title: 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.
  
  
  OBJECTIVE
  To critically examine the available literature relevant to alarm fatigue.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  We extracted data on setting, collection methods, proportion of alarms determined to be actionable, nurse response time, and associations between interventions and alarm rates.
  
  
  RESULTS
  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.
authors.affiliation: Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.|PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Christine Weirich
authors.initials: CW
authors.lastname: Paine
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, California.|Division of Systems Medicine, Stanford University School of Medicine, Stanford, California.|Department of Clinical Informatics, Stanford Children's Health, Stanford, California.|Division of Pediatric Hospital Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, California.
authors.forename: Veena V
authors.initials: VV
authors.lastname: Goel
authors.affiliation: Center for Pediatric Nursing Research and Evidence-Based Practice, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ely
authors.affiliation: Lane Medical Library, Stanford University School of Medicine, Stanford, California.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Stave
authors.affiliation: Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Shannon
authors.initials: S
authors.lastname: Stemler
authors.affiliation: Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Miriam
authors.initials: M
authors.lastname: Zander
authors.affiliation: Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.|Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.|Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.|Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Bonafide
mesh_terms: D056902:Clinical Alarms / Q000009:adverse effects / Q000706:statistics & numerical data; D004562:Electrocardiography / Q000379:methods; D006761:Hospitals; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*; D009741:Nursing Staff, Hospital; D061214:Patient Safety; D013997:Time Factors