Reducing Alarm Burden in a Level IV Neonatal Intensive Care Unit

Abstract

Introduction: Excessive alarm burden contributes to alarm fatigue, causing staff to ignore or delay response to clinically significant alarms. The objective of this quality improvement project was to reduce yellow self-resolving SpO2 alarms from a mean of 14 alarms/patient-hour (APH) to 7 APH (a 50% reduction) within a 6-month period, without significantly decreasing the amount of time spent in target SpO2 range (90%–95%). Methods: A multidisciplinary team used Define-Measure-Analyze-Improve-Control methodology to identify etiologies of alarm frequency and design improvement interventions to reduce alarm burden in a single-site Level IV NICU. Data-driven changes in alarm limit settings, alarm delay, and trial of a new pulse oximeter probe were used. Alarm data from the bedside monitor were analyzed following each improvement cycle. As a balancing measure, histograms monitored time spent in target SpO2 range. Results: SpO2 alarm data were collected for 4,320 patient-hours (180 patient-days) on 40 neonatal intensive care unit patients meeting inclusion criteria. Corresponding histograms were obtained for each patient day. Following 5 Plan-Do-Study-Act cycles, the mean number of yellow self-resolving SpO2 alarms decreased from 14 to 5 APH, a 64% decrease. There was no difference in time spent in target SpO2 range (50% versus 50%, P = 0.93). After achieving the project aim, 2 control phase measurements demonstrated sustained improvement (mean APH = 6). Conclusions: Yellow self-resolving SpO2 alarm frequency was reduced by 64% through the implementation of data-driven changes in alarm limit settings, alarm delays, and trial of a more sensitive oximeter probe without introducing harm to patients.