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

Abstract

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.

The Alarm Fatigue Challenge in the Neonatal Intensive Care Unit: A “before” and “after” Study

“…Different quality improvement (QI) studies have demonstrated that the use of standard protocols for alarm management have been able to reduce AF prevalence in intensive care units. [8][9][10][11] In this study, the idea of individualizing alarm limits and the education of our staff in this matter have led to the reduction of the number of nonactionable alarms seen before the AMP implementation. Cvach 12 have published a review of this topic that includes suggestions to reduce AF.…”

Integrating Physiological Data Artifacts Detection With Clinical Decision Support Systems: Observational Study

“…By discussing and reaching consensus with our clinical collaborators at CHEO, we translated clinical rules into low-level logic to create a CED component with a requirements interface that conforms to the CRM. Alarm generation studies suggest these two approaches to reduce the FAR: (1) modifying or adjusting the alarm thresholds and (2) introducing alarm annunciation delays, that is, a delay between when an alarm threshold is crossed and when the alert is sounded or displayed [25,[40][41][42][43]. These studies test alarm annunciation delays anywhere from 5 to 120 seconds for a variety of physiological data types.…”

Listen to the Real Experts: Detecting Need of Caregiver Response in a NICU using Multimodal Monitoring Signals

“…Some works discussed reducing alarm fatigue in NICUs by implementing delays between exceeding a threshold and the start of the alarm, or by using longer average periods for vital signs, to account for patient self-stabilization [16,21]. Other heuristic approaches aimed towards wider limits for alarm thresholds [25] or customizing them to patient characteristics [18,24]. However, these approaches do not use interaction of the caregiver with the system to investigate clinical relevance of an alarm.…”

“…We have two main sensors in this work: 1) the ECG to measure the electrical activity of the heart, and 2) the pulse oximeter for SpO 2 . These sensors were chosen because the majority of critical alarms in a NICU comes from them [24]. We derived three different feature groups: 1) HR-based, 2) HRV-based and 3) SpO 2 -based (see Table 2).…”