Clinical alarm management in intensive care units: A scoping review

Abstract

Background: Clinical alarms are highly prevalent in intensive care units (ICUs), serving to alert health care providers when patients' physiological parameters exceed preset thresholds or when medical devices malfunction. However, clinical alarms also introduce new challenges that threaten patient safety. Therefore, enhancing the management of clinical alarms is of critical importance. ICU nurses are the first responders to clinical alarms, and their ability to manage alarms is closely linked to patient safety. Although many studies have investigated ICU nurse-led strategies for managing clinical alarms, a comprehensive overview of the methods and indicators for alarm management in these settings is still lacking.

Aim: To identify and map management approaches, interventions and evaluation metrics for clinical alarms in ICUs.

Study design: A systematic search was conducted in PubMed, The Cochrane Library, Web of Science, CINAHL, EMBASE, CNKI, SinoMed and Wan Fang Data databases to include studies related to the management of clinical alarms in ICUs.

Results: The included studies (n = 23), guided by various approaches and frameworks, implemented different strategies for managing clinical alarms in ICUs. The primary management measures can be summarized as follows: tailoring alarm parameters, providing education and training on alarm management, standardizing the operation of medical devices, developing and applying assistive tools and technologies and establishing standardized alarm response procedures and protocols. Evaluation metrics addressed three levels: the alarm system, health care professionals and patients.

Conclusions: The management of clinical alarms in ICUs remains an area of ongoing exploration, with a primary focus on the management of monitor alarms. Although some progress has been made, more comprehensive and systematic studies are still needed.

Relevance to clinical practice: This review summarizes and consolidates studies on the management of clinical alarms in ICUs, highlighting the importance of multidisciplinary collaboration and the implementation of intelligent alarm management systems. Future research should focus on strengthening interdepartmental collaboration, conducting more specialized studies based on the differences between various ICU specialties, enhancing ICU nurses' alarm management capabilities and further ensuring patient safety.

Keywords: alarm fatigue; alarm management; clinical alarms; intensive care units; scoping review.