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

CONTEXT In pediatric inpatient settings, excess alarms from physiologic monitors lead to alarm fatigue, which can jeopardize patient safety. OBJECTIVE To systematically review interventions to reduce alarms from pulse oximeters and cardiorespiratory monitors in neonatal intensive care units (NICUs), pediatric intensive care units (PICUs), and medical/surgical units (MSUs). DATA SOURCES PubMed, Embase, CINAHL, and citations of selected articles were searched from January 2010 to August 2025. STUDY SELECTION Two reviewers independently screened studies. Included studies were conducted in the NICU, PICU, or MSU; implemented at least 1 intervention intended to reduce alarms; and reported alarm frequency from pulse oximeters and/or cardiorespiratory monitors. DATA EXTRACTION At least 2 reviewers independently appraised study quality and extracted data, including setting, design, population, interventions, alarm type, alarm frequency, and balancing measures. RESULTS Twenty-three studies were included: 12 NICU, 2 PICU, 8 MSU, and 1 that was both PICU and MSU. There were 16 quality improvement (QI) studies, 5 nonrandomized studies, and 2 randomized controlled trials. Common interventions included educating staff, widening alarm parameters for all patients, customizing alarm parameters for specific ages or conditions, lengthening alarm time delays, and standardizing communication about patients’ monitoring plans. Because of significant heterogeneity among studies, the impacts of individual interventions could not be compared. LIMITATIONS Balancing measures were inconsistently reported. There is a lack of standardized methodology for systematically reviewing QI studies. CONCLUSIONS Most studies reported decreased alarm frequency. All studies measuring nonactionable alarms reported decreases. This systematic review can inform local improvement work to decrease excess alarms from physiologic monitors.