Changing defaults could help hospitals reduce pulse oximetry alarm fatigue

Key takeaways:

• Changes to pulse oximetry alarm defaults could help hospitals decrease nonactionable alarms.
• Future studies should explore patient-level SpO₂ alarms and clinical outcomes.

Making key changes to pulse oximetry alarm defaults could help hospitals reduce nonactionable alarms, allowing staff to focus on actionable alarms, according to a study published in Pediatrics.

The researchers, from Children’s Mercy Kansas City and Monroe Carell Jr. Children’s Hospital at Vanderbilt, said physiologic monitors are used in children’s hospitals “at high rates and with significant variation, resulting in frequent alarms” and that continuous pulse oximetry (CSpO₂) “is the greatest contributor to this alarm burden.”

“Excess alarms may drive overdiagnosis and prolong length of stay, thereby increasing health care exposure and costs,” they wrote. “Response time to alarms increases with the number of nonactionable alarms.”

Their quality improvement study included patients admitted to Children’s Mercy Kansas City from January 2019 to June 2022, excluding ICU and cardiology units. They implemented three intervention strategies: changing default alarm SpO2 limits on monitors from lower than 90% to lower than 88%, changing the SpO₂ order default from continuous to intermittent, and adding indication requirements for CSpO₂.

Over the course of 120,408 patient days with 2.98 million SpO₂ alarms, total SpO₂ alarms per patient day decreased by 17.9% from 30.57 to 25.09, and alarms for SpO₂ at 88% or greater decreased by 35.8% from 12.50 to 8.02.

“Our team considered the differences between goals and alarm limits, recognizing that alarms sounding just outside of goal parameters may contribute to alarm burden without triggering a change in patient care,” they wrote. “These nonactionable alarms likely capture transient desaturations that are normal or expected as part of the clinical course. Another contributor was overutilization of CSpO₂, thought to be driven by order defaults that encouraged continuous use, lack of consideration of its clinical indications and misunderstanding of its utility and risks.”

The authors concluded that decreasing nonactionable alarms is “especially important” for allowing hospital staff to focus on actionable alarms.

“Focusing improvement efforts on high-reliability interventions with widening of alarm limits, when appropriate, may allow for continued decrease in monitor alarms,” they wrote. “Future study should explore patient-level SpO₂ alarms and clinical outcomes.”