Reducing Alarm Fatigue in Two Neonatal Intensive Care Units through a Quality Improvement Collaboration

Abstract

Objective To reduce nonactionable oximeter alarms by 80% without increasing time infants were hypoxemic (oxygen saturation [SpO₂] ≤ 80%) or hyperoxemic (SpO₂ > 95% while on supplemental oxygen).

Study Design In 2015, a multidisciplinary team at Connecticut Children's Medical Center initiated a quality improvement project to reduce nonactionable oximeter alarms in two referral neonatal intensive care units (NICUs). Changes made through improvement cycles included reduction of the low oximeter alarm limit for specific populations, increased low alarm delay, development of postmenstrual age-based alarm profiles, and updated bedside visual reminders. Manual alarm tallies and electronic SpO₂ data were collected throughout the project.

Results Alarm tallies were collected for 158 patient care hours with SpO₂ data available for 138 of those hours. Mean number of total nonactionable alarms per patient per hour decreased from 9 to 2 (78% decrease) and the mean number of nonactionable low alarms per patient per hour decreased from 5 to 1 (80% decrease). No change was noted in the balancing measures of percentage time with SpO₂ ≤ 80% (mean 4.3%) or SpO₂ > 95% (mean 23.7%).

Conclusion Through small changes in oximeter alarm settings, including revision of alarm limits, alarm delays, and age-specific alarm profiles, our NICUs significantly reduced nonactionable alarms without increasing hypoxemia.

Keywords

infant - neonatal - oximeter alarms - alarm desensitization

Authors' Contributions

Dr. Johnson conceptualized and designed the study, performed data analysis, drafted and revised the article, and approved the final article as submitted. Dr. Hagadorn and Dr. Sink conceptualized and designed the study, supervised data analysis, reviewed and revised the article, and approved the final article as submitted.

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