Multidimensional Analysis of Alarm Management in the NICU: Alarm Frequencies, Actionable Alarms and Nurse Perceptions

Neonatal intensive care unit (NICU) environments are characterised by a high prevalence of alarms. The majority of these alarms are non-actionable, meaning they do not require immediate clinical intervention by nurses leading to nurse desensitisation and alarm fatigue. Currently, there is no assessment of this problem from a technical in combination with the clinical perspectives.

This study aimed to evaluate alarm frequencies, the proportion of actionable alarms and nurses' perceptions to identify optimal improvement strategies.

A single-centre prospective cohort study was conducted at an open-bay Level III NICU in a teaching hospital in the Netherlands. Over 2 months (February-March 2024), alarm data from patient monitors were collected and categorised into high, medium priority and technical alarms. Clinical observations assessed the proportion of actionable alarms. Additionally, NICU nurses completed the Charité Alarm Fatigue Questionnaire to evaluate alarm fatigue and their perceptions of evidence-based improvement strategies. Data were analysed using descriptive statistics (mean and frequencies).

A total of 678 212 alarms were recorded, with the majority being medium priority alarms (57.6%). Observations (n = 1467) showed that nurses did respond to 16.6% of alarms. Among the 39 nurses surveyed (response rate 66%), 48.7% experienced considerable alarm fatigue. For three out of five proposed interventions, the majority of nurses it feasible and useful.

This study highlights the important issue of high alarm rates and low responsiveness in the NICU, contributing to significant alarm fatigue among nurses. Implementing targeted improvement strategies to reduce alarm frequency and improve response rates, such as personalised alarm settings, is essential for enhancing nurse well-being and patient care.

Enhancement of alarm management and mitigation of alarm fatigue should be addressed by both technical and human factors evidence-based strategies to improve nurse well-being and patient outcomes, optimising NICU safety and efficacy.