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Alarm safety and oxygen saturation targets in the Vermont Oxford Network iNICQ 2015 collaborative

Abstract

Objectives:

To assess progress of neonatal intensive care units (NICUs) participating in the Vermont Oxford Network iNICQ 2015: Alarm Safety Collaborative in achieving Joint Commission 2014 alarm safety goals with respect to oximeters, and to compare patient-level oxygen saturation (SpO2) and oximeter alarm data to local policies.

Study Design:

Prospective multicenter audits in February and August 2015 assessed implementation of policies addressing Joint Commission 2014 Alarm Safety goals, and ascertained SpO2 targets, oximeter alarm settings and compliance with policy-specified SpO2 targets and alarms.

Results:

Eighty-six NICUs completed both audits. Of 13 policies addressing mandated goals, median (interquartile range) 8 (5, 9) policies were implemented at audit 1 and 9 (6, 11) at audit 2 (P=0.004). At audit 1, 28 NICUs had implemented 9 policies versus 47 at audit 2. For 794 infants <31 weeks gestation, <36 weeks postmenstrual age, and on supplemental oxygen, median SpO2 target lower limit was 88% (interquartile range 87%, 90%; range 75% to 94%), upper limit 95% (interquartile range 94%, 96%; range 85% to 100%). High oximeter alarm was set according to local policy for 63% of infants, for whom SpO2 >97% was less frequent than when high alarm was not set to policy (10.1% vs 21.5%, P=0.006).

Conclusions:

Participating NICUs showed significant progress between audits in their implementation of Joint Commission Alarm Safety goals for oximeter monitoring. Oximeter high alarm not set per local policy is associated with increased hyperoxemia in preterm infants. Recommendations to standardize oxygen saturation targets for infants at risk for oxygenation-related outcomes have not been widely adopted.

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Acknowledgements

No external funding was secured for this study.

Author contributions

Dr Hagadorn drafted the initial manuscript; Dr Edwards and Ms Morrow performed statistical analysis; and all authors contributed to conceptualization, design, and analytical approach, reviewed and revised the manuscript, approved the final manuscript as submitted and agree to be responsible for the content accordingly.

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Correspondence to D W Sink.

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Competing interests

Dr Buus-Frank, Ms Ferrelli, Ms Morrow, Dr Horbar and Dr Soll are employees of the Vermont Oxford Network. Dr Edwards is supported by a grant from the Vermont Oxford Network to the University of Vermont. Drs Hagadorn and Sink were paid consultants to the Vermont Oxford Network for this project.

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Supplementary Information accompanies the paper on the Journal of Perinatology website

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Hagadorn, J., Sink, D., Buus-Frank, M. et al. Alarm safety and oxygen saturation targets in the Vermont Oxford Network iNICQ 2015 collaborative. J Perinatol 37, 270–276 (2017). https://doi.org/10.1038/jp.2016.219

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