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

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 1^st, 2^nd, 3^rd, 4^th, and 5^th 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.