Journal of Education and Health Promotion

Quality improvement initiative for reduction of false alarms from multiparameter monitors in neonatal intensive care unit

Document Type : Original Article

Authors

. Tanushree Sahoo
. Meena Joshi
. Shamnad Madathil
. Ankit Verma
. Mari Jeeva Sankar
. Anu Thukral
Abstract
INTRODUCTION: Unnecessary and excessive activation of alarms (“false alarm”) in neonatal
intensive care unit (NICU) often results in alarm fatigue among health‑care professionals, which can
potentially result in deleterious effects in sick neonates.
AIMS AND OBJECTIVES: The aim of this study is to reduce the frequency of false alarms from
multiparameter monitors (MPM) by 50% from the existing baseline level over a period of 12 weeks.
METHODS: In this quality improvement (QI) project conducted over 1 year (November
2016–October 2017) at All India Institute of Medical Sciences, New Delhi, we collected data on
activation of false alarms from MPM (outcome measure) over a period of 2 months in 134 randomly
selected observations of 1‑h duration (baseline phase [10 days, 20 observations] and developing
and testing the changes in five Plan‑Do‑study‑Act (PDSA) cycles over the next 50 days, 114
observations. We also measured the pre‑ and postassessment of knowledge level in use of MPM
among health‑care professionals using checklist (process measure). Following that, we continued
data collection for next 10 months to check sustenance of the project.
RESULTS: Baseline characteristics including gestation, birth weight, and sickness level did not vary
during the study period. The median (range) number of activation of false alarms/hour/MPM was
23 (18–35) in the baseline phase. This reduced to 22 (17–30), 19 (15–30), 16 (14–30), 14 (8–17),
and 9 (6–12) at the end of 1st, 2nd, 3rd, 4th, and 5th PDSA cycles, respectively. In sustenance phase,
it could be maintained in target range from January 2017 to October 2017.
CONCLUSIONS: Small sustained changes can contribute a lot in continuous QI in decreasing false
alarms and subsequent improvement of neurodevelopmental outcomes discharged neonates.

Keywords

False alarms
multiparameter monitors
quality improvement initiative
1. Graham KC, Cvach M. Monitor alarm fatigue: Standardizing use
of physiological monitors and decreasing nuisance alarms. Am J
Crit Care 2010;19:28‑34.
2. Petersen EM, Costanzo CL. Assessment of clinical alarms
influencing nurses’ perceptions of alarm fatigue. Dimens Crit
Care Nurs 2017;36:36‑44.
3. Drew BJ, CaliffRM, Funk M, Kaufman ES, Krucoff MW, Laks MM,
et al. Practice standards for electrocardiographic monitoring
in hospital settings: An American Heart Association scientific
statement from the councils on cardiovascular nursing, clinical
cardiology, and cardiovascular disease in the young: Endorsed
by the international society of computerized electrocardiology
and the American Association of critical‑care nurses. Circulation
2004;110:2721‑46.
4. Wachman EM, Lahav A. The effects of noise on preterm infants
in the NICU. Arch Dis Child Fetal Neonatal Ed 2011;96:F305‑9.
5. Ruppel H, Funk M, Whittemore R. Measurement of physiological
monitor alarm accuracy and clinical relevance in intensive care
units. Am J Crit Care 2018;27:11‑21.
6. Korniewicz DM, Clark T, David Y. A national online survey on
the effectiveness of clinical alarms. Am J Crit Care 2008;17:36‑41.
7. Phillips J, Barnsteiner JH. Clinical alarms: Improving efficiency
and effectiveness. Crit Care Nurs Q 2005;28:317‑23.
8. Atzema C, Schull MJ, Borgundvaag B, Slaughter GR, Lee CK.
ALARMED: Adverse events in low‑risk patients with chest
pain receiving continuous electrocardiographic monitoring in
the emergency department. A pilot study. Am J Emerg Med
2006;24:62‑7.
9. 10 Healthcare Technology Hazards for 2015. Available from:
http://www.healthcarebusinesstech.com/2015-healthcaretechnology/. [Last accessed on 2018 Jun 04].
10. ECRI’s Top 10 Health Technology Hazards for 2016. Available from: http://www.healthcarebusinesstech.com/healthtechnology-hazards/. [Last accessed on 2018 Jun 04].
11. BRIEF E. Top 10 Health Technology Hazards for 2017.
Available from: http://www.healthcarebusinesstech.com/
health‑technology‑hazards/. [Last accessed on 2018 Jun 04].
12. BRIEF E. Top 10 Health Technology Hazards for 2018. 2016.
Available from: http://www.healthcarebusinesstech.com/
health-technology‑hazards/. [Last accessed on 2018 Jun 04].
13. New alert promotes medical device alarm safety in hospitals. Jt
Comm Perspect 2013;33:1, 3‑4, 10.
14. Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F,
Stevens D, et al. SQUIRE 2.0 (Standards for QUality improvement
reporting excellence): Revised publication guidelines from a
detailed consensus process. J Contin Educ Nurs 2015;46:501‑7.
15. Point of Care Quality Improvement. Available from: https://
www.pocqi.org/. [Last accessed on 2019 May 19].
16. Singh H, Yadav G, Mallaiah R, Joshi P, Joshi V, Kaur R, et al.
INICU – Integrated neonatal care unit: Capturing neonatal
journey in an intelligent data way. J Med Syst 2017;41:132.
17. Johnson KR, Hagadorn JI, Sink DW. Reducing alarm fatigue in
two neonatal intensive care units through a quality improvement
collaboration. Am J Perinatol 2018;35:1311‑8.
18. Goel V, Poole S, Kipps A, Palma J, Platchek T, Pageler N, et al.
Implementation of data drive heart rate and respiratory rate
parameters on a pediatric acute care unit. Stud Health Technol
Inform 2015;216:918.
19. Chawla S, Barach P, Dwaihy M, Kamat D, Shankaran S,
Panaitescu B, et al. A targeted noise reduction observational
study for reducing noise in a neonatal intensive unit. J Perinatol
2017;37:1060‑4.
20. Sendelbach S, Wahl S, Anthony A, Shotts P. Stop the noise:
A Quality improvement project to decrease electrocardiographic
nuisance alarms. Crit Care Nurse 2015;35:15‑22.
21. Tsien CL, Fackler JC. Poor prognosis for existing monitors in the
intensive care unit. Crit Care Med 1997;25:614‑9.
22. Bitan Y, Meyer J, Shinar D, Zmora E. Nurses? Reactions to
alarms in a neonatal intensive care unit. Cogn Technol Work
2004;6:239‑46.
Journal of Education and Health Promotion
Volume 9, Issue 10
October 2019
Pages 1-7

Home

Guide for Authors

Submit Manuscript

Reviewers

Contact Us