AimAlarm fatigue is a well-recognized patient safety concern in intensive care settings. Decreased nurse responsiveness and slow response times to alarms are the potentially dangerous consequences of alarm fatigue. The aim of this study was to determine the factors that modulate nurse responsiveness to critical patient monitor and ventilator alarms in the context of a private room neonatal intensive care setting.MethodsThe study design comprised of both a questionnaire and video monitoring of nurse-responsiveness to critical alarms. The Likert scale questionnaire, comprising of 50 questions across thematic clusters (critical alarms, yellow alarms, perception, design, nursing action, and context) was administered to 56 nurses (90% response rate). Nearly 6000 critical alarms were recorded from 10 infants in approximately 2400 hours of video monitoring. Logistic regression was used to identify patient and alarm-level factors that modulate nurse-responsiveness to critical alarms, with a response being defined as a nurse entering the patient’s room within the 90s of the alarm being generated.ResultsBased on the questionnaire, the majority of nurses found critical alarms to be clinically relevant even though the alarms did not always mandate clinical action. Based on video observations, for a median of 34% (IQR, 20–52) of critical alarms, the nurse was already present in the room. For the remaining alarms, the response rate within 90s was 26%. The median response time was 55s (IQR, 37-70s). Desaturation alarms were the most prevalent and accounted for more than 50% of all alarms. The odds of responding to bradycardia alarms, compared to desaturation alarms, were 1.47 (95% CI = 1.21–1.78; <0.001) while that of responding to a ventilator alarm was lower at 0.35 (95% CI = 0.27–0.46; p <0.001). For every 20s increase in the duration of an alarm, the odds of responding to the alarm (within 90s) increased to 1.15 (95% CI = 1.1–1.2; p <0.001). The random effect per infant improved the fit of the model to the data with the response times being slower for infants suffering from chronic illnesses while being faster for infants who were clinically unstable.DiscussionEven though nurses respond to only a fraction of all critical alarms, they consider the vast majority of critical and yellow alarms as useful and relevant. When notified of a critical alarm, they seek waveform information and employ heuristics in determining whether or not to respond to the alarm.ConclusionAmongst other factors, the category and duration of critical alarms along with the clinical status of the patient determine nurse-responsiveness to alarms.

Aim To address alarm fatigue, a new alarm management system which ensures a quicker delivery of alarms together with waveform information on nurses' handheld devices was implemented and settings optimised. The effects of this clinical implementation on alarm rates and nurses' responsiveness were measured in an 18‐bed single family rooms neonatal intensive care unit (NICU). Methods The technical implementation of the alarm management system was followed by clinical workflow optimisation. Alarms and vital parameters from October 2017 to December 2019 were analysed. Measures included monitoring alarms, nurses' response to alarms and time spent by patients in different saturation ranges. A survey among nurses was performed to evaluate changes in alarm rate and use of protocols. Results A significant reduction of monitoring alarms per patient days was detected after the optimisation phase (in particular for SpO2 ≤ 80%, P < .001). More time was spent by infants within the optimal peripheral oxygen saturation range (88% < SpO2 < 95%, P < .001). Results from the surveys showed that false alarms are less likely to cause an inappropriate response after the optimisation phase. Conclusion The implementation of an alarm management solution and an optimisation programme can safely reduce the alarm burden inside of the NICU environment.

ObjectivesTo determine differences in alarm pressure between two otherwise comparable neonatal intensive care units (NICUs) differing in architectural layout—one of a single-family room (SFR) design and the other of an open bay area (OBA) design.DesignRetrospective audit of more than 2000 patient days from each NICU cataloguing the differences in the number and duration of alarms for critical and alerting alarms, as well as the interaction of clinicians with the patient monitor.SettingTwo level 3 NICUs.ResultsA total of more than 150 000 critical and 1.2 million alerting alarms were acquired from the two NICUs. The number of audible alarms and the associated noise pollution varied considerably with the OBA NICU generating 44% more alarms per infant per day even though the SFR NICU generated 2.5 as many critical desaturation alarms per infant per day.ConclusionDifferences in the architectural layout of NICUs and the consequent differences in delays, thresholds and distribution systems for alarms are associated with differences in alarm pressure.

Background : Diagnostic radiology is essential in the care of neonates. Survival of extremely preterm neonates and neonates with multiple birth defects inevitably results in a number of diagnostic radiological procedures being performed in modern Neonatal Intensive Care Unit (NICU). Aim :To assess, radiographic investigations done on Neonates admitted to Neonatal Intensive Care Unit (NICU). Methods: Retrospective study was collected. Data was collected from the hospital records. It included neonates admitted to the NICU during the period of January -October 2016. The neonates included in the study were those who underwent a radiographic investigation. ASSESSMENT OF RADIOGRAPHIC INVESTIGATIONS DONE ON NEONATES ADMITTED TOTHE NEONATAL INTENSIVE CARE UNIT (NICU) Results: Out of 410 neonates admitted during January -October, 2016, 190(46.3%) underwent radiographic investigations. Most of the neonates were male {120(63.1%)}, admitted on the first day of life{136(71.6%)} and born preterm {108(56.8%)}. The Mean (SD) weight on admission was 2.15(0.68) kg. Low Birth Weight{85(44.7%)}, Respiratory Distress {58(30.5%)} and Birth Asphyxia {50(26.3%)} were found be the most common indication for admission in the NICU, which resulted in an X-ray investigation. 106 (58.3%)underwent only one Chest X-ray while 12 (6.3%) underwent one Abdominal X-ray .The maximum number of radiographs that a neonate underwent were found to be 16. Conclusion: Based on the above results, one can conclude that preterm neonates with a diagnosis of Low Birth Weight, Respiratory Distress and Birth Asphyxia have a high probability of undergoing radiological investigation.Therefore, preterm neonates will be at a higher risk of being exposed to more radiation dose than other neonates in the NICU.