Variations in Alarm Burden, Source, and Cause Across Inpatient Units at a Children's Hospital.

BACKGROUND AND OBJECTIVES: Alarms at hospitals are frequent and can lead to alarm fatigue posing patient safety risks. We aimed to describe alarm burden over a 1-year period and explored variations in alarm rates stratified by unit type, alarm source, and cause. METHODS: A retrospective study of inpatient alarm and patient census data at 1 children's hospital from January 1, 2019, to December 31, 2019, including 8 inpatient units: 6 medical/surgical unit (MSU), 1 PICU, and 1 NICU. Rates of alarms per patient day (appd) were calculated overall and by unit type, alarm source, and cause. Poisson regression was used for comparisons. RESULTS: There were 7 934 997 alarms over 84 077 patient days (94.4 appd). Significant differences in alarm rates existed across inpatient unit types (MSU 81.3 appd, PICU 90.7, NICU 117.5). Pulse oximetry (POx) probes were the alarm source with highest rate, followed by cardiorespiratory leads (54.4 appd versus 31). PICU had lowest rate of POx alarms (33.3 appd, MSU 37.6, NICU 92.6), whereas NICU had lowest rate of cardiorespiratory lead alarms (16.2 appd, MSU 40.1, PICU 31.4). Alarms stratified by cause displayed variation across unit types where "low oxygen saturation" had the highest overall rate, followed by "technical" alarms (43.4 appp versus 16.3). ICUs had higher rates of low oxygenation saturation alarms, but lower rates of technical alarms than MSUs. CONCLUSIONS: Clinical alarms are frequent and vary across unit types, sources, and causes. Unit-level alarm rates and frequent alarm sources (eg, POx) should be considered when implementing alarm reduction strategies.

Reducing the Frequency of Pulse Oximetry Alarms at a Children's Hospital.

BACKGROUND AND OBJECTIVES: Alarm fatigue is exacerbated by frequent, nonactionable physiologic monitor alarms. Overutilization of pulse oximetry (SpO2) compounds this alarm burden. Narrow default alarm limits and overutilization of continuous (CSpO2) rather than intermittent monitoring contribute to nonactionable alarms. There were 1.12 million SpO2 alarms on included units during the baseline period, of which 41.0% were for SpO2 ≥ 88%. We aimed to decrease SpO2 alarms per patient day by 20% within 12 months. METHODS: This quality improvement study included patients admitted January 2019 to June 2022. Intensive care and cardiology units were excluded. Interventions included (1) changing default alarm SpO2 limits on monitors from <90% to <88%, (2) changing SpO2 order default from continuous to intermittent, and (3) adding indication requirements for CSpO2. Outcome measures were total SpO2 alarms and alarms for SpO2 ≥ 88% per patient day. Balancing measures were high acuity transfers and code blues without CSpO2 ordered. Control charts were used for each. RESULTS: Our study included 120 408 patient days with 2.98 million SpO2 alarms. Total SpO2 alarms and alarms for SpO2 ≥ 88% per patient day decreased by 5.48 (30.57 to 25.09; 17.9%) and 4.48 (12.50 to 8.02; 35.8%), respectively. Special cause improvement was associated with changing default monitor alarm parameters. Balancing measures remained stable. CONCLUSIONS: SpO2 monitors alarm frequently at our children's hospital. Widening default alarm limits was associated with decreased SpO2 alarms, particularly nonactionable alarms (≥88%). This high-reliability intervention may be applied, when appropriate, to other monitor alarm parameters to further mitigate alarm burden.