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Abstract
Alarm fatigue is a national problem and the number one medical device technology hazard in 2012. The problem of alarm desensitization is multifaceted and related to a high false alarm rate, poor positive predictive value, lack of alarm standardization, and the number of alarming medical devices in hospitals today. This integrative review synthesizes research and non-research findings published between 1/1/2000 and 10/1/2011 using The Johns Hopkins Nursing Evidence-Based Practice model. Seventy-two articles were included. Research evidence was organized into five main themes: excessive alarms and effects on staff; nurse's response to alarms; alarm sounds and audibility; technology to reduce false alarms; and alarm notification systems. Non-research evidence was divided into two main themes: strategies to reduce alarm desensitization, and alarm priority and notification systems. Evidence-based practice recommendations and gaps in research are summarized.
Background
A cacophony of sound echoes through the modern hospital. Bells, beeps, chimes, and horns are all part of the noise-polluted environment that patients, families, and staffendure. They may be exposed to as many as 700 physiologic monitor alarms per patient per day.1 The myriad of medical device alarms has created an environment that poses significant risk to patient safety. Device alarms are intended to alert clinicians of a hazardous condition and potential problems. However, when a caregiver is subjected to too many alarms, it disrupts his or her usual workflow and may result in errors due to omission, distraction, or inattention.
The ECRI Institute, a nonprofit organization that uses applied scientific research in healthcare to establish best practices for improving patient care, publishes an annual top ten technology hazards list. "Alarm hazards" is the number one health technology hazard for 2012.2 Such hazards include inappropriate alarm modification, alarm fatigue, modifying alarms without restoring them to their original settings, and improperly relaying alarm signals to the appropriate person.3 The problem of excessive alarms resulting in alarm fatigue has been reported in research literature for many years.4-10 Studies have indicated that the presence of false and/or clinically insignificant alarms ranges from 80%-99%.4-6
Medical devices generate enough false alarms to cause a reduction in responding known as the cry wolf effect.11 Frequent alarms are distracting and interfere with clinicians performing critical tasks and may lead to staffdisabling alarm systems. Excessive false positive...