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Crying wolf, alarm safety and management in paediatrics: A scoping review
Roni Cole1,2, Geraldine Roderick3,4, Osayed Cheema5
1Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia.
Insights
This review highlights the overwhelming number of clinical alarms and varied definitions, emphasizing the need for better alarm management. Empowering clinicians with education and setting appropriate alarm limits can improve patient safety.
Area of Science:
- Neonatal and Paediatric Patient Safety
- Clinical Alarm Systems Management
Background:
- Clinical alarm burden is a significant issue in neonatal and paediatric care.
- Existing literature shows heterogeneity in alarm definitions and management strategies.
Purpose of the Study:
- To provide an overview of studies on alarm-related patient safety in neonatal and paediatric populations.
- To identify factors contributing to alarm burden and review alarm management initiatives.
Main Methods:
- A scoping review was conducted using a systematic search of multiple databases (PubMed, Embase, CINAHL, Scopus, EBSCOhost) from 2013 to 2023.
- Included studies were observational, qualitative, or interventional, focusing on monitoring and alarm practices or interventions.
- Study quality was assessed using the mixed methods appraisal tool.
Main Results:
- 37 studies of acceptable quality were identified, with 95% focusing on physiological monitoring alarms.
- Alarm definitions were reported in 46% of studies, and only 19% detailed clinician response to alarms.
- Interventions for alarm management were categorized into six domains, including parameter adjustment, education, and technology.
Conclusions:
- Clinical settings face a substantial alarm burden with diverse definitions.
- Effective alarm management requires standardized definitions, appropriate limit setting, and clinician education.
- Optimizing alarm systems is crucial for enhancing patient safety in neonatal and paediatric care.
Aim:
To provide a contemporaneous evidentiary overview of neonatal and paediatric studies investigating alarm-related patient safety and alarm system management. Furthermore, to describe how clinical alarm burden is captured and reported, to identify clinical devices that contribute to alarm burden, to explore alarm-related and patient safety measures and terminologies and to review alarm management initiatives.
Design:
Scoping review.
Data Sources:
A systematic search of PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus and EBSCOhost was conducted from 2013 to 2023 using predetermined search terms, index terms, medical subject headings and truncation.
Methods:
Observational and qualitative studies with neonatal and paediatric populations reporting monitoring and alarm practices; and interventional studies reporting the success of alarm safety interventions were included. The quality of the included studies was assessed using the mixed methods appraisal tool.
Results:
The search yielded 37 studies of acceptable quality. The majority explored alarm burden associated with physiological monitoring (n = 35; 95%). Alarm definitions were reported in 46% (n = 17) of studies, and commonly included what constituted actionable and non-actionable alarms. While 32% (n = 12) of studies considered alarms in relation to clinical outcomes surrounding patient safety, clinician response to alarms was only reported in 19% (n = 7) of studies. Alarm and monitoring interventions were assessed in 51% (n = 19) of included studies, with categorization into six domains: changing alarm parameters, clinician education, communication and planning, technology, alarm ordering and standardization or guidelines.
Conclusion:
This review has demonstrated the enormity of alarms in clinical settings, heterogeneity of alarm definitions and outlined interventions associated with alarm burden and patient safety.
Implication For The Profession/Patient Care:
Strategies to ensure appropriate alarm limits are set and clinicians are empowered through education to recognize and respond appropriately to alarms can maximize patient safety.
Reporting Method:
This review adheres to the preferred reporting items for systematic reviews and meta-analysis protocols extension for scoping reviews.
Patient Or Public Contribution:
No patient or public contribution.
