Alarm fatigue mitigation through nurse empowerment: a pre-post intervention study in two intensive care units

Abstract

Background: Alarm fatigue in intensive care units (ICUs) is a pressing issue that jeopardizes patient safety and staff well-being. In Israel, although hospitals are permitted to determine who sets alarm thresholds, most have historically assigned this authority exclusively to physicians. This stems from the absence of national policy and institutional reluctance, driven by risk management and physician resistance to transfer clinical responsibilities to nurses, limiting timely responses to patient needs.

Methods: This was a prospective pre-post intervention study using multiple data sources, including structured observations and staff surveys, conducted in pediatric and adult general ICUs at Assuta Ashdod University Hospital. The intervention involved transferring alarm threshold-setting authority for bedside monitor alarms from physicians to nursing staff, supported by a comprehensive training program. Evaluation included structured observations of alarm events (435 pre- and 288 post-intervention), staff surveys (n = 33 pre, n = 24 post), and feedback on the implementation process.

Results: The primary outcome, alarm response rate-defined as the proportion of monitor alarms that elicited any observable staff reaction-increased slightly in the pediatric ICU, from 65 to 69%, and remained unchanged (50%) in the adult ICU. Notably, 90% of nurses in the pediatric ICU and 75% in the adult ICU reported increased confidence in setting alarm thresholds independently. Additionally, nursing staff expressed greater awareness of alarm fatigue and improved trust in alarm systems.

Conclusions: Empowering nursing staff by delegating alarm threshold authority resulted in enhanced alarm management and increased self-efficacy among nurses, though outcomes varied between units. These findings highlight the need for national guidelines to support this delegation while considering the unique characteristics of each ICU.

Trial registration: Not applicable.

Keywords: Alarm fatigue; Authority delegation; Intensive care unit; Nurse empowerment; Nursing staff; Patient safety.

Fig. 1

Observation results-staff response by unit and intervantion period. Bedside entry – the staff member physically entered the patient’s room in response to the alarm. Remote Intervention – Action was taken from the nurse’s station or control panel without entering the room. Visual Orientation – The staff responded by visually checking the monitor or patient from outside the room. No Response – No observable reaction occurred within the observation window. Note: Percentages reflect the distribution of first observed staff responses to monitor-based alarms during structured observation sessions. “Pre Intervention” = baseline period (July–September 2022); “Post Intervention” = follow-up period (March 2024). p-values (left axis) are based on Chi-squared tests comparing pre- and post-intervention response type distributions within each ICU unit