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

Abstract

INTRODUCTION: Alarm fatigue (AF) happens when professionals are exposed to many alarms and they become desensitized to them. It is related to proliferation of devices, not standardized alarm limits and high prevalence of “non-actionable alarms”, i.e. false alarms (triggered by equipment issues) or nuisance alarms (physiologic change not requiring clinical action). When AF happens, response time seems to be longer and important alarms could be dismissed. After evaluating the situation in our NICU, an alarm management program (AMP) was developed to reduce AF. OBJECTIVES: To compare the proportion of true alarms, non-actionable alarms and to measure response time to alarms in the NICU before and after implementing an AMP. To determine variables associated with non-actionable alarms and response time. METHODS: Cross-sectional study. 100 observations were collected between 12/2019-1/2020. After an AMP was implemented, 100 new observations were collected between 6/2021-8/2021. We estimated the true and non-actionable alarms proportion. Univariate analyses were performed to determine variables associated with non-actionable alarms and response time. Logistic regression was performed to assess independent variables. RESULTS: The proportion of true alarms before and after AMP was 31% versus 57% (p 0.001) while the proportion of non-actionable alarms was 69% versus 43% (p 0.001). Median response time was significantly reduced (35 versus 12 secs (p 0.001). Before AMP, neonates with less intensive care needs had a higher proportion of non actionable alarms and a longer response time. After AMP, response time was similar for true and non-actionable alarms. For both periods, the need of respiratory support was significantly associated with true alarms (p 0.001). In the adjusted analysis, response time (p=0.001) and respiratory support (p=0.003) remained associated with non-actionable alarms. CONCLUSIONS: AF was highly prevalent in our NICU. After the implementation of an AMP, response time and the proportion of non-actionable alarms can be significantly reduced.