title: Under-recognition of alarms in a neonatal intensive care unit.
abstract: BACKGROUND
  Treatment decisions for apnoea of prematurity (AOP) are usually based on nursing staff's documentation of pulse oximeter and heart rate alarms.
  
  
  OBJECTIVE
  In an observational study, to compare the accuracy of oxygen saturation (SpO2) and heart rate alarm documentation, and the resulting interventions by nursing staff, with objectively registered events using polysomnographic and video recording.
  
  
  METHODS
  Data on 21 preterm neonates (12 male) with a diagnosis of AOP were analysed. Nursing staff's desaturation (<80% SpO2) and bradycardia (<80/min) alarm documentation was compared with events registered objectively using simultaneous polysomnography. Interventions by nursing staff were evaluated using 24 h video recordings and compared with their chart documentation. Nursing staff had been unaware that the polygraphic and video recordings would be used subsequently for this purpose.
  
  
  RESULTS
  Median (minimum-maximum) postnatal age was 15.5 (3-65) days. 968 SpO2 desaturation events and  415 bradycardias were documented by polysomnography. Nursing staff registered 23% of these desaturation events, and 60% of bradycardias (n=223, and n=133, respectively). Intraclass correlation coefficient (95% CI) between objectively measured desaturation events and those documented by nursing staff was 0.14 (-0.31 to 0.53); and for bradycardias 0.51 (0.11 to 0.78). 225 nursing staff interventions were registered on video, of which 87 (39%) were documented.
  
  
  CONCLUSIONS
  The alarm documentation by neonatal intensive care unit staff does not appear to be sufficiently accurate to permit further understanding and treatment of AOP. It is unclear if the alarms missed here would have led to clinical consequences had they been documented.
authors.affiliation: Department of Neonatology, University Children's Hospital, , Tuebingen, Germany.
authors.forename: Pablo E
authors.initials: PE
authors.lastname: Brockmann
authors.forename: Cornelia
authors.initials: C
authors.lastname: Wiechers
authors.forename: Tobias
authors.initials: T
authors.lastname: Pantalitschka
authors.forename: Jessica
authors.initials: J
authors.lastname: Diebold
authors.forename: Jan
authors.initials: J
authors.lastname: Vagedes
authors.forename: Christian F
authors.initials: CF
authors.lastname: Poets
mesh_terms: D001049:Apnea / Q000097:blood*; D001919:Bradycardia / Q000175:diagnosis*; D005260:Female; D005865:Gestational Age; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000592:standards*; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods / Q000592:standards*; D009726:Nurses / Q000523:psychology* / Q000592:standards; D010092:Oximetry / Q000379:methods* / Q000592:standards; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption / Q000502:physiology; D017286:Polysomnography / Q000379:methods; D013997:Time Factors; D014741:Video Recording / Q000379:methods
chemical_list: D010100:Oxygen
keywords: Monitoring; Neonatology; Nursing Care