Ten Years Later, Alarm Fatigue Is Still a Safety Concern

Kimberly Albanowski; Kendall J Burdick; Christopher P Bonafide; Ruth Kleinpell; Joseph J Schlesinger

doi:10.4037/aacnacc2023662

Ten Years Later, Alarm Fatigue Is Still a Safety Concern

AACN Adv Crit Care. 2023 Sep 15;34(3):189-197. doi: 10.4037/aacnacc2023662.

Authors

Kimberly Albanowski¹, Kendall J Burdick², Christopher P Bonafide³, Ruth Kleinpell⁴, Joseph J Schlesinger⁵

Affiliations

¹ Kimberly Albanowski is Clinical Research Coordinator II, Section of Hospital Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
² Kendall J. Burdick is Pediatric Resident, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02215 (kendall.burdick@childrens.harvard.edu).
³ Christopher P. Bonafide is Academic Pediatric Hospitalist, Section of Hospital Medicine, Department of Pediatrics, Children's Hospital of Philadelphia; Director of Pediatric Implementation Research, Penn Implementation Science Center at the Leonard Davis Institute for Health Economics (PISCE@LDI); and Associate Professor, University of Pennsylvania, Philadelphia, Pennsylvania.
⁴ Ruth Kleinpell is Associate Dean for Clinical Scholarship, Independence Foundation Chair in Nursing Education, and Professor, Vanderbilt University School of Nursing, Nashville, Tennessee.
⁵ Joseph J. Schlesinger is Associate Professor, Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, and Adjunct Professor of Electrical and Computer Engineering, McGill University, Montreal, Quebec, Canada.

PMID: 37644627
DOI: 10.4037/aacnacc2023662

Abstract

Ten years after the publication of a landmark article in AACN Advanced Critical Care, alarm fatigue continues to be an issue that researchers, clinicians, and organizations aim to remediate. Alarm fatigue contributes to missed alarms and medical errors that result in patient death, increased clinical workload and burnout, and interference with patient recovery. Led by the American Association of Critical-Care Nurses, national patient safety organizations continue to prioritize efforts to battle alarm fatigue and have proposed alarm management strategies to mitigate the effects of alarm fatigue. Similarly, clinical efforts now use simulation studies, individualized alarm thresholds, and interdisciplinary teams to optimize alarm use. Finally, engineering research efforts have innovated the standard alarm to convey information more effectively for medical users. By focusing on patient and provider safety, clinical workflow, and alarm technology, efforts to reduce alarm fatigue over the past 10 years have been grounded in an evidence-based and personnel-focused approach.

Keywords: alarm fatigue; alarm management; alarms; clinical workflow; interdisciplinary.

MeSH terms

Clinical Alarms*
Critical Care
Humans
Medical Errors / prevention & control
Patient Safety
Stress Disorders, Post-Traumatic*