Download PDF
Am J Perinatol 2023; 40(12): 1378-1382
DOI: 10.1055/a-1785-9175
Clinical Opinion

Reducing Alarm Fatigue in Maternal Monitoring on Labor and Delivery: A Commentary on Deimplementation in Obstetrics

Adina R. Kern-Goldberger 
1   Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
,
Rebecca F. Hamm
1   Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
,
Nandini Raghuraman
2   Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
,
Sindhu K. Srinivas
1   Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Hospital labor and delivery floors frequently operate like intensive care units (ICUs)—with continuous data feeds pouring into central monitoring stations against a background of blaring alarms. Yet the majority of obstetric patients are healthy and do not require ICU-level care. Despite limited organizational recommendations guiding the frequency of vital sign measurement, continuous pulse oximetry is used widely for laboring patients. There is also no evidence that morbidity prevention is linked to specific frequencies of vital sign monitoring in low-risk patients. In fact, studies examining the performance of maternal early warnings systems based on vital signs suggest that these may not reliably provide actionable information regarding maternal physiologic status. Furthermore, it is very possible that intrapartum maternal overmonitoring can impact care negatively by generating alarm fatigue, causing providers to miss actual abnormal vital signs that may precede morbidity.

Key Points

  • Labor and delivery units may engage in maternal physiologic overmonitoring.

  • Overmonitoring increases risk for alarm fatigue.

  • Deimplementing low-value care may improve obstetric outcomes.

Keywords

alarm fatigue - deimplementation - implementation science - maternal monitoring - labor and delivery - patient safety


Publication History

Received: 13 August 2021

Accepted: 18 February 2022

Accepted Manuscript online:
02 March 2022

Article published online:
26 April 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Blumenthal EA, Hooshvar N, McQuade M, McNulty J. A validation study of maternal early warning systems: a retrospective cohort study. Am J Perinatol 2019; 36 (11) 1106-1114
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Bonafide CP, Lin R, Zander M. et al. Association between exposure to nonactionable physiologic monitor alarms and response time in a children's hospital. J Hosp Med 2015; 10 (06) 345-351
    CrossrefPubMedGoogle Scholar
  • 3 The Joint Commission. National Patient Safety Goal on Alarm Management. Vol. 33. 2013. Official Publication of Joint Commission Requirements.
    PubMedGoogle Scholar
  • 4 Simpson KR, Lyndon A, Davidson LA. Patient safety implications of electronic alerts and alarms of maternal - fetal status during labor. Nurs Womens Health 2016; 20 (04) 358-366
    CrossrefPubMedGoogle Scholar
  • 5 Simpson KR, Lyndon A. False alarms and overmonitoring: major factors in alarm fatigue among labor nurses. J Nurs Care Qual 2019; 34 (01) 66-72
    CrossrefPubMedGoogle Scholar
  • 6 Rosenstein MG. Application of implementation science to OB/GYN quality improvement efforts. Clin Obstet Gynecol 2019; 62 (03) 594-605
    CrossrefPubMedGoogle Scholar
  • 7 Bonafide CP, Keren R. Negative studies and the science of deimplementation. JAMA Pediatr 2018; 172 (09) 807-809
    CrossrefPubMedGoogle Scholar
  • 8 Wolf ER, Krist AH, Schroeder AR. Deimplementation in pediatrics: past, present, and future. JAMA Pediatr 2021; 175 (03) 230-232
    CrossrefPubMedGoogle Scholar
  • 9 Smith Sr M, Stuckhardt L, McGinnis JM. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. WA: The National Academies Press; 2013
    Google Scholar
  • 10 Powers BW, Jain SH, Shrank WH. De-adopting low-value care: evidence, eminence, and economics. JAMA 2020; 324 (16) 1603-1604
    CrossrefPubMedGoogle Scholar
  • 11 Brownlee S, Chalkidou K, Doust J. et al. Evidence for overuse of medical services around the world. Lancet 2017; 390 (10090): 156-168
    CrossrefPubMedGoogle Scholar
  • 12 Choosing Wisely. Accessed February 10, 2021 at: https://www.choosingwisely.org/
    PubMed
  • 13 Niven DJ, Mrklas KJ, Holodinsky JK. et al. Towards understanding the de-adoption of low-value clinical practices: a scoping review. BMC Med 2015; 13: 255
    CrossrefPubMedGoogle Scholar
  • 14 Raghuraman N, Wan L, Temming LA. et al. Effect of oxygen vs room air on intrauterine fetal resuscitation: a randomized noninferiority clinical trial. JAMA Pediatr 2018; 172 (09) 818-823
    CrossrefPubMedGoogle Scholar
  • 15 SMFM. Twenty Things Physicians and Patients Should Question. 2021. Choosing Wisely Campaign;
    Google Scholar
  • 16 Augustsson HIS, Nilsen P, von Thiele Schwarz U, Muli I, Dervish J, Hasson H. Determinants for the use and de-implementation of low-value care in healthcare: a scoping review. Implementation Science Communications 2021; 2 (13) x
    PubMedGoogle Scholar
  • 17 Klumpner TT, Kountanis JA, Langen ES, Smith RD, Tremper KK. Use of a novel electronic maternal surveillance system to generate automated alerts on the labor and delivery unit. BMC Anesthesiol 2018; 18 (01) 78
    CrossrefPubMedGoogle Scholar
  • 18 Rosenberg A, Agiro A, Gottlieb M. et al. Early trends among seven recommendations from the Choosing Wisely Campaign. JAMA Intern Med 2015; 175 (12) 1913-1920
    CrossrefPubMedGoogle Scholar
  • 19 Berg K, Nedved A, Richardson T, Montalbano A, Michael J, Johnson M. Actively doing less: deimplementation of unnecessary interventions in bronchiolitis care across urgent care, emergency department, and inpatient settings. Hosp Pediatr 2020; 10 (05) 385-391
    CrossrefPubMedGoogle Scholar
  • 20 Curry SJ, Krist AH, Owens DK. et al; US Preventive Services Task Force. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA 2018; 320 (07) 674-686
    CrossrefPubMedGoogle Scholar