Systematic Review of Physiologic Monitor Alarm Characteristics and Pragmatic Interventions to Reduce Alarm Frequency

Overview

Journal J Hosp Med

Publisher Wiley

Specialties General Medicine
Health Services

Date 2015 Dec 15

PMID 26663904

Citations 48

Authors

Christine Weirich Paine

Veena V Goel

Elizabeth Ely

Christopher D Stave

Shannon Stemler

Miriam Zander

Christopher P Bonafide

Affiliations

Soon will be listed here.

Abstract

Background: Alarm fatigue from frequent nonactionable physiologic monitor alarms is frequently named as a threat to patient safety.

Purpose: To critically examine the available literature relevant to alarm fatigue.

Data Sources: Articles published in English, Spanish, or French between January 1980 and April 2015 indexed in PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Cochrane Library, Google Scholar, and ClinicalTrials.gov.

Study Selection: Articles focused on hospital physiologic monitor alarms addressing any of the following: (1) the proportion of alarms that are actionable, (2) the relationship between alarm exposure and nurse response time, and (3) the effectiveness of interventions in reducing alarm frequency.

Data Extraction: We extracted data on setting, collection methods, proportion of alarms determined to be actionable, nurse response time, and associations between interventions and alarm rates.

Data Synthesis: Our search produced 24 observational studies focused on alarm characteristics and response time and 8 studies evaluating interventions. Actionable alarm proportion ranged from <1% to 36% across a range of hospital settings. Two studies showed relationships between high alarm exposure and longer nurse response time. Most intervention studies included multiple components implemented simultaneously. Although studies varied widely, and many had high risk of bias, promising but still unproven interventions include widening alarm parameters, instituting alarm delays, and using disposable electrocardiographic wires or frequently changed electrocardiographic electrodes.

Conclusions: Physiologic monitor alarms are commonly nonactionable, and evidence supporting the concept of alarm fatigue is emerging. Several interventions have the potential to reduce alarms safely, but more rigorously designed studies with attention to possible unintended consequences are needed.

Citing Articles

A descriptive investigation of alarm activation in a critical care setting.

Nguyen V, MacDonald B, Cignarella A, Miller C Nurs Crit Care. 2025; 30(2):e13302.

PMID: 39995316 PMC: 11851092. DOI: 10.1111/nicc.13302.

A systems engineering approach to alarm management on pediatric medical-surgical units.

Ruppel H, Luo B, Rasooly I, McNamara M, McLoone M, Kern-Goldberger A J Hosp Med. 2024; 20(1):98-103.

PMID: 39417242 PMC: 11698627. DOI: 10.1002/jhm.13507.

Alarm Management in Intensive Care: Qualitative Triangulation Study.

Mosch L, Sumer M, Flint A, Feufel M, Balzer F, Morike F JMIR Hum Factors. 2024; 11:e55571.

PMID: 38888941 PMC: 11220431. DOI: 10.2196/55571.

The effect of intelligent management interventions in intensive care units to reduce false alarms: An integrative review.

Li B, Yue L, Nie H, Cao Z, Chai X, Peng B Int J Nurs Sci. 2024; 11(1):133-142.

PMID: 38352290 PMC: 10859571. DOI: 10.1016/j.ijnss.2023.12.008.

A new algorithm for an old problem: Reducing false alarms and alarm fatigue for ventricular tachycardia detection in the hospital setting.

Harvey M Heart Rhythm O2. 2023; 4(11):723-724.

PMID: 38034888 PMC: 10685155. DOI: 10.1016/j.hroo.2023.10.003.

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