Alarm Strategies and Surveillance for NIV Outside Intensive Care Units

Background: Since 2014, The Joint Commission introduced use alarms safely as a National Patient Safety Goal. In 2019 published by AARC, ventilator alarms are ranked fourth. The biggest contributing factor to alarm-related adverse events is suggested to be the excessive number of alarms in a clinical environment, which can be as high as 942 alarms per day. This review utilizes the tele-NIV system, which is a telemetry system that continuously transmits live data, such as NIV readings and vital signs. Tele-NIV examines the factors that affect NIV alarm utility and provides recommendations to improve patient safety and clinician efficiency while reducing alarm fatigue. Methods: A retrospective study was conducted from April to June 2021. A total of 113 NIV patients received additional telemonitoring during the study period during their stay at the hospital. All data were recorded and extracted from the tele-NIV server. Logistic regression was performed on the importance of tele-NIV and the frequent alarms in ensuring NIV alarms were resolved within 2 min. This study was approved by the Institution Domain Specific Review Board (NHG DSRB 2022/00455). Results: Among our 113 patients, there were a total of 5,146 alarm encounters during the period. 384 alarms were recorded by the respiratory therapists (RTs) as essential alarms, with a median of 3.5 (1.0 – 4.9) essential alarms per patient. The most common essential NIV alarms were low pressure or patient disconnect alarms (194 alarms [50.5%]), low SpO2 alarms (101 [26.3%]), and low tidal volume alarms (42 [10.9%]). Out of the 384 essential alarms, 76 (19.8%) essential alarms were recorded simultaneously and are mostly linked to the disconnection from the patient. The median response time in resolving the alarm was 2.0 (2.0-8.0) min. Management responses to the telemonitoring of NIV events were that most of the alarm encounters (205 [53.4%]) were reported to be resolved remotely, and 179 [46.6%] of alarms required the support of the RTs to review the patient. 204 (53.1%) of the essential alarms responded and were resolved within 2 min. Of those, 135 (66.2%) were resolved through tele-NIV. Conclusions: This review identified essential NIV alarms that will help clinicians respond appropriately and reduce alarm fatigue. Tele-NIV has made remote monitoring of alarms and provided clinicians with a better awareness of NIV alarms. Further research is needed to determine the alarms' priorities and expand the tele-NIV system to improve patient care.Table 1: Comparing median time taken to respond different types of (essential) alarm between tele-NIV and in-person (n=384) Time taken to resolve alarm using Tele-NIV (n=205)Time taken to resolve alarm through in-person RT (n=179)P-valueAlarms from low pressure/ patient disconnect2.0 (2.0-4.0)3.3 (2.0-8.0)0.275Alarms from vital signs (SpO2)2.0 (2.0-2.0)2.0 (2.0-2.0)0.936Alarms from low or high volume2.0 (1.0-2.0)2.5 (2.0-7.0)0.023*Categorical variables were reported as frequencies and proportions and were compared using the Chi-square test. Non-parametric data was reported as median (interquartile range, IQR) and compared using the median test. Statistical difference was considered significant at p ≤ 0.05.Table 2: Binary logistic regression model for meeting gold standard of resolving alarm within two minutes Odds Ratio (95% CI)P-valueTele-NIV3.17 (2.13-4.74)<0.001*Low pressure alarm0.39 (0.24-0.61)<0.001*SpO2 alarm0.88 (0.50-1.52)0.638Volume related alarm1.29 (0.72-2.29)0.390*p-value < 0.05