• Halley Ruppel, Marjorie Funk, and Robin Whittemore.
• Halley Ruppel is a doctoral candidate, Marjorie Funk is the Helen Porter Jayne and Martha Prosser Jayne professor of nursing, and Robin Whittemore is a professor at Yale School of Nursing, West Haven, Connecticut. halley.ruppel@yale.edu.
• Am. J. Crit. Care. 2018 Jan 1; 27 (1): 11-21.

BackgroundAlarm fatigue threatens patient safety by delaying or reducing clinician response to alarms, which can lead to missed critical events. Interventions to reduce alarms without jeopardizing patient safety target either inaccurate or clinically irrelevant alarms, so assessment of alarm accuracy and clinical relevance may enhance the rigor of alarm intervention studies done in clinical units.ObjectivesTo (1) examine approaches used to measure accuracy and/or clinical relevance of physiological monitor alarms in intensive care units and (2) compare the proportions of inaccurate and clinically irrelevant alarms.MethodsAn integrative review was used to systematically search the literature and synthesize resulting articles.ResultsTwelve studies explicitly measuring alarm accuracy and/or clinical relevance on a clinical unit were identified. In the most rigorous studies, alarms were annotated retrospectively by obtaining alarm data and parameter waveforms rather than being annotated in real time. More than half of arrhythmia alarms in recent studies were inaccurate. However, contextual data were needed to determine alarms' clinical relevance. Proportions of clinically irrelevant alarms were high, but definitions of clinically irrelevant alarms often included inaccurate alarms.ConclusionsFuture studies testing interventions on clinical units should include alarm accuracy and/or clinical relevance as outcome measures. Arrhythmia alarm accuracy should improve with advances in technology. Clinical interventions should focus on reducing clinically irrelevant alarms, with careful consideration of how clinical relevance is defined and measured.©2018 American Association of Critical-Care Nurses.

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