Reducing Alarm Burden in a Level IV Neonatal Intensive Care Unit.

Introduction: Excessive alarm burden contributes to alarm fatigue, causing staff to ignore or delay response to clinically significant alarms. The objective of this quality improvement project was to reduce yellow self-resolving SpO2 alarms from a mean of 14 alarms/patient-hour (APH) to 7 APH (a 50% reduction) within a 6-month period, without significantly decreasing the amount of time spent in target SpO2 range (90%-95%).

Methods: A multidisciplinary team used Define-Measure-Analyze-Improve-Control methodology to identify etiologies of alarm frequency and design improvement interventions to reduce alarm burden in a single-site Level IV NICU.

Use of healthcare failure mode and effect analysis (HFMEA) to quantify risks of the human milk feeding process.

The complexity of the expressed breast milk feeding process in the neonatal intensive care unit was not fully appreciated until we used a healthcare failure mode and effect analysis. This approach identified latent risks and provided semiquantitative estimates of the effectiveness of recommendations. Findings demonstrated nursing interruptions and multitasking requirements contributed to risk, emphasizing the need for focused and isolated expressed breast milk handling to improve patient safety and outcomes.