July 15, 2015
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Hyperoxia alarms in NICUs may impact patients negatively

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A recent study found that the implementation and overuse of narrowed oxygen saturation alarms to alert medical workers of possible hyperoxia in neonatal ICUs may negatively impact patient care and safety.

“This report emphasizes the importance of selecting appropriate balancing measures for quality improvement efforts,” Anastasia K. Ketko, MD, of the Children’s Hospital and Clinics of Minnesota, and colleagues wrote. “The goal for reduced hyperoxia/retinopathy of prematurity can cause unintended secondary quality metrics to deteriorate (alarms), but this process can be mitigated and even improved with the modification of technology.”

Narrowing the threshold on oxygen saturation alarms results in an increased amount of false alarms, the researchers said. They hypothesized this may create alarm fatigue — a condition of sensory overload that causes alarm desensitization and burnout — and potentially lead to patient harm.

From January 2012 to July 2014, study researchers recorded 3,459,637 saturation alarms in a single NICU. The researchers measured an average of 78 alarms per patient-day, compared with 105 per patient-day after the threshold had been narrowed. They then modified the high saturation alarm algorithm, allowing them to adjust the alarm threshold on a per-patient basis. This resulted in a decreased number of alarms per patient-day.

The adjusted alarm saturation levels also resulted in a better perception of the alarm systems by nursing staff. In a 2014 survey, the majority of responding nurses (n = 69) agreed or strongly agreed that alarm frequency had improved and alarm fatigue was being addressed.

During the intervention period, there were no severe events reported as a result of alarm management, possibly indicating an increase in patient safety. The researchers also emphasized that by shifting the alarm response burden from being the sole responsibility of the nursing staff to the entire NICU, alarm fatigue could be reduced.

“We anticipate that by standardizing the use of this technology, we will be able to better identify time within the target range and individualize alarm settings when needed, resulting in fewer overall alarms while maintaining target saturation goals,” Ketko and colleagues wrote. – by David Costill

Disclosure: The researchers report no relevant financial disclosures