Reducing Alarm Fatigue in Two Neonatal Intensive Care Units through a Quality Improvement Collaboration.

Abstract:

OBJECTIVE:To reduce nonactionable oximeter alarms by 80% without increasing time infants were hypoxemic (oxygen saturation [SpO2] ≤ 80%) or hyperoxemic (SpO2 > 95% while on supplemental oxygen). STUDY DESIGN:In 2015, a multidisciplinary team at Connecticut Children's Medical Center initiated a quality improvement project to reduce nonactionable oximeter alarms in two referral neonatal intensive care units (NICUs). Changes made through improvement cycles included reduction of the low oximeter alarm limit for specific populations, increased low alarm delay, development of postmenstrual age-based alarm profiles, and updated bedside visual reminders. Manual alarm tallies and electronic SpO2 data were collected throughout the project. RESULTS:Alarm tallies were collected for 158 patient care hours with SpO2 data available for 138 of those hours. Mean number of total nonactionable alarms per patient per hour decreased from 9 to 2 (78% decrease) and the mean number of nonactionable low alarms per patient per hour decreased from 5 to 1 (80% decrease). No change was noted in the balancing measures of percentage time with SpO2 ≤ 80% (mean 4.3%) or SpO2 > 95% (mean 23.7%). CONCLUSION:Through small changes in oximeter alarm settings, including revision of alarm limits, alarm delays, and age-specific alarm profiles, our NICUs significantly reduced nonactionable alarms without increasing hypoxemia.

journal_name

Am J Perinatol

authors

Johnson KR,Hagadorn JI,Sink DW

doi

10.1055/s-0038-1653945

subject

Has Abstract

pub_date

2018-11-01 00:00:00

pages

1311-1318

issue

13

eissn

0735-1631

issn

1098-8785

journal_volume

35

pub_type

杂志文章
  • Risk factors for placenta accreta: a large prospective cohort.

    abstract:OBJECTIVE:Placenta previa and prior cesarean delivery are known risk factors for placenta accreta. However, other risk factors have not been identified. Our objective was to examine risk factors for accreta using data collected prospectively in a large multicenter cohort. STUDY DESIGN:Secondary analysis of women with ...

    journal_title:American journal of perinatology

    pub_type: 杂志文章,多中心研究

    doi:10.1055/s-0033-1361833

    authors: Bowman ZS,Eller AG,Bardsley TR,Greene T,Varner MW,Silver RM

    更新日期:2014-10-01 00:00:00

  • Fetal and neonatal alloimmune thrombocytopenia: harvesting the evidence to develop a clinical approach to management.

    abstract::Neonatal alloimmune thrombocytopenia (NAIT) is the most common cause of severe thrombocytopenia in an otherwise healthy newborn. The most serious complication is intracranial hemorrhage, which can occur either in the fetus or the newborn. Despite the known serious sequelae, both antenatal management and neonatal treat...

    journal_title:American journal of perinatology

    pub_type: 杂志文章,评审

    doi:10.1055/s-0030-1263296

    authors: Symington A,Paes B

    更新日期:2011-02-01 00:00:00

  • The role of novel biomarkers in early diagnosis and prognosis of acute kidney injury in newborns.

    abstract::Acute kidney injury (AKI) refers to the rapid loss of renal function. In clinical practice, AKI is common among hospitalized patients of all age groups including neonates and remains an important cause of morbidity and mortality due to its late diagnosis and therefore delayed therapeutic intervention. Although the pre...

    journal_title:American journal of perinatology

    pub_type: 杂志文章,评审

    doi:10.1055/s-0032-1326985

    authors: Argyri I,Xanthos T,Varsami M,Aroni F,Papalois A,Dontas I,Fanos V,Iacovidou N

    更新日期:2013-05-01 00:00:00

  • Meconium plugs and intussusception in a premature infant.

    abstract::Neonatal intussusception in premature infants is uncommon and may mimic other abdominal disorders. We present a case of intussusception in a very low birthweight neonate. Presenting signs initially suggested necrotizing enterocolitis and meconium disease, and the diagnosis was confirmed at laparotomy. ...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-2007-999916

    authors: Glick B,Alpan G,Vinograd I,Udassin R,Mogle P,Eyal F

    更新日期:1985-04-01 00:00:00

  • The Impact of Sperm and Egg Donation on the Risk of Pregnancy Complications.

    abstract:OBJECTIVE:The aim of this study was to evaluate obstetric outcomes in relation to the extent of donor sperm exposure with and without egg donation. MATERIALS AND METHODS:This is a retrospective cohort study in a single tertiary care center. All women with a singleton pregnancy who conceived following sperm donation (S...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-0038-1667029

    authors: Fishel Bartal M,Sibai BM,Bart Y,Shina A,Mazaki-Tovi S,Eisen IS,Hendler I,Baum M,Schiff E

