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. 2018 Aug;38(8):1030-1038.
doi: 10.1038/s41372-018-0095-x. Epub 2018 May 8.

Epidemiology of patient monitoring alarms in the neonatal intensive care unit

Taibo Li  1 , Minoru Matsushima  1   2 , Wendy Timpson  3 , Susan Young  3 , David Miedema  3 , Munish Gupta  3 , Thomas Heldt  4
Affiliations

Epidemiology of patient monitoring alarms in the neonatal intensive care unit

Taibo Li et al. J Perinatol. 2018 Aug.

Erratum in

Abstract

Objective: To characterize the rate of monitoring alarms by alarm priority, signal type, and developmental age in a Level-IIIB Neonatal Intensive Care Unit (NICU) population.

Study design: Retrospective analysis of 2,294,687 alarm messages from Philips monitors in a convenience sample of 917 NICU patients, covering 12,001 patient-days. We stratified alarm rates by alarm priority, signal type, postmenstrual age (PMA) and birth weight (BW), and reviewed and adjudicated over 21,000 critical alarms.

Results: Of all alarms, 3.6% were critical alarms, 55.0% were advisory alarms, and 41.4% were device alerts. Over 60% of alarms related to oxygenation monitoring. The average alarm rate (±SEM) was 177.1 ± 4.9 [median: 135.9; IQR: 89.2-213.3] alarms/patient-day; the medians varied significantly with PMA and BW (p < 0.001) in U-shaped patterns, with higher rates at lower and higher PMA and BW. Based on waveform reviews, over 99% of critical arrhythmia alarms were deemed technically false.

Conclusions: The alarm burden in this NICU population is very significant; the average alarm rate significantly underrepresents alarm rates at low and high PMA and BW. Virtually all critical arrhythmia alarms were artifactual.

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Conflict of interest statement

Conflict of Interest

Dr. Heldt has received research funding from the National Institutes of Health, Nihon Kohden Corporation, Maxim Integrated, and Philips Healthcare. Dr. Matsushima remained a salaried employee of Nihon Kohden Corporation while contributing to this study as a Visiting Scientist at MIT’s Institute for Medical Engineering & Science. Mr. Li received partial internship support from Nihon Kohden Innovation Center. Ms. Young, Mr. Miedema, Dr. Timpson, and Dr. Gupta declare no potential conflict of interest.

Supplementary Information accompanies the paper on the Journal of Perinatology website (http://www.nature.com/jp).

Figures

Figure 1
Figure 1
Distribution of NICU patient monitoring alarms by alarm priority: red (critical) alarms, yellow (advisory) alarms, and INOPs (device alerts). SpO2: blood oxygenation; CPAP: continuous positive airway pressure; HR: heart rate; ABP: arterial blood pressure; Resp: respiratory rate; ECG: electrocardiogram; PPG: pulse plethysmogram.
Figure 2
Figure 2
Average alarm rates, stratified by postmenstrual age, broken down into constituent categories to reveal major alarm rate trends. All: average alarm rate across all 917 patients.
Figure 3
Figure 3
Average alarm rates (±SEM) for micro preemies, ELBW infants, VLBW infants, LBW infants, infants of normal birth weight (NBW), and the entire study population (All).
See this image and copyright information in PMC

References

    1. Tsien CL, Fackler JC. Poor prognosis for existing monitors in the intensive care unit. Crit Care Med. 1997;25(4):614–619. - PubMed
    1. Johnson KR, Hagadorn JI, Sink DW. Alarm Safety and Alarm Fatigue. Clin Perinatol. 2017;44(3):713–728. - PubMed
    1. Paine CW, Goel VV, Ely E, Stave CD, Stemler S, Zander M, et al. Systematic Review of Physiologic Monitor Alarm Characteristics and Pragmatic Interventions to Reduce Alarm Frequency. J Hosp Med. 2016;11(2):136–144. - PMC - PubMed
    1. Association for the Advancement of Medical Instrumentation. Clinical Alarms – 2011 summit. Arlington, VA: Association for the Advancement of Medical Instrumentation; 2011.
    1. Cvach M. Monitor alarm fatigue: an integrative review. Biomed Instrum Technol. 2012;46(4):268–277. - PubMed

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