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J Hosp Med. 2016 Feb;11(2):136-44. doi: 10.1002/jhm.2520. Epub 2015 Dec 14.

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

Author information

1
Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
2
PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
3
Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
4
Division of Systems Medicine, Stanford University School of Medicine, Stanford, California.
5
Department of Clinical Informatics, Stanford Children's Health, Stanford, California.
6
Division of Pediatric Hospital Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, California.
7
Center for Pediatric Nursing Research and Evidence-Based Practice, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
8
Lane Medical Library, Stanford University School of Medicine, Stanford, California.
9
Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
10
Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
11
Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

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.

Comment in

PMID:
26663904
PMCID:
PMC4778561
DOI:
10.1002/jhm.2520
[Indexed for MEDLINE]
Free PMC Article
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