    更新日期:2019-01-01 00:00:00

  • A primary cytomegalovirus infection in pregnancy presenting with unusual hematologic manifestations: a case report.

    abstract::A previously healthy multigravida woman presenting with pyrexia was found to be pancytopenic at 32 weeks' gestation. The leukopenia and the thrombocytopenia responded to supportive therapy. The anemia, which was Coombs' negative, continued and was associated with a drop in fibrinogen, but both eventually returned to n...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-2007-994758

    authors: Soliman SR,Burrows RF

    更新日期:1993-09-01 00:00:00

  • Pregnant women with the sickle cell trait are not at increased risk for developing preeclampsia.

    abstract::The primary objective of this study was to determine whether having the sickle cell trait is independently associated with preeclampsia. We performed a retrospective cohort study of 1998 pregnant patients who either did or did not have the sickle cell trait. All patients were screened for the sickle trait using the "S...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-2003-37953

    authors: Stamilio DM,Sehdev HM,Macones GA

    更新日期:2003-01-01 00:00:00

  • Gestational Weight Gain and Pregnancy Outcomes among Nulliparous Women.

    abstract:OBJECTIVE: To determine the association between total gestational weight gain and perinatal outcomes. STUDY DESIGN: Data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be (NuMoM2b) study were used. Total gestational weight gain was categorized as inadequate, adequate, or excessive based on the 20...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-0039-1696640

    authors: Dude AM,Grobman W,Haas D,Mercer BM,Parry S,Silver RM,Wapner R,Wing D,Saade G,Reddy U,Iams J,Kominiarek MA

    更新日期:2021-01-01 00:00:00

  • Survival and ventilatory course of a regional cohort of very low birthweight (501-1500 gm) infants.

    abstract::To minimize the selection bias inherent in reporting results gathered only in neonatal intensive care units, this study presents survival and respiratory course data on all 299 infants of birthweight 501 to 1500 gm liveborn to residents of the North Central Illinois Perinatal Region in 1985-1986. The survival rate was...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-2007-999632

    authors: Powers WF,Hegwood PD

    更新日期:1989-10-01 00:00:00

  • Application of transcutaneous carbon dioxide tension monitoring with low electrode temperatures in premature infants in the early postnatal period.

    abstract:OBJECTIVE:The aim of this article is to evaluate the accuracy, precision, and safety of transcutaneous carbon dioxide tension (TcPCO2) monitoring at different electrode temperatures in preterm infants in the early postnatal period. STUDY DESIGN:A total of 26 neonates with a median birth weight of 974 g (432-1,694 g) a...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-0033-1352485

    authors: Hirata K,Nishihara M,Oshima Y,Hirano S,Kitajima H

    更新日期:2014-05-01 00:00:00

  • Role of Cord Blood Carboxyhemoglobin in Detecting Significant Hyperbilirubinemia in Term Neonates with ABO Alloimmunization.

    abstract:OBJECTIVE: This study aimed to assess whether cord blood carboxyhemoglobin (COHb) levels in jaundiced term neonates with and without a positive direct Coombs test (DCT) and in healthy controls could be used as a predictor of severe hyperbilirubinemia. The percentage of cord blood COHb should be higher among neonates wi...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-0040-1722328

    authors: Tıraş M,Can E,Hamilçıkan Ş

    更新日期:2021-01-04 00:00:00

  • The rate of severe preeclampsia is increased in triplet as compared to twin gestations.

    abstract::The objective of this study was to determine if the rate of preeclampsia is increased in triplet as compared to twin gestations. Fifty-three triplet pregnancies between 1986 and 1993 at The New York Hospital-Cornell Medical Center were reviewed. These were matched for maternal age, parity, and race to twin gestations ...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-2007-994140

    authors: Mastrobattista JM,Skupski DW,Monga M,Blanco JD,August P

    更新日期:1997-05-01 00:00:00

  • Association of midgestational paraoxonase 1 activity with pregnancies complicated by preeclampsia.

    abstract::The antioxidant enzyme paraoxonase 1 is a marker of oxidative stress and has been implicated in the pathogenesis of preeclampsia. Our objective was to determine if an association exists between low paraoxonase 1 activity at midgestation and the development of preeclampsia. We conducted a case-control study of 50 women...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-0029-1236438

    authors: Baker AM,Klein RL,Haeri S,Moss KL,Boggess KA

    更新日期:2010-03-01 00:00:00

  • Conflicts between physicians and patients in non-elective cesarean delivery: incidence and the adequacy of informed consent.

