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Background: Overutilization of continuous pulse oximetry (CPO) contributes to overdiagnosis and prolonged supplemental oxygen utilization. It may also negatively impact patient sleep, mobility, length of stay (LOS), and cost. Response times to actionable alarms increase with the number of non-actionable alarms. Our baseline data revealed an average of 29.6 pulse oximetry monitor alarms sounded for each admitted patient each day of their hospitalization. Most notably, 38.7% of pulse oximetry alarms were for ≥88% which is generally considered non-actionable.

Objective: We aimed to decrease both total pulse oximetry alarms per patient day and alarms for ≥88% per patient day by 20%, each by September 2020.

Design/Methods: This single-center quality improvement study included patients admitted to inpatient pediatric units from January 2019 to September 2020. Those in intensive care or cardiology units were excluded. Process measures were 1) percentage of patients with CPO order and 2) percentage of LOS with CPO orders in place. Outcome measures were 1) total pulse oximetry alarms per patient day and 2) alarms for ≥88% per patient day. Frequencies of high acuity transfers to intensive care and code blue events without CPO ordered served as balancing measures. Plan-Do-Study-Act cycles included: 1) changing default alarm limits from <90% to <88%, 2) changing pulse oximetry order default to intermittent rather than continuous monitoring, and 3) requiring selection of an indication for CPO from a new list within the order. Statistical process control charts monitored improvement.

Results: Our project included 18,080 patients. Process measures of percentages of patients with CPO order and of LOS with CPO order in place decreased by 29.9% (44.2% to 31.0%; Fig 1) and 29.2% (45.2% to 32.0%; Fig 2), respectively. Outcome measures of total pulse oximetry alarms and alarms ≥88% per patient day decreased by 37.2% (29.6 to 18.6; Fig 3) and by 54.0% (12.4 to 5.7; Fig 4), respectively. Balancing measures were unchanged.

Conclusion(s): Change in default pulse oximetry alarm limits was associated with decreased pulse oximetry alarms, particularly of non-actionable alarms. Changes to pulse oximetry order defaults and requirements impacted provider ordering behavior with subsequent decrease in frequency and duration of CPO orders, but had a lesser impact on alarms. Such system-level changes may be applied to reduce non-actionable cardiorespiratory monitor alarms and further reduce overall alarm burden and fatigue.

Presented at the 2021 PAS Virtual Conference

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Patient Safety | Pediatrics

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Presented at the 2021 PAS Virtual Conference

Reducing alarm burden by promoting judicious ordering of continuous pulse oximetry