Balancing the Tension Between Hyperoxia Prevention and Alarm Fatigue in the NICU

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: SpO(2) 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 (SpO(2)) 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.