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

Creator(s)

• Kathleen J. Berg, Children's Mercy Kansas City
• Kori Hess, Children's Mercy HospitalFollow
• Megan Gripka, Children's Mercy HospitalFollow
• Andrea Melanson, Children's Mercy Kansas CityFollow
• Kelli Ott, Children's Mercy Kansas CityFollow
• Todd A. Glenski, Children's Mercy HospitalFollow
• Jarrod Dusin, Children's Mercy HospitalFollow
• Nicholas Clark, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

9-1-2026

Identifier

DOI: 10.1542/hpeds.2025-009079

Abstract

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.

Journal Title

Hosp Pediatr

Volume

16

Issue

9

First Page

731

Last Page

752

MeSH Keywords

Humans; Clinical Alarms; Intensive Care Units, Pediatric; Monitoring, Physiologic; Patient Safety; Child; Quality Improvement; Intensive Care Units, Neonatal; Alert Fatigue, Health Personnel; Oximetry; Infant, Newborn

PubMed ID

42442759

Keywords

Clinical Alarms; Pediatric Intensive Care Units; Physiologic Monitoring; Patient Safety; Quality Improvement; Neonatal Intensive Care Units; Health Personnel Alert Fatigue; Oximetry

Recommended Citation

Berg KJ, Hess K, Gripka M, et al. Interventions to Reduce Monitor Alarms Across Pediatric Inpatient Settings: A Systematic Review. Hosp Pediatr. 2026;16(9):e731-e752. doi:10.1542/hpeds.2025-009079