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Avoiding Alarm Fatigue in the NICU

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Alarm fatigue is a significant concern in the Neonatal Intensive Care Unit (NICU) where oxygen therapy is one of the most common therapies used for preterm infants.

“Hypoxemia and iatrogenic hyperoxemia are common among very low birth weight preterm infants with lung disease and central and obstructive apnea, and aberrant oxygenation can contribute to adverse outcomes, including retinopathy of prematurity and neurodevelopmental impairment,” wrote Karen Fairchild, MD, of the University of Virginia, and colleagues in 2016 in the Journal of Neonatal Perinatal Medicine.

Peripheral oxygen saturation (SpO2) targets of 91-95% have been shown to reduce preterm infant mortality. But striking the right balance can be tricky. SpO2 targets that are set too low, or too high, can trigger false alarms leading to alarm fatigue among NICU nurses.

The SpO2 Alarm Management Toolkit by the National Coalition for Alarm Management Safety from the AAMI Foundation, developed in partnership with industry experts including Medtronic, highlights a number of strategies that have been shown to reduce false alarms. Selecting a longer SpO2 time (which generally ranges from two to 16 seconds) could help, but there are number of other practices that may lower false alarms. Setting alarms to the patient’s specific clinical condition and physiologic needs will reduce false alarms. For example, pre-term infants with lung disease or obstructive apnea are more susceptible to hypoxemia and iatrogenic hyperoxemia.

Machine alarms are another leading cause of alarm fatigue, but these are more easily resolvable than patient alarms. Low batteries, sensor disconnects, too much ambient light or other technical problems should be addressed before they become problematic.

Alarm fatigue can be dangerous in the NICU. Setting a correct range of oxygen saturation can increase the survival rate of pre-term infants and reduce morbidity associated with neurosensory conditions.

Sources:

AAMI Foundation, National Coalition for Alarm Management Safety, SpO2 Alarm Management Toolkit
(https://www.aami.org/docs/default-source/foundation/alarms/aamifdn_2017_spo2_toolkit.pdf?sfvrsn=ca90c27d_2)

McClure, S. Young Jang, and K. Fairchild. “Alarms, oxygen saturations, and SpO2 averaging time in the NICU,” Journal of Neonatal Perinatal Medicine. Nov. 14, 2016. doi: 10.3233/NPM-16162 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684874/)


This content was developed by American Nurse Journal and was provided through an educational grant by Medtronic.

 

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