Alarm Fatigue and Alarm Management in Nursing: A Literature Review
This literature review examines alarm fatigue and alarm management in nursing, drawing on eight peer-reviewed studies published from 2016 onward. The paper explores what alarm fatigue is, why it occurs, and how it threatens patient safety when nurses become desensitized to a constant stream of alarms—many of which are non-actionable. It evaluates proposed interventions such as customized alarm thresholds, artifact discrimination, machine learning, and structured nurse training. The central PICO question asks whether alarm management (differentiating the priority of alarms) reduces alarm fatigue among nurses in inpatient general hospital settings. The review concludes that while alarm fatigue is a well-documented problem, no evidence-based protocol has yet been validated, and further research into effective alarm management strategies is urgently needed.
- Introduction: Defines alarm fatigue and frames research gap
- Review of Literature: Synthesizes eight studies on alarm fatigue causes and impacts
- PICO Question and Methodology: States clinical question and describes search strategy
- Evaluation and Recommendations: Identifies sticking points and proposes alarm management interventions
- Conclusion: Calls for evidence-based alarm management research
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What makes this paper effective
- The paper synthesizes eight peer-reviewed sources into a coherent narrative, clearly distinguishing between studies that describe the problem (alarm fatigue) and those that explore potential solutions (alarm management).
- The use of a formal PICO question gives the literature review a clinical research framework, anchoring the analysis to a specific, answerable question about nursing practice.
- The evaluation section moves beyond description to apply critical reasoning, identifying three concrete sticking points (unfamiliarity with machines, alarm overload, and excessive computer interaction) before proposing a direction for intervention.
Key academic technique demonstrated
This paper demonstrates systematic source integration: rather than summarizing each study in isolation, the author weaves findings together thematically, using one study's conclusions to introduce or complicate the next. For example, Hravnak et al.'s identification of non-actionable alarms is connected directly to Lewandowska et al.'s finding that nurses feel demoralized by equipment demands, creating a cumulative argument rather than a list of summaries.
Structure breakdown
The paper opens with a conceptual introduction defining alarm fatigue and framing the research gap. The literature review follows, organized by theme rather than by source. A dedicated PICO and methodology section explains search strategy and inclusion/exclusion criteria. The evaluation section applies critical analysis to the reviewed evidence, and a brief conclusion identifies directions for future research. This five-part structure is appropriate for a graduate-level nursing literature review.
Introduction
Alarm fatigue is an expression that consists of two terms with very different meanings. Alarm conveys surprise, alertness, and the need to respond immediately. Fatigue conveys the opposite — weariness, lack of responsiveness, and an inability to act due to tiredness. When combined, "alarm fatigue" describes a troubling phenomenon, particularly when it occurs among nurses: nurses are trained to respond to alarms and provide care to patients when an alarm sounds; however, because so many different alarms now go off constantly throughout a unit, nurses can become indifferent or unresponsive to them, which can put patients at risk.
Because alarm fatigue is a relatively new problem in nursing research, it is still unclear how it affects nurses (Lewandowska et al., 2020). While ample literature has been published on the issue, the extent to which it represents an actual problem for nurses — and, if it does, what can be done about it — are questions that have yet to be substantially answered (Hravnak et al., 2018). As researchers have shown, it is also unclear how precisely to manage alarms so as to prevent fatigue (Cho, Kim, Lee, & Cho, 2016). This study addresses the gap in the literature by focusing specifically on whether alarms can be managed to reduce alarm fatigue. It is an important question because patient safety is the ultimate issue at stake: if alarm fatigue is not prevented, patient safety can suffer as a result.
Review of Literature
The literature on alarm fatigue and alarm management shows that alarm fatigue is a problem for nurses and for patient safety, and that alarm management may have potential to address the situation, though significant questions remain (Baker & Rodger, 2020; Cho et al., 2016; Hravnak et al., 2018; Lewandowska et al., 2020). The key to understanding this issue is to first understand alarm fatigue — what it is and how and why it occurs — before examining the possible solution of alarm management to see what researchers have found.
Alarm fatigue is said to be caused by sensory overload: nurses are often surrounded by various alarms that go off throughout their shift. Because so many similar alarms sound continuously, nurses can become tired of or fatigued by them, such that they no longer respond with the same vigor and assertiveness required for patient safety (Baker & Rodger, 2020). Baker and Rodger (2020) examine the ins and outs of alarm fatigue through a qualitative literature review. They show that one common cause of alarm fatigue is that nurses do not know whose responsibility it is to respond to certain alarms; they have difficulty differentiating one sound from another or recognizing whose role it is to act (Baker & Rodger, 2020). Another issue is that a busy nurse may simply assume that a nearby colleague will respond to an alarm — revealing a broader lack of communication, shared understanding, and protocol at nursing workstations (Baker & Rodger, 2020).
That is one reason Cho et al. (2016) found that alarm management can be prone to failure. Human error remains an issue regardless of what system is in place. The analogy to computer security is apt: firewalls may be in place, yet systems can still be compromised because of errors on the part of end users. In alarm management it is no different — nurses are still human and must be thoroughly trained to understand their roles, the different alarm types, and when and how to respond. That training takes time and is layered on top of already extensive onboarding requirements for new nurses (Cho et al., 2016). Additionally, new monitoring technology can disrupt carefully cultivated response protocols, requiring further adjustment.
Hravnak et al. (2018) point out that the majority of bedside alarms are non-actionable, meaning no immediate response is required. This is a primary driver of alarm fatigue: nurses experience sensory overload from a constant stream of alarms throughout their shift that serve no real purpose. The danger arises when an actual emergency occurs and nurses fail to respond because they assume it is yet another non-actionable alarm (Hravnak et al., 2018). Their qualitative literature review identifies the different causes of alarm fatigue, explains why they are complex, and examines proposed solutions. They acknowledge that reducing non-actionable alarms is the most important goal, as this is the primary source of the problem. Some researchers have suggested customizing alarm baselines so that minor deviations from normal states do not trigger an alert; however, other researchers indicate this approach does not significantly improve outcomes. One potential solution noted by Hravnak et al. (2018) is artifact discrimination using machine learning; another is the development of smart alarms. However, all of these options involve technology upgrades that carry significant costs.
Lewandowska et al. (2020) demonstrate in their systematic review that nurses feel overwhelmed by a constant wave of alarms and believe this is what undermines their performance. Importantly, this finding suggests that alarms — rather than assisting nurses — actually interfere with their work, raising the question of whether current alarm configurations are truly necessary (Lewandowska et al., 2020). The most significant observation in their review is that monitoring and operating modern equipment consumes so much of nurses' time that nurses feel it would be better spent on direct patient care. Nurses report feeling discouraged and demoralized by the need to interact constantly with advanced computer systems and to attend to the alarms those systems generate. Many nurses believe much of this equipment was introduced not because of clinical necessity, but because facility managers were pressured by vendors. In other words, nurses have a strong distaste for modern monitoring equipment that they believe impedes their ability to actually nurse — and this contributes to alarm-ignoring behavior.
Oliveira, Machado, Santos, and Almeida (2018) conducted a quantitative observational study over seven hours, monitoring 20 different patient beds. Of 103 alarms activated during that period, two-thirds were associated with alarm fatigue. The multi-parameter monitor was the device that most frequently generated alarms. The researchers concluded that relevant alarms may be ignored, thereby compromising patient safety. Their study does not prescribe a solution to alarm fatigue, but it underscores the need for one.
Torabizadeh, Yousefinya, Zand, Rakhshan, and Fararooei (2017) arrive at a similar conclusion regarding alarm fatigue's impact on nursing performance. Their particular contribution, however, was the development of a validated psychometric questionnaire that can measure how alarm fatigue affects nurses. Their study produced strong results for both validity and reliability, offering researchers a standardized tool for assessing alarm fatigue rather than developing new metrics from scratch.
Sowan et al. (2017) addressed the issue of nurse preparedness through a descriptive study involving a survey of 30 nurses across four ICUs. The nurses reported a lack of confidence in the monitoring machines, and nearly half did not understand the majority of the machines' functions. The researchers concluded that nurses require more comprehensive training on these devices. The hypothesis is that a better understanding of how machines work and what different alarms indicate would improve response accuracy. However, as Sowan et al. (2017) acknowledge, training is time-consuming and costly, and healthcare facilities are already under pressure to reduce expenditures — making broad implementation unlikely.
Van Pelt and Weinger (2017) reported on a professional conference addressing distractions among healthcare workers. A major finding was that alarm fatigue is a serious problem partly because nurses find it difficult to distinguish false alarms from true ones. Alarm thresholds and volumes can also be altered by nurses themselves, which can further affect responsiveness. Because no standardized, evidence-based protocol has been implemented to address alarm fatigue, the problem persists. Their report reinforces the core challenge identified across all reviewed studies: determining how to effectively address alarm fatigue remains an open question.
Conclusion
Alarm fatigue is a major problem among nurses, and it is receiving increasing attention from researchers. Studies have demonstrated that it does impact patient safety; however, no clear, evidence-based solution has yet been established. More research should be conducted on how alarm management can be implemented to prevent alarm fatigue. Alarm management approaches have varied across studies, but one promising option is to differentiate the priority of alarms. This may require refining current machine learning systems so that monitoring equipment is better able to distinguish minor, inconsequential fluctuations from those that require staff attention.
Every aspect of this problem warrants more detailed study, because the solution may not be limited to training nurses or differentiating alarm sounds alone. Alarm fatigue is a multifaceted issue involving technology, institutional culture, training, and communication protocols. Nurses do need better training regarding their roles when an alarm sounds — for example, when one nurse is occupied and another is nearby, both nurses need to understand what to do. Nursing protocols need to be standardized, but standardization cannot be achieved until evidence-based practices have been validated through rigorous research and real-world application.
References
Baker, K., & Rodger, J. (2020). Assessing causes of alarm fatigue in long-term acute care and its impact on identifying clinical changes in patient conditions. Informatics in Medicine Unlocked, 18, 100300.
Cho, O. M., Kim, H., Lee, Y. W., & Cho, I. (2016). Clinical alarms in intensive care units: Perceived obstacles of alarm management and alarm fatigue in nurses. Healthcare Informatics Research, 22(1), 46–53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756058/
Hravnak, M., Pellathy, T., Chen, L., Dubrawski, A., Wertz, A., Clermont, G., & Pinsky, M. R. (2018). A call to alarms: Current state and future directions in the battle against alarm fatigue. Journal of Electrocardiology, 51(6), S44–S48. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6263784/
Lewandowska, K., Weisbrot, M., Cieloszyk, A., Medrzycka-Dabrowska, W., Krupa, S., & Ozga, D. (2020). Impact of alarm fatigue on the work of nurses in an intensive care environment — A systematic review. International Journal of Environmental Research and Public Health, 17, 8409. https://search.proquest.com/openview/23f7f6945718250d9afb6d5db5564120/1?pq-origsite=gscholar&cbl=54923
Oliveira, A. E. C. D., Machado, A. B., Santos, E. D. D., & Almeida, É. B. D. (2018). Alarm fatigue and the implications for patient safety. Revista Brasileira de Enfermagem, 71(6), 3035–3040. https://www.scielo.br/scielo.php?pid=S0034-71672018000603035&script=sci_arttext
Sowan, A. K., Vera, A. G., Fonseca, E. I., Reed, C. C., Tarriela, A. F., & Berndt, A. E. (2017). Nurse competence on physiologic monitors use: Toward eliminating alarm fatigue in intensive care units. The Open Medical Informatics Journal, 11, 1–11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5420192/
Torabizadeh, C., Yousefinya, A., Zand, F., Rakhshan, M., & Fararooei, M. (2017). Nurses' alarm fatigue questionnaire: Development and psychometric properties. Journal of Clinical Monitoring and Computing, 31(6), 1305–1312.
Van Pelt, M., & Weinger, M. B. (2017). Distractions in the anesthesia work environment: Impact on patient safety? Report of a meeting sponsored by the Anesthesia Patient Safety Foundation. Anesthesia & Analgesia, 125(1), 347–350. https://journals.lww.com/anesthesia-analgesia/FullText/2017/07000/Distractions_in_the_Anesthesia_Work_Environment_.54.aspx
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