Best Evidence Summary of Intervention Strategies for Alarm Fatigue Among Critical Care Nurses

Abstract

Objective: To appraise and synthesise the best available evidence on intervention strategies for reducing alarm fatigue among critical care nurses, and to provide actionable recommendations for adult and paediatric intensive care unit (ICU) practice. Methods: Following the JBI approach to evidence summary, PubMed/MEDLINE, CINAHL, the Cochrane Library, Web of Science, CNKI and Wanfang Data, together with relevant grey literature, were searched in August 2026. Studies evaluating any intervention aimed at reducing alarm fatigue, alarm burden or false alarm rates among ICU nurses were included. Two reviewers independently screened records, appraised study quality with the JBI critical appraisal tools and AMSTAR 2, and extracted data. Each included study was assigned a JBI level of evidence and a grade of recommendation. Results: Twenty studies were finally included, comprising one randomised controlled trial, nine quasi-experimental or pre-post studies, four analytical observational studies, three qualitative or mixed-methods studies and three evidence syntheses. Four clusters of interventions emerged: (1) nurse-led individualisation of monitor thresholds; (2) intelligent and technological alarm filtering, consolidation and redistribution; (3) structured education and training programmes; and (4) multidisciplinary process and bundle interventions. The strongest evidence supported nurse-empowered threshold adjustment and multidisciplinary bundles (Level 2, Grade A); one pre-post study reported an increase in ventilator alarm response rate from 32% to 87%. Technological filtering and education alone were graded Level 1–3, Grade B. Conclusions: A bundled, nurse-led approach that combines bedside threshold customisation, selective intelligent filtering, systematic training and continuous multidisciplinary audit is recommended to mitigate alarm fatigue in critical care. Future studies should adopt multicentre stepped-wedge designs and report patient-level safety outcomes alongside alarm metrics.