Technologic Distractions (Part 2): A Summary of Approaches to Manage Clinical Alarms With Intent to Reduce Alarm Fatigue

Objective: Alarm fatigue is a widely recognized safety and quality problem where exposure to high rates of clinical alarms results in desensitization leading to dismissal of or slowed response to alarms. Nonactionable alarms are thought to be especially problematic. Despite these concerns, the number of clinical alarm signals has been increasing as an everincreasing number of medical technologies are added to the clinical care environment. Data Sources: PubMed, SCOPUS, Embase, and CINAHL. Study Selection: We performed a systematic review of the literature focused on clinical alarms. We asked a primary key question; "what interventions have been attempted and resulted in the success of reducing alarm fatigue?" and 3-secondary key questions; "what are the negative effects on patients/families; what are the balancing outcomes (unintended consequences of interventions); and what human factor approaches apply to making an effective alarm?" Data Extraction: Articles relevant to the Key Questions were selected through an iterative review process and relevant data was extracted using a standardized tool. Data Synthesis: We found 62 articles that had relevant and usable data for at least one key question. We found that no study used/developed a clear definition of "alarm fatigue." For our primary key question 1, the relevant studies focused on three main areas: quality improvement/bundled activities; intervention comparisons; and analysis of algorithm-based false and total alarm suppression. All sought to reduce the number of total alarms and/or false alarms to improve the positive predictive value. Most studies were successful to varying degrees. None measured alarm fatigue directly. Conclusions: There is no agreed upon valid metric(s) for alarm fatigue, and the current methods are mostly indirect. Assuming that reducing the number of alarms and/or improving positive predictive value can reduce alarm fatigue, there are promising avenues to address patient safety and quality problem. Further investment is warranted not only in interventions that may reduce alarm fatigue but also in defining how to best measure it. This study was performed at the Johns Hopkins School of Medicine Evidence-Based Practice Center Supported by the Moore Foundation through a grant to the Society for Critical Care Medicine. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/29S62lw). Dr. Winters' institution received funding and support from the Moore Foundation (through a Society of Critical Care Medicine [SCCM] Task Force) and he received funding from various legal firms for medico-legal consulting. Dr. Bonafide's institution received funding from the National Heart, Lung, and Blood Institute (NHLBI)/National Institutes of Health (NIH) Career Development Award research grant focused on alarms. Dr. Konkani's institution received funding from the NHLBI, and he received support for article research from the NIH. Dr. O'Connor received support from the Moore Foundation (through SCCM), and disclosed off-label product use of alarms and alerts, which are used often through unapproved uses. Ms. McLean received funding from Edwards Lifesciences, and received other support from AACN. Dr. Kane-Gill's institution received funding from a grant by the Gordon and Betty Moore Foundation provided to SCCM. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: bwinters@jhmi.edu Copyright © by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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