Reviews

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

J. Hosp. Med. 2016 February;11(2):136-144
By: Christine Weirich Paine, MPH, Veena V. Goel, MD, Elizabeth Ely, PhD, RN, Christopher D. Stave, MLS, Shannon Stemler, BA, Miriam Zander, BA, Christopher P. Bonafide, MD, MSCE 

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. Journal of Hospital Medicine 2016;11:136–144. © 2015 Society of Hospital Medicine
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