Alarm fatigue can lead to desensitization to safety alerts and threaten patient safety. In this survey of 3,986 registered nurses, the majority (83%) reported alarm fatigue and over half (55%) experienced a situation where an alarm went unchecked despite a patient requiring urgent attention. The researchers found that alarm burden was more common among respondents who rated their hospital’s safety as poor or reported poor work environments.

Shared situation awareness is shown to improve patient outcomes in the pediatric intensive care unit (PICU). This article outlines the process of designing communication and signage tools to maintain or improve situational awareness in anticipation of moving to a new clinical space. With the new tools in place in the new PICU, shared situation awareness for residents, nurses, and respiratory therapists improved.

Healthcare workers can become desensitized to electronic safety alerts (alert fatigue) which can lead to errors and adverse events. Based on Safety II concepts such as organizational resilience and using in situ simulations of critical hypoxemic-event alarms in pediatric inpatient settings, this study identified four types of system resilience contributing to alarm resilience – secondary notification, team-based care, direct visualization of bedside monitors from outside patient rooms (or a central monitoring station) and presence at the bedside.

Alarm (or alert) fatigue occurs when clinicians ignore alarms, usually due to the majority being invalid or nonactionable, and thus fail to respond or respond more slowly to actionable alerts. The article describes the progress made in reducing nonactionable alarms and making actionable alarms more useful to responding clinicians. Clinical approaches include customization of alert parameters to reduce nonactionable alarms, while engineering solutions include reducing the volume or adjusting the tone of auditory alerts.

Situation awareness supports effective teamwork and safe care delivery. This commentary highlights the role of situation awareness in watching the condition of pediatric inpatients to reduce instances of unrecognized clinical deterioration. It features rapid response models enhanced by event review, psychological safety, and patient and family partnering as mechanisms improved through situation awareness.

Diagnostic uncertainty can arise in complex clinical scenarios. This qualitative study explored how physicians in pediatric emergency and inpatient settings mitigate diagnostic uncertainty. Participants discussed common mitigation strategies, such as employing a “diagnostic pause.” The authors also noted outstanding gaps regarding communicating diagnostic uncertainty to families.

Reducing diagnostic errors in pediatric care remains a critical area of research and quality improvement. This narrative review presents the incidence and epidemiology of pediatric diagnostic error and strategies for additional innovative research to develop effective interventions to reduce these errors.

Many medications and medical devices can result in preventable harm in pediatric patients. This article describes one hospital’s efforts to implement explicit, structured processes and huddles to increase situational awareness regarding high-risk therapies among the care team and family members. After implementation, the percentage of electronic health record (EHR) alerts correctly describing high-risk therapies increased from 11% to 96%.

Situational awareness during critical incidents is a key attribute of effective teams. This article describes the development of a situational awareness model, which included involving families and the interