(645) De-implementing Intrapartum Maternal Vitals Monitoring to Reduce Alarm Fatigue: An L&D Quality and Safety Initiative

Objective: Many L&D units likely overuse continuous and automated maternal physiologic monitors. Given national attention to reducing alarm fatigue in healthcare, which adversely impacts response times and patient outcomes, this study evaluates vital sign monitoring and alarm patterns before and after implementing a vital sign protocol to reduce overmonitoring in low-risk obstetric patients.

Study Design: This is a quality improvement study conducted at an academic, tertiary hospital (4200 deliveries/year). The lack of guidance for maternal vital sign assessment in low-risk patients was identified as a safety challenge. A vital sign protocol was developed with multidisciplinary input and implemented. Total vital signs and alarm rates for all patients delivered during designated calendar days were assessed 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, defined according to the CDC), used as a balancing metric, were compared peri-intervention.

Results: 35 individual 24-hour periods of vital sign and alarm volume were evaluated surrounding implementation of the protocol (10 baseline, 20 peri-intervention, 5 delayed follow-up). There was a decrease from a mean of 208.3 to 135.5 vitals/patient after implementation (incidence rate ratio [IRR] 0.65, p < 0.01) and in alarms/patient from a mean of 14.3 to 10.5 (IRR 0.73, p = 0.045) [Figures]. There were no significant differences in patient characteristics aggregated over the 2 calendar months of the immediate pre/post implementation periods (6-7/2021, 8-9/2021), or in SMM with and without transfusion (p = 0.34, 0.45).

Conclusion: Introducing a maternal vital sign protocol 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.