Original Research|Articles in Press, 100893

The Impact of an Intervention to Improve Intrapartum Maternal Vital Sign Monitoring and Reduce Alarm Fatigue

Published:February 10, 2023DOI:



      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.


      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.


      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.


      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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