Abstract
Background: Due to immaturity, excess oxygen in the bloodstream of neonates can lead to the production of free radicals and proinflammatory markers. Hyperoxia and excess ventilation can lead to complications such as retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD). Conversely, hypoxia can lead to cell death. Conditions associated with hypoxia in the neonate include hypoxic ischemic encephalopathy, periventricular leukomalacia, and necrotizing enterocolitis. Oxygen saturation guidelines have been created to maintain infants on oxygen within a set target goal to avoid these short- and long-term complications. Titrating oxygen appropriately to keep the infant within a target range is part of the nurse’s role. Unfortunately, there is a low compliance in maintaining target oxygen saturations among nurses in our NICU. Improving nursing knowledge through training about the risks of hyperoxia and hypoxia can lead to vigilance in monitoring target saturations and in turn, increase the amount of time infants spent in their policy specific target ranges. Utilization of histograms has also brought awareness to the amount of time infants are within their goal range. In addition, nurses deal with alarms on a continual basis in the NICU. Excess numbers of false alarms can lead to desensitization and burnout which can lead to patient harm.|Purpose: The purpose of this QI project was to increase the percentage of time an infant on oxygen is within the specific target range for gestational age and decrease alarm fatigue.|Methods: After each shift, bedside nurses completed a form which included histogram data on any infant requiring greater than 21% oxygen. Data were collected for approximately one month. An updated oxygen saturation range policy was then created and an educational presentation about the risks of hyperoxia and hypoxia were presented to the nurses along with the new policy. A short alarm fatigue survey was also distributed and completed by the nursing staff. Post-implementation oxygen saturation data were collected by the nurses for approximately two additional months. Nurses were then asked to fill out the alarm fatigue survey after implementation of the new policy.|Results/Findings: The amount of time spent within target range pre implementation was 53%. The amount of time spent within target range post implementation was 61%. Alarm fatigue perception slightly increased post-implementation.|Implications for Practice/Research: Nurses are more aware of the amount of time they are spending within the infant’s target range for oxygenation. They also are more alert to alarm fatigue. Implementation of the use of histograms may lead to improved outcomes. However further research over the use of histograms is needed, specifically how much time an infant should spend within the target oxygen saturation range. Further studies are also still needed to decide on the most suitable oxygen saturation range for preterm infants.|Conclusion: Hypoxia and hyperoxia can be detrimental to neonates. The use of histograms leads to increased vigilance of oxygen use in the NICU and increases the amount of time infants are within their target. However, increased awareness of oxygen target goal along with education may increase nurse perception of alarm fatigue.