Epidemiology of patient monitoring alarms in the neonatal intensive care unit

objective to characterize the rate of monitoring alarms by alarm priority, signal type, and developmental age in a level-iiib neonatal intensive care unit (nicu) population. study design retrospective analysis of 2,294,687 alarm messages from philips monitors in a convenience sample of 917 nicu patients, covering 12,001 patient-days. we stratified alarm rates by alarm priority, signal type, postmenstrual age (pma) and birth weight (bw), and reviewed and adjudicated over 21,000 critical alarms. results of all alarms, 3.6% were critical alarms, 55.0% were advisory alarms, and 41.4% were device alerts. over 60% of alarms related to oxygenation monitoring. the average alarm rate (±sem) was 177.1 ± 4.9 [median: 135.9; iqr: 89.2–213.3] alarms/patient-day; the medians varied significantly with pma and bw (p < 0.001) in u-shaped patterns, with higher rates at lower and higher pma and bw. based on waveform reviews, over 99% of critical arrhythmia alarms were deemed technically false. conclusions the alarm burden in this nicu population is very significant; the average alarm rate significantly underrepresents alarm rates at low and high pma and bw. virtually all critical arrhythmia alarms were artifactual.