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

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, 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.

Measurement of Physiological Monitor Alarm Accuracy and Clinical Relevance in Intensive Care Units

“…Published interventions implemented in clinical settings have been primarily quality improvement projects, often bundling several components together. [9][10][11][12][13] Although these projects have resulted in a reduction of 43% to 89% of total alarms on the clinical units where they were implemented, [9][10][11][12][13] it was generally not possible to determine which component of the intervention was most effective. Moreover, the projects often lacked statistical evaluation and were not generalizable beyond the setting.…”

“…Moreover, the projects often lacked statistical evaluation and were not generalizable beyond the setting. 9 More rigorous alarm intervention research is clearly needed. 9 One additional method to enhance rigor is measurement of outcomes beyond reduction in the total number of alarms.…”

“…9 More rigorous alarm intervention research is clearly needed. 9 One additional method to enhance rigor is measurement of outcomes beyond reduction in the total number of alarms. Because physiological monitor alarm reduction strategies typically target either inaccurate or clinically irrelevant alarms, 14,15 understanding which is more problematic for a clinical unit would not only lead to more specific intervention selection but would also be a more precise assessment of intervention effectiveness.…”

“…Although intervention studies implemented on clinical units have not used proportions of inaccurate and clinically irrelevant alarms as outcome measures, the proportions of these types of alarms have been assessed in descriptive studies. 9,17 The methods used in descriptive studies to measure alarm accuracy and clinical relevance may inform the design of future research that tests the effectiveness of interventions on clinical units. Therefore, the purposes of this integrative review were to (1) examine the approaches that have been used to measure physiological monitor alarm accuracy and/or clinical relevance in intensive care units (ICUs) and (2) compare proportions of inaccurate and clinically irrelevant alarms reported in the studies.…”

Continuous Postoperative Respiratory Monitoring with Calibrated Respiratory Effort Belts: Pilot Study

“…During postoperative care, respiratory status can be assessed, for example, with capnometry, pulse oximetry, oxygen saturation (SpO2) measurements, blood gas measurements, subjective clinical assessment and intermittent, manual measurements of respiratory rate [5,9]. The problems with current methods are that they have poor accuracy, precision, low patient tolerance and they are liable to false alarms [10,11]. Additionally, they are slow and especially subjective methods are unreliable and give inconsistent results [12].…”