title: Alarm safety and oxygen saturation targets in the Vermont Oxford Network iNICQ 2015 collaborative.
abstract: To assess progress of neonatal intensive care units (NICUs) participating in the Vermont Oxford Network iNICQ 2015: Alarm Safety Collaborative in achieving Joint Commission 2014 alarm safety goals with respect to oximeters, and to compare patient-level oxygen saturation (SpO2) and oximeter alarm data to local policies.
  
  
  
  Prospective multicenter audits in February and August 2015 assessed implementation of policies addressing Joint Commission 2014 Alarm Safety goals, and ascertained SpO2targets, oximeter alarm settings and compliance with policy-specified SpO2targets and alarms.
  
  
  
  Eighty-six NICUs completed both audits. Of 13 policies addressing mandated goals, median (interquartile range) 8 (5, 9) policies were implemented at audit 1 and 9 (6, 11) at audit 2 (P=0.004). At audit 1, 28 NICUs had implemented ⩾9 policies versus 47 at audit 2. For 794 infants <31 weeks gestation, <36 weeks postmenstrual age, and on supplemental oxygen, median SpO2target lower limit was 88% (interquartile range 87%, 90%; range 75% to 94%), upper limit 95% (interquartile range 94%, 96%; range 85% to 100%). High oximeter alarm was set according to local policy for 63% of infants, for whom SpO2>97% was less frequent than when high alarm was not set to policy (10.1% vs 21.5%, P=0.006).
  
  
  
  Participating NICUs showed significant progress between audits in their implementation of Joint Commission Alarm Safety goals for oximeter monitoring. Oximeter high alarm not set per local policy is associated with increased hyperoxemia in preterm infants. Recommendations to standardize oxygen saturation targets for infants at risk for oxygenation-related outcomes have not been widely adopted.
authors.affiliation: Division of Neonatology, Connecticut Children's Medical Center, Hartford, CT, USA.|Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA.
authors.forename: J I
authors.initials: JI
authors.lastname: Hagadorn
authors.affiliation: Division of Neonatology, Connecticut Children's Medical Center, Hartford, CT, USA.|Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA.
authors.forename: D W
authors.initials: DW
authors.lastname: Sink
authors.affiliation: Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.|Department of Pediatrics, University of Vermont, Burlington, VT, USA.|Vermont Oxford Network, Burlington, VT, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Buus-Frank
authors.affiliation: Vermont Oxford Network, Burlington, VT, USA.|Department of Mathematics and Statistics, University of Vermont, Burlington, VT, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Edwards
authors.affiliation: Vermont Oxford Network, Burlington, VT, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Morrow
authors.affiliation: Department of Pediatrics, University of Vermont, Burlington, VT, USA.|Vermont Oxford Network, Burlington, VT, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Horbar
authors.affiliation: Vermont Oxford Network, Burlington, VT, USA.
authors.forename: K
authors.initials: K
authors.lastname: Ferrelli
authors.affiliation: Department of Pediatrics, University of Vermont, Burlington, VT, USA.|Vermont Oxford Network, Burlington, VT, USA.
authors.forename: R F
authors.initials: RF
authors.lastname: Soll
mesh_terms: D056902:Clinical Alarms / Q000592:standards*; D005865:Gestational Age; D006801:Humans; D018496:Hyperoxia / Q000517:prevention & control; D000860:Hypoxia / Q000517:prevention & control; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood*; D007363:Intensive Care Units, Neonatal / Q000592:standards*; D016015:Logistic Models; D008991:Monitoring, Physiologic; D010092:Oximetry / Q000379:methods; D010100:Oxygen / Q000097:blood*; D061214:Patient Safety; D011446:Prospective Studies; D014707:Vermont
chemical_list: D010100:Oxygen