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, CINAHL, 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. While 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.