    abstract::A study was undertaken in 372 consecutive patients undergoing non-elective cesarean delivery to explore the incidence and nature of conflicts between physician and patient surrounding the decision to undergo non-elective cesarean delivery; to examine the adequacy of informed consent at the time of non-elective cesarea...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-2007-994319

    authors: Lescale KB,Inglis SR,Eddleman KA,Peeper EQ,Chervenak FA,McCullough LB

    更新日期:1996-04-01 00:00:00

  • Associations of Measured Protein and Energy Intakes with Growth and Adiposity in Human Milk-Fed Preterm Infants at Term Postmenstrual Age: A Cohort Study.

    abstract:OBJECTIVE:To determine the associations of measured protein, energy, and protein-to-energy (PER) intakes with body composition in human milk (HM)-fed preterm infants. STUDY DESIGN:Neonates born at < 33 gestational weeks were eligible. Standard fortification method with modular supplements was used and the HM compositi...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-0038-1626717

    authors: Macedo I,Pereira-da-Silva L,Cardoso M

    更新日期:2018-07-01 00:00:00

  • Oxygenation of the human fetus as a function of hemoglobulin concentration.

    abstract::We studied the relationships between fetal hemoglobin concentration, acid base status, and lactate concentration in umbilical venous and fetal heart blood in 157 fetuses affected by blood group incompatibility who had been exposed for 214 fetal blood sampling procedures (cordocentesis in 153 and intracardiac puncture ...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-2007-994524

    authors: Westgren M,Lingman G,Stangenberg M

    更新日期:1994-01-01 00:00:00

  • Third-trimester uterine rupture without previous cesarean: a case series and review of the literature.

    abstract::We sought to describe a case series and literature review of uterine rupture in the absence of a previous cesarean delivery. In addition to four cases in our institution, a search of the literature from 1994 to 2008 identified cases of uterine rupture unrelated to a prior cesarean. Uterine rupture in the absence of a ...

    journal_title:American journal of perinatology

    pub_type: 杂志文章,评审

    doi:10.1055/s-0029-1223287

    authors: Dow M,Wax JR,Pinette MG,Blackstone J,Cartin A

    更新日期:2009-11-01 00:00:00

  • Feasibility of postpartum rapid hospital discharge: a study from a community hospital population.

    abstract::We have examined the safety and efficacy of an early postpartum discharge program in 289 patients who were identified prior to delivery and counseled and educated for discharge 12 to 36 hours after delivery. A total of 55% of the study patients were able to be discharged early. There were 4.3% significant maternal pro...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-2007-994768

    authors: Welt SI,Cole JS,Myers MS,Sholes DM Jr,Jelovsek FR

    更新日期:1993-09-01 00:00:00

  • Uterine rupture in patients with a prior cesarean delivery: the impact of cervical ripening.

    abstract::The purpose of this study was to examine factors that were associated with uterine rupture in patients attempting vaginal birth after cesarean delivery. We analyzed the results of all patients attempting vaginal birth after cesarean delivery between September 1996 to December 1999 at a single institution using a conte...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-2004-828608

    authors: Hoffman MK,Sciscione A,Srinivasana M,Shackelford DP,Ekbladh L

    更新日期:2004-05-01 00:00:00

  • Histologic examination of the placenta in the growth-retarded fetus.

    abstract::This investigation was undertaken to determine whether histologic examination of the placenta contributed to a better understanding of the cause of intrauterine fetal growth retardation. Placentas were examined of 151 liveborn infants whose birthweights were in the lower 10th percentile for gestational age. One or mor...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-2007-999546

    authors: Rayburn W,Sander C,Compton A

    更新日期:1989-01-01 00:00:00

  • Gastric residual in growing preterm infants: effect of body position.

    abstract::Studies of the effect of body position during and after bolus feeding upon gastric emptying or gastric residual have not had consistent results. We tested the hypotheses that right lateral decubitus leads to less gastric residual than left lateral decubitus and that the prone position leads to less gastric residual th...

    journal_title:American journal of perinatology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1055/s-2004-823778

    authors: Cohen S,Mandel D,Mimouni FB,Solovkin L,Dollberg S

    更新日期:2004-04-01 00:00:00

  • The Acylcarnitine Profile in Dried Blood Spots is Affected by Hematocrit: A Study of Newborn Screening Samples in Very-Low-Birth-Weight Infants.

    abstract:OBJECTIVE: The acylcarnitine profile is analyzed in dried blood spots (DBS) to screen for inborn errors of metabolism. Hematocrit (Ht) is known to affect the result of quantitative analyses of DBS samples; however, the effects of Ht on the acylcarnitine profiles in DBS have not been studied in actual samples from newbo...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-0040-1721849

    authors: Haga M,Isobe M,Kawabata K,Shimizu M,Mochizuki H

    更新日期:2020-12-29 00:00:00

  • The neonatal autopsy: can it be revived?

    abstract:OBJECTIVES:To describe the trend and factors associated with the autopsy over the past decade at a level III neonatal intensive care unit (NICU) where all patients are presented with an option. STUDY DESIGN:Retrospective study of the autopsy in a cohort of infants who died in the NICU from January 1, 2001, to December...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-0032-1332798

    authors: Swinton CH,Weiner J,Okah FA

    更新日期:2013-10-01 00:00:00

  • Intravenous immunoglobulin in antiphospholipid syndrome and maternal floor infarction when standard treatment fails: a case report.

    abstract::Obstetrical antiphospholipid syndrome (APS) is associated with maternal and fetal morbidity and mortality. Standard treatment with low-dose acetylsalicylic acid and unfractionated heparin has achieved up to a 70 to 80% likelihood of success. Conversely, up to 30% of women with APS will have further pregnancy losses, d...

    journal_title:American journal of perinatology

    pub_type: 杂志文章,评审

    doi:10.1055/s-2006-931805

    authors: Chang P,Millar D,Tsang P,Lim K,Houlihan E,Stephenson M

    更新日期:2006-02-01 00:00:00

  • Prophylactic pelvic artery catheterization and embolization in women with placenta accreta: can it prevent cesarean hysterectomy?

    abstract::We present the outcome of a relatively large cohort of women with suspected placenta accreta who underwent prophylactic pelvic artery catheterization prior to cesarean section. All pregnant women with suspected placenta accreta who delivered in one tertiary center were included in this retrospective study. All patient...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-0030-1247599

    authors: Sivan E,Spira M,Achiron R,Rimon U,Golan G,Mazaki-Tovi S,Schiff E

    更新日期:2010-06-01 00:00:00

  • A Multicentered Randomized Study on Early versus Rescue Calsurf Administration for the Treatment of Respiratory Distress Syndrome in Preterm Infants.

    abstract:OBJECTIVE:Surfactant and noninvasive ventilation are two major strategies for the treatment of neonates with respiratory distress syndrome (RDS). However, the optimal time for surfactant administering is yet controversial. This study compared the early and rescue Calsurf administration in preterm infants with RDS. STU...

    journal_title:American journal of perinatology

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1055/s-0039-1678530

    authors: Rong Z,Chang L,Cheng H,Wang H,Zhu X,Peng F,Fan Q,Lu W,Pan R,Xiong L,Jiao R,Sun J,Xia S,Xie J

    更新日期:2019-12-01 00:00:00

  • Obstetric outcomes of human immunodeficiency virus-1-serodiscordant couples following in vitro fertilization with intracytoplasmic sperm injection.

    abstract::The objective of this article is to report obstetric outcomes of human immunodeficiency virus-1 (HIV-1)-serodiscordant couples who underwent in vitro fertilization and embryo transfer (IVF-ET) with intracytoplasmic sperm injection (ICSI) at a tertiary care center. We reviewed the outcomes of seronegative women after I...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-2003-42694

    authors: Cleary-Goldman J,Peña JE,Thornton MH 2nd,Robinson JN,D'Alton ME,Sauer MV

    更新日期:2003-08-01 00:00:00

  • Severe neutrophilia in an infant with persistent pulmonary hypertension of the newborn.

    abstract::We report the case of a term male infant with severe persistent pulmonary hypertension of the newborn, who developed massive neutrophilia of unknown etiology. An extensive evaluation failed to disclose an obvious cause for his neutrophilia. A bone marrow aspirate was performed and was consistent with a leukemoid react...

    journal_title:American journal of perinatology

    pub_type: 杂志文章,评审

    doi:10.1055/s-2003-45288

    authors: Engmann C,Donn SM

    更新日期:2003-10-01 00:00:00

  • Fetuses of Mothers with Thyroid Disease May Be at Higher Risk of Developing Supraventricular Tachycardia.

    abstract:OBJECTIVE:Fetal tachyarrhythmias complicate 0.5% of pregnancies, with high morbidity and mortality. We hypothesized that maternal factors may predispose to fetal supraventricular tachycardia (SVT). STUDY DESIGN:We reviewed medical records of all 124 mothers who presented to the Vanderbilt Fetal Cardiology Clinic from ...

    journal_title:American journal of perinatology

    pub_type: 杂志文章

    doi:10.1055/s-0035-1552942

    authors: Johnson JA,Williams P,Lu Z,Kavanaugh-McHugh A,Fish FA,Killen SA

    更新日期:2015-11-01 00:00:00

  • A review of studies with chlorhexidine applied directly to the umbilical cord.

    abstract::Infection-related neonatal mortality due to omphalitis in developing country home births is an important public health problem. Three cluster randomized trials of 4% chlorhexidine applied to the umbilical cord stump from once to multiple times in the days following a home birth have evaluated this intervention compare...

    journal_title:American journal of perinatology

    pub_type: 杂志文章,评审

    doi:10.1055/s-0032-1329695

    authors: Goldenberg RL,McClure EM,Saleem S

    更新日期:2013-09-01 00:00:00