Quality improvement initiative for reduction of false alarms from multiparameter monitors in neonatal intensive care...

Unnecessary and excessive activation of alarms ("false alarm") in neonatal intensive care unit (NICU) often results in alarm fatigue among health-care professionals, which can potentially result in deleterious effects in sick neonates.

The aim of this study is to reduce the frequency of false alarms from multiparameter monitors (MPM) by 50% from the existing baseline level over a period of 12 weeks.

In this quality improvement (QI) project conducted over 1 year (November 2016-October 2017) at All India Institute of Medical Sciences, New Delhi, we collected data on activation of false alarms from MPM (outcome measure) over a period of 2 months in 134 randomly selected observations of 1-h duration (baseline phase [10 days, 20 observations] and developing and testing the changes in five Plan-Do-study-Act (PDSA) cycles over the next 50 days, 114 observations. We also measured the pre- and postassessment of knowledge level in use of MPM among health-care professionals using checklist (process measure). Following that, we continued data collection for next 10 months to check sustenance of the project.

Baseline characteristics including gestation, birth weight, and sickness level did not vary during the study period. The median (range) number of activation of false alarms/hour/MPM was 23 (18-35) in the baseline phase. This reduced to 22 (17-30), 19 (15-30), 16 (14-30), 14 (8-17), and 9 (6-12) at the end of 1^st, 2^nd, 3^rd, 4^th, and 5^th PDSA cycles, respectively. In sustenance phase, it could be maintained in target range from January 2017 to October 2017.

Small sustained changes can contribute a lot in continuous QI in decreasing false alarms and subsequent improvement of neurodevelopmental outcomes discharged neonates.