6815 False beeps, true alarm- preliminary results of a project aimed at improving compliance with alarm limits on saturation monitors in a level II NICU

Objectives To check the compliance of oxygen saturation targets on monitors in the neonatal unit with the standard saturation targets according to gestational age. To demonstrate tangible improvement in compliance by running more than one PDSA cycle with an aim to achieve 100% conformity with the established criteria. Methods The guideline used for the purpose of this project was the East of England Neonatal ODN guideline Data was gathered through random point checks performed on monitors in the neonatal unit. Inclusion Criteria Babies of all gestational ages admitted to NICU who are attached to saturation monitors irrespective of whether they are on respiratory support or self-ventilating in air. Exclusion Criteria Babies admitted to the unit but not requiring saturation monitoring or those with congenital heart diseases. Results PDSA cycle 1 15 episodes were recorded for babies receiving care in the unit during point checks done in the months of April and May 2023. There was very low compliance seen with the EOE ODN guideline with only 19% of saturation monitors found to be adherent with the given standards. Interestingly, this was seen to translate into a higher corresponding oxygen saturation in babies compared to the target saturation range for their gestational age. The results were discussed locally and a practice development nurse for the neonatal service was involved. This led to the implementation of various suggested interventions including staff training, handover reminders and stricter safety checks to improve the conformity standards. PDSA cycle 2 A repeat PDSA cycle was run in 4 months' time to assess the effectiveness of remedial actions taken and to measure changes from the previous practice, if any. Data was again collected from 15 baby episodes. There was a marked improvement in the compliance seen with 80% of saturation monitors meeting the EOE ODN standards. However, due to the turnover of the trainee cohort, continuity of these measures could not be ensured. This was reflected in initial results from the data collected for 3rd PDSA cycle which demonstrated a fall in compliance rates to 50% Conclusion Setting the correct alarm limits on the saturation monitors might help the babies to maintain saturation in the recommended target range and prevent hyperoxaemia, which will be particularly beneficial in preterm babies. Maintaining correct upper and lower limits on oxygen saturation monitors can often be overlooked by both nursing and medical teams in busy neonatal units. Simple interventions like handover reminders, nursing education and stricter shift safety checks were seen to be effective in trying to achieve the aim of 100% compliance with standards. However, these measures can tend to be short-lived unless supplemented with more permanent strategies. Further suggested action points to achieve compliance include attaching printed and laminated sheets with standard alarm limits to all saturation monitors in use and including random alarm compliance checks as a part of medical and nursing grand rounds. References Noemi Hughes, Raj Gupta, Agnieszka Nowacka, Oxygen saturation targeting in infants on the neonatal unit, BMJ 30/9/21.