outcome given evidence that reducing non-actionable alarm frequency is associated with improved nursing satisfaction and morale 22. A decrease in alarm notifications can also help reduce nursing’s perceived workload and improve work environment satisfaction 26 27.…”

Individualized parameterization of multiparametric monitors alarms in infarcted patients

“…The implementation of measures of impact on the management of SpO2, HR and STS alarms already recommended in the literature is of utmost importance, such as the preparation of the skin for the adhesion of electrodes, their replacement in an appropriate period (within 24 hours), the use of an oximetry reading device with good end-to-end adaptation, disabling oximetry in patients with poor peripheral perfusion, correct ST-segment alarm configuration, daily monitoring of the soundness of monitoring cables, adjusting the gain of the R wave and the need to apply short delays of some alarms, especially those of SpO2 (25,26) .…”