138 - Reducing Barriers to Providing Targeted Oxygen Saturation in Preterm Infants

Publication Number: 3132.138

Sripriya Sundararajan, University of Maryland School of Medicine, Baltimore, MD, United States; Tanya Abraham, University of Maryland Children's Hospital, Baltimore, MD, United States; Adrianna Jackson, University of Maryland Children's Hospital, Baltimore, MD, United States; Sharen C. `Wilson, University of Maryland Children's Hospital, Kensington, MD, United States; Brandi Sargent, University of Maryland Children's Hospital, Hanover, MD, United States; Deborah L. Linehan, University of Maryland Medical Center, Littlestown, PA, United States; Danielle Wolter, University of Maryland Medical System, Baltimore, MD, United States; Meg Reno, University of Maryland Children’s Hospital- Neonatal Intensive Care Unit, Middletown, DE, United States; Mary Marzo, University of Maryland Children's Hospital, Baltimore, MD, United States; Mary K. O'Brien, University of Maryland Children's Hospital, Washington, DC, United States; Colleen Driscoll, University of Maryland School of Medicine, Baltimore, MD, United States

Background: Maintaining targeted oxygen saturations (tSpO2) is critical to reducing morbidity and mortality in preterm infants. Despite continuous SpO2 monitoring and established protocols, neonatal intensive care units (NICU) face challenges in achieving optimal oxygen balance. A multi-disciplinary team assembled to improve targeted oxygen management in our NICU.

Objective: 1) Increase the median percentage of time preterm infants < 35 wks gestational age remain within their tSpO2 range by 10% within one year. 2) Address unit-based barriers to providing targeted oxygen care.

Design/Methods: Baseline median percentage of time infants remained within their tSpO2 range was 35%. Key barriers identified included limited access to SpO2 histogram data during rounds, variable understanding of the nurse’s role in maintaining tSpO2, and misalignment between SpO2 alarm alert notifications and clinical urgency, contributing to alarm fatigue, and frequent disengagement of high alarm settings. Guided by the PDSA framework, the following interventions were implemented during 2024–2025: A) creation of a dotphrase in electronic health record to facilitate histogram data review during rounds B) reinforcement of bedside SpO2 target cards C) modification of the alarm alert sound, volume and time delay for high SpO2 notifications transmitted to the nurses’ personal communication devices and D) bedside alarm parameters audit with real-time feedback and corrective action, accompanied by nurse education. Time spent within the tSpO2 range was prospectively collected weekly intervals from Jun 2024 and analyzed using run chart interpretation rules. Nurse knowledge surveys were collected pre- & post-education.

Results: Median time within tSpO2 range statistically increased to 38.5% following intervention A but waned after 3 months despite ongoing interventions(Fig). Following intervention D, time spent in tSpO2 range increased to 37%. During this period, the percentage of patients with incorrect SpO2 alarm settings decreased from 46% to 21% and nurses’ knowledge of the correct tSpO2 range increased from 6% to 53%.

Conclusion(s): A structured QI approach, supported by a multidisciplinary team, improved adherence to key process measures, including appropriate alarm setting use and nursing knowledge of tSpO2 management. Ongoing evaluation is needed to assess the impact of modified alarm alert transmission on tSpO2 maintenance, bedside alarm accuracy, and alarm alert frequency to personal communication devices. Future initiatives aim to maintain these improvements and expand tSpO2 histogram use to guide oxygen management.

Compliance to Target O2 saturation
Compliance to Target O2 saturation.pdfFigure