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

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.