Epidemiology of patient monitoring alarms in the neonatal intensive care unit

Abstract

Objective To characterize the rate of monitoring alarms by alarm priority, signal type and developmental age in a Level-IIIB Neonatal Intensive Care Unit (NICU) population. Study Design Retrospective analysis of 2 294 687 alarm messages from Philips monitors in a convenience sample of 917 NICU patients, covering 12 001 patient-days. We stratified alarm rates by alarm priority, signal type, postmenstrual age (PMA), and birth weight (BW) and reviewed and adjudicated over 21 000 critical alarms. Results Of all alarms, 3.6% were critical alarms, 55.0% were advisory alarms, and 41.4% were device alerts. Over 60% of alarms related to oxygenation monitoring. The average alarm rate (±SEM) was 177.1±4.9 [median: 135.9; IQR: 89.2–213.3] alarms/patient-day; the medians varied significantly with PMA and BW (p<0.001) in U-shaped patterns, with higher rates at lower and higher PMA and BW. Based on waveform reviews, over 99% of critical arrhythmia alarms were deemed technically false. Conclusions The alarm burden in this NICU population is very significant; the average alarm rate significantly underrepresents alarm rates at low and high PMA and BW. Virtually all critical arrhythmia alarms were artifactual.

Incubator-based Sound Attenuation: Active Noise Control In A Simulated Clinical Environment

“…Device alarms are consistently found to be a source of excessive noise in NICUs, [20,21,26]. Patient monitor alarms are an especially frequent contributor to the noise in NICUs, with an average of 177 alarms/patient/day [27].…”

Management of oxygen saturation monitoring in preterm newborns in the NICU: the Italian picture

“…A recent paper investigating the signal type of alarms in the NICU, reported that over 60% of alarms were related to oxygenation monitoring; thus, these represent the major burden of all alarms in newborns population [ 24 ]. In this survey, the setting of the maximum value is influenced by the presence or absence of both written operational procedures and staff training, with attention to hyperoxia conditions.…”

Optimisation of clinical workflow and monitor settings safely reduces alarms in the NICU

“… Protocols for application, positioning and replacement of electrodes and sensors and protocol for the patients' admission and discharge from system were standardised. Delay time for saturation‐related alarms was increased from 10 to 20 seconds based on the findings from 7,23,24 . Averaging time was decreased from 10 to 4 seconds as suggested in 21,25 . An additional red ‘smart alarm’ was introduced to indicate yellow alarms lasting for more than 5 minutes.…”

“…7,23,24 Averaging time was decreased from 10 to 4 seconds as suggested in. 21,25 An additional red 'smart alarm' was introduced to indicate yellow alarms lasting for more than 5 minutes. All modification to alarms are summarised in Table 2.…”