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Interventions to Reduce Monitor Alarms Across Pediatric Inpatient Settings: A Systematic Review

Kathleen J Berg1, Kori Hess1, Megan Gripka1

  • 1Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.

Hospital Pediatrics
|July 13, 2026
PubMed

Insights

Excessive physiologic monitor alarms in hospitals cause alarm fatigue. This review found most interventions successfully reduced alarm frequency, especially nonactionable alarms, improving patient safety.

Area of Science:

  • Pediatric Patient Safety
  • Clinical Alarm Management
  • Health Informatics

Background:

  • Physiologic monitor alarms in pediatric inpatient settings contribute to alarm fatigue, posing risks to patient safety.
  • Alarm fatigue is a significant concern in neonatal intensive care units (NICUs), pediatric intensive care units (PICUs), and medical/surgical units (MSUs).

Purpose of the Study:

  • To systematically review interventions aimed at reducing alarms from pulse oximeters and cardiorespiratory monitors.
  • The review focused on studies conducted in NICUs, PICUs, and MSUs.

Main Methods:

  • Searched major databases (PubMed, Embase, CINAHL) and article citations from January 2010 to August 2025.
  • Included studies that implemented interventions to reduce alarms and reported alarm frequency, with independent screening and data extraction by two reviewers.
  • Appraised study quality and extracted data on setting, design, population, interventions, alarm type, frequency, and balancing measures.

Main Results:

  • Twenty-three studies were included (12 NICU, 2 PICU, 8 MSU, 1 combined PICU/MSU), comprising 16 quality improvement (QI) studies, 5 nonrandomized, and 2 RCTs.
  • Common interventions involved staff education, wider or customized alarm parameters, delayed alarm time delays, and standardized communication.
  • Most studies reported decreased alarm frequency, with all studies measuring nonactionable alarms showing reductions.

Conclusions:

  • While most interventions reduced alarm frequency, significant heterogeneity prevented direct comparison of individual intervention impacts.
  • Inconsistent reporting of balancing measures and a lack of standardized methodology for reviewing QI studies were noted limitations.
  • The findings can guide local efforts to decrease excess physiologic monitor alarms and mitigate alarm fatigue.
Abstract

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