Impact of Alarm Fatigue on the Work of Nurses in an Intensive Care Environment—A Systematic Review
1.1. New Technologies—New Challenges for the Nursing Staff
1.2. Nursing Staff Overload—Causes and Effects
2.1. Research Protocol and Guidelines
2.2. Search Strategy
2.3. Study Selection
- articles in English,
- research group consisting only of medical personnel,
- research carried out among nurses working at adult intensive therapy units, to assess alarm fatigue among personnel,
- studies with adult patients, and
- studies describing acute and chronic fatigue.
- articles in a language other than English or Polish,
- research where a study group consisted of members other than medical personnel,
- moreover, articles were eliminated that focused on the perception of alarms generated by a single device (e.g., injection pumps or a pulse oximeter), and
- studies concerning pediatric intensive therapy units.
2.4. Study Quality Assessment
2.5. Data Extraction
2.6. Data Analysis
3.1. Burdensome and False Alarms
3.2. Alarm Fatigue
3.3. Alarm Management
3.4. Risk of Bias
4.1. Theoretical Implications
4.2. Practical Implications
- Alarms are unavoidable in intensive care units. The dynamic development of technology makes their number grow drastically, and this will undoubtedly increase in the future as well. Therefore, it is necessary to introduce effective strategies of alarm management as soon as possible.
- Nursing personnel feel overburdened with an excessive amount of duties and a continuous wave of clinical alarms.
- Nurses often do not perceive the need for education regarding alarms, which is an important element of any alarm management strategy.
- In the future, it is worth focusing on assessing the level of alarm fatigue. This would help provide safety both to patients and nursing personnel and verify the effectiveness of strategies that are introduced.
Conflicts of Interest
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|Author and Year of Publication||Country of Study||Ward of Study||Study Group||Type of Research||Method of Assessing Alarm Fatigue||Conclusions|
|Christensen et al. (2014) ||Australia||ICU/CCU/HDU||48 nurses||Descriptive, survey design||Proprietary questionnaire:|
8 open-ended questions
2 multiple choice questions
|Sowan et al. (2015) ||United States of America||TCICU||39 nurses||A cross-sectional survey |
|Clinical study of alarms |
(20 statements + 9 ranking positions)
|Cho et al. (2016) ||South Korea||ICU||77 nurses||A cross-sectional survey||Clinical study of alarms HTF |
(14 statements + 9 ranking positions)
|Petersen et al. (2017) ||United States of America||ICU|
|26 nurses||A cross-sectional survey||Clinical study of alarms HTF |
(20 statements + 9 ranking positions)
|Casey et al. (2018) ||Ireland||ICU|
|166 nurses||A cross-sectional survey||Clinical study of alarms HTF |
(19 statements + 9 ranking positions)
|Ruppel at al. (2019) ||United States of America||ICU||27 nurses||Quality study||Semi-structured interviews|
|Poncette et al. (2019) ||Germany||ICU||6 nurses||Qualitative Study||Semi-structured interviews|
|Ranking Statements on Issues That Inhibit Effective Management of Clinical Alarms:||Sowan et al. (2015) ||Cho et al. (2016) ||Petersen et al. (2017) ||Casey et al. (2018) ||Weighted Average|
|Frequent false alarms, which lead to reduced attention or response to alarms when they occur||Average||4.15||2.75||3.83||2.43||2.84|
|Difficulty in understanding the priority of an alarm||Average||3.06||3.53||3.48||3.69||3.55|
|Inadequate staff to respond to alarms as they occur||Average||4.23||4.86||3.13||2.66||3.45|
|Difficulty in hearing alarms when they occur||Average||3.93||4.94||4.83||3.8||4.18|
|Difficulty in identifying the source of an alarm||Average||2.94||5.22||3.65||3.81||4.04|
|Over reliance on alarms to call attention to patient problems||Average||4.77||5.35||4.87||3.4||4.18|
|Noise competition from non-clinical alarms and pages||Average||4.45||5.74||6.04||4.1||4.73|
|Lack of training on alarm systems||Average||6.6||6.21||4.83||3.86||4.87|
|Difficulty in setting alarms properly||Average||4.44||6.39||4.25||4.14||5.02|
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Lewandowska, K.; Weisbrot, M.; Cieloszyk, A.; Mędrzycka-Dąbrowska, W.; Krupa, S.; Ozga, D. Impact of Alarm Fatigue on the Work of Nurses in an Intensive Care Environment—A Systematic Review. Int. J. Environ. Res. Public Health 2020, 17, 8409. https://doi.org/10.3390/ijerph17228409
Lewandowska K, Weisbrot M, Cieloszyk A, Mędrzycka-Dąbrowska W, Krupa S, Ozga D. Impact of Alarm Fatigue on the Work of Nurses in an Intensive Care Environment—A Systematic Review. International Journal of Environmental Research and Public Health. 2020; 17(22):8409. https://doi.org/10.3390/ijerph17228409Chicago/Turabian Style
Lewandowska, Katarzyna, Magdalena Weisbrot, Aleksandra Cieloszyk, Wioletta Mędrzycka-Dąbrowska, Sabina Krupa, and Dorota Ozga. 2020. "Impact of Alarm Fatigue on the Work of Nurses in an Intensive Care Environment—A Systematic Review" International Journal of Environmental Research and Public Health 17, no. 22: 8409. https://doi.org/10.3390/ijerph17228409