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

Journal of Hospital Medicine - Tập 11 Số 2 - Trang 136-144 - 2016
Christine Weirich Paine1,2, Veena Goel3,4,5,6, Elizabeth Ely7, Christopher D Stave8, Shannon Stemler1, Miriam Zander1, Christopher P. Bonafide9,10,11,1
1Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
2PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
3Department of Clinical Informatics Stanford Children's Health Stanford California
4Department of Pediatrics, Stanford University School of Medicine, Stanford, California
5Division of Pediatric Hospital Medicine Lucile Packard Children's Hospital Stanford Palo Alto California
6Division of Systems Medicine Stanford University School of Medicine Stanford California
7Center for Pediatric Nursing Research and Evidence‐Based Practice The Children's Hospital of Philadelphia Philadelphia Pennsylvania
8Lane Medical Library, Stanford University School of Medicine, Stanford, California
9Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
10Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
11Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania

Tóm tắt

BACKGROUNDAlarm fatigue from frequent nonactionable physiologic monitor alarms is frequently named as a threat to patient safety.PURPOSETo critically examine the available literature relevant to alarm fatigue.DATA SOURCESArticles 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 SELECTIONArticles 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 EXTRACTIONWe extracted data on setting, collection methods, proportion of alarms determined to be actionable, nurse response time, and associations between interventions and alarm rates.DATA SYNTHESISOur 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.CONCLUSIONSPhysiologic 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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Journal of Hospital Medicine

Tập 11 Số 2

136-144

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