Alarm fatigue levels and associated factors among intensive care unit nurses: A systematic review and meta-analysis

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Objective To estimate the pooled mean alarm fatigue score among intensive care unit nurses and to synthesise evidence on factors associated with alarm fatigue. Methods Eight Chinese and international databases were systematically searched to identify original observational studies of alarm fatigue among ICU nurses published between January 2017 and February 2026. Two reviewers independently screened the records, appraised the methodological quality of the included studies, and extracted the data. A random-effects meta-analysis was conducted using Stata version 14 to pool mean alarm fatigue scores and their 95% confidence intervals. Sensitivity analysis was performed to assess the robustness of the findings, and potential publication bias was evaluated using Begg's and Egger's tests. Results Sixteen studies were included in the systematic review, of which 15 provided data suitable for meta-analysis, comprising 4084 intensive care unit nurses. The meta-analysis revealed a pooled mean alarm fatigue score of 25.93 (95% CI, 24.38–27.48). Subgroup analysis indicated that higher levels of alarm fatigue were observed in female nurses (25.89, 95% CI: 22.72–29.06), those aged ≤25 years (26.80, 95% CI: 23.26–30.34), unmarried individuals(24.56, 95% CI: 22.70–26.43), junior-level nurses (27.42, 95% CI: 23.60–31.24), and those with a master's degree (27.15, 95% CI: 24.32–29.99). Elevated alarm fatigue was also observed among nurses without a critical care specialty (24.09, 95% CI: 22.75–25.44), those engaged in rotating night shifts (24.07, 95% CI, 21.98–26.16), nurses without alarm management training (31.52, 95% CI, 25.97–37.07), and those working in general ICUs (26.80, 95% CI, 22.27–31.34). Conclusion The pooled mean alarm fatigue score among ICU nurses fell within the moderate range. Hospitals and nursing managers should strengthen standardised alarm management procedures and provide alarm management training for all ICU nurses. These measures may help mitigate alarm fatigue, improve the quality of nursing care, and promote patient safety.