Improving the Quality of Nursing Care Through Clinical Alarm Management in Intensive Care Units: An Integrative Review

Vollständiger Abstract

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Background/Objectives: Clinical alarm management in continuous patient monitoring systems remains a major challenge in intensive care units (ICUs). The high frequency of nonactionable alarms contributes to alarm fatigue among healthcare professionals, potentially compromising patient safety, clinical surveillance, and the quality of nursing care. As nurses play a central role in monitoring critically ill patients, evidence-based alarm management strategies are essential to improve the quality of care and patient outcomes. This review aimed to synthesize the scientific evidence on nursing interventions for managing clinical alarms in continuous monitoring systems and their contribution to patient safety and quality of care among critically ill patients. Methods: An integrative literature review was conducted following the methodological framework proposed by Whittemore and Knafl. A comprehensive literature search was performed in CINAHL Plus with Full Text, MEDLINE with Full Text, Supplemental Index, Complementary Index, Academic Search Index, the Directory of Open Access Journals (via EBSCOhost®), PubMed, Scopus, and ScienceDirect. Studies published between 2020 and 2025 in English, Portuguese, or Spanish were eligible for inclusion. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. Nine studies met the eligibility criteria and were included in the final synthesis. Results: The identified interventions were grouped into five main domains: alarm parameter customization, nurse education and training, implementation of structured protocols and alarm management bundles, optimization of monitoring devices and sensors, and interventions addressing human and organizational factors. The evidence indicated that multifaceted and integrated interventions were associated with reductions in nonactionable alarms and improvements in clinical responses to alarms. However, their effectiveness in reducing alarm fatigue appeared to depend on organizational culture, staff engagement, and contextual factors. Conclusions: Effective alarm management requires the consistent implementation of evidence-based nursing interventions. Nurses play a pivotal role in promoting patient safety through clinical expertise, technological competence, and adherence to structured alarm management practices. Strengthening alarm management strategies may contribute to improved quality of care, safer care delivery, and better outcomes for critically ill patients.