Auditing of Monitoring and Respiratory Support Equipment in a Level III-C Neonatal Intensive Care Unit

Abstract

Background. Random safety audits (RSAs) are a safety tool but have not been widely used in hospitals. Objectives. To determine the frequency of proper use of equipment safety mechanisms in relation to monitoring and mechanical ventilation by performing RSAs. The study also determined whether factors related to the patient, time period, or characteristics of the area of admission influenced how the device safety systems were used. Methods. A prospective observational study was conducted in a level III-C Neonatal Intensive Care Unit (NICU) during 2012. 87 days were randomly selected. Appropriate overall use was defined when all evaluated variables were correctly programmed in the audited device. Results. A total of 383 monitor and ventilator audits were performed. The Kappa coefficient of interobserver agreement was 0.93. The rate of appropriate overall use of the monitors and respiratory support equipment was 33.68%. Significant differences were found with improved usage during weekends, OR 1.85 (1.12–3.06, p = 0.01), and during the late shift (3 pm to 10 pm), OR 1.59 (1.03–2.4, p = 0.03). Conclusions. Equipment safety systems of monitors and ventilators are not properly used. To improve patient safety, we should identify which alarms are really needed and where the difficulties lie for the correct alarm programming.

Real-Time Safety Audits of Neonatal Delivery Room Resuscitation Areas: Are We Sufficiently Prepared?

“…Interestingly, our study showed similar global percentages of RRTSAs without defects as those reported by Bergon–Sendin et al who also conducted RRTSAs in different Spanish hospital neonatal areas and NICU work procedures and showed surprisingly low percentages of satisfactory audits. These authors detected defects in areas as important as the use of ventilation materials and respiratory monitoring (383 audits; adequate overall use: 33.7%), 13 resuscitation materials (296 audits; adequate overall use: 62.5%), 14 or infusion pumps (160 audits; adequate global use: 73.1%). 15 This low percentage of audits without defect should lead us to reflect upon whether our current hospital delivery room protocols are able to ensure the correct and complete preparation of positions used during the care of newborns at the time of their delivery.…”

“…7,12 Several studies on RRTSAs have been performed in neonatal intensive care units (NICUs) for various procedures and materials (for example, ventilation and respiratory monitoring, materials available for resuscitation, infusion pumps, and prevention of nosocomial infections). 11,[13][14][15][16] However, to the best of our knowledge, no specific work on RRTSAs has been performed for neonatal delivery room CPR stabilization areas. Thus, the objective of this study was to use audits to verify the level of preparation of these areas, analyze any circumstances that could influence their correct availability, and check the value of this quality-control tool to prevent safety-related incidents in this field.…”

Mechanical Ventilation Alarms and Alarm Fatigue

“…Although most alarms recorded lasted Ͻ 1 min, the study noted that some infants were subjected to audible alarms for 10% of the day, which may negatively affect recovery and neurodevelopment. 30,31 In addition, this contributes to feelings of fear and anxiety in patients and visitors. 27…”

Reducing alarms in the NICU

“…When performing such audits in a NICU setting, the rate of appropriate overall use of monitoring and respiratory support equipment was only 34%, that is, these devices were inappropriately used for two-thirds of the time. Rates of appropriate use were lowest for pulse oximeter saturation (SpO 2 ) target and respiratory rate alarms on patient monitors, and for minute volume alarms on ventilators 4. Thus, as now in part also shown by Belteki and Morley for ventilators, both ventilators and pulse oximeters are the devices we should focus on first if we want to tackle alarm rates in the NICU.…”