Balancing the Tension Between Hyperoxia Prevention and Alarm Fatigue in the NICU
Anastasia K Ketko1, Craig M Martin2, Michelle A Nemshak3
1Minnesota Neonatal Physicians P.A., Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota;
Insights
Alarm management strategies in NICUs can reduce alarm frequency and improve patient safety. Customizing alarm limits and modifying algorithms decrease high saturation alarms, enhancing nursing satisfaction and infant care.
Area of Science:
- Neonatal Intensive Care Unit (NICU) care
- Patient safety and alarm management
- Healthcare quality improvement
Background:
- Narrowed oxygen saturation alarms increased frequency in NICUs, potentially impacting patient safety.
- The Joint Commission mandated alarm management policies following a 2013 Sentinel Event Alert.
Purpose of the Study:
- To decrease alarm frequency in a NICU setting.
- To improve patient safety through optimized alarm management.
Main Methods:
- Developed a multidisciplinary alarm management bundle with patient care and system-based interventions.
- Quantitatively tracked saturation alarms and time within targeted saturation range.
- Assessed nursing morale qualitatively.
Main Results:
- SpO2 alarms per patient-day increased from 78 to 105 after narrowing alarm limits.
- Modified high saturation alarm algorithm reduced high pulse oxygen saturation (SpO2) alarms.
- Customized alarm limits using histogram technology increased time in target range and decreased daily alarms; nurses reported improved satisfaction.
Conclusions:
- Alarm fatigue can negatively impact patient care and safety.
- NICU alarm management strategies must integrate with oxygen management, particularly in single-patient rooms.
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:
SpO2 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 (SpO2) 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 >1 infant with frequent alarms, as identified by an alarm frequency tool.
Conclusions:
Alarm fatigue may detrimentally affect patient care and safety. Alarm management strategies should coincide with oxygen management within a NICU, especially in single-patient-bed units.
Related Concept Videos
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:23Physiological Control of Respiration
Breathing, a seemingly passive process, is regulated by the respiratory center in the brainstem. This center coordinates the involuntary control of respirations, which means it occurs without conscious effort, ensuring a smooth and uninterrupted pattern.
Regulation of Ventilation
The body maintains ventilation by monitoring levels of carbon dioxide (CO2), oxygen (O2), and hydrogen ion concentration (pH) in the arterial blood. Among these factors, the level of CO2 plays a crucial...
01:30Acute Respiratory Failure-III
01:30Administering Oxygen by Mask
Administering oxygen by mask is a common nursing intervention that provides supplemental oxygen to patients with respiratory distress or chronic lung conditions. This procedure involves delivering oxygen at a specified rate through a face mask connected to an oxygen source.
Equipment
The equipment necessary for this procedure includes:
01:19Special considerations while measuring oxygen saturation
Ensuring accuracy in vital sign recordings while prioritizing patient comfort and minimizing anxiety is...
01:26Oxygen Delivering System I: Nasal Cannula and Face Mask
Nasal Cannula
A nasal cannula is a lightweight tube split at one end into two prongs and placed in the nostrils. It is typically used to deliver low to medium levels of oxygen.
Suggested flow rate: The suggested flow rate for a nasal cannula typically ranges between 1 and 6 L/min.
Oxygen percentage setting:...