Abstract
Background
The infrastructure of many labor and delivery units in the U.S. may dispose clinicians
to overuse continuous and automated maternal physiologic monitors. Overmonitoring
low-risk patients can negatively impact patient care, primarily through generating
alarm fatigue.
Objective
Given national attention to reducing alarm fatigue across healthcare settings and
concern for vital sign monitoring overuse on our labor and delivery unit, the purpose
of this quality improvement study was to evaluate vital sign monitoring patterns and
alarm rates, as well as nursing experiences of alarm fatigue, before and after implementing
a vital sign monitoring guideline for low-risk obstetric patients.
Study Design
This is a quality improvement study conducted on the labor and delivery unit of an
urban, academic, tertiary hospital. The lack of guidance for maternal vital sign assessment
in low-risk patients was identified as a potential safety challenge. A vital sign
guideline was developed with multidisciplinary input, followed by a pre/post implementation
study evaluating vital sign volume and alarm rates. Total vital signs and alarm rates
for all patients delivered during designated calendar days were assessed as a rate
of vitals/patient and compared across baseline, peri-intervention, and follow-up periods.
Data were examined in p-type statistical process control charts as well as with time-series
analysis. Patient characteristics and severe maternal morbidity (SMM), as a balancing
metric, were compared across periods. Nursing perceptions of vital sign monitoring
and experience of alarm fatigue were assessed via survey before and after implementation
of the guideline.
Results
35 individual 24-hour periods of vital sign and alarm volume were evaluated. There
was a decrease from a mean of 208.34 to 135.46 vitals/patient after implementation
(IRR 0.65) and in alarms/patient from a mean of 14.31 to 10.51 (IRR 0.73), with no
difference in SMM. There were 85 total respondents to the nursing surveys, and comparison
of modified task-load index scores before and after implementation demonstrated overall
lower scores in the post-period, though these were not statistically significant.
Conclusion
Introducing a maternal vital sign guideline for low-risk patients on L&D decreased
vital signs measured as well as alarms, which may ultimately reduce alarm fatigue.
This strategy should be considered on L&D units widely to improve patient safety and
optimize outcomes.
Key words
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Article info
Publication history
Accepted:
January 31,
2023
Received in revised form:
January 27,
2023
Received:
December 15,
2022
Publication stage
In Press Accepted ManuscriptFootnotes
Presentation: These data will be presented at The Society for Maternal Fetal Medicine (SMFM) 43rd Annual Meeting. San Francisco, CA. February 6-11, 2023. Abstract 645.
Disclosures: The authors report no conflict of interest.
Adina Kern-Goldberger was supported by a National Institutes of Health T32 Training Grant in Perinatal Epidemiology at the University of Pennsylvania and a Society for Maternal Fetal Medicine-AMAG Health Policy Award.
Condensation: Introducing a maternal vital sign guideline for low-risk patients on L&D decreased vital signs measured as well as alarms, which may ultimately reduce risk of alarm fatigue.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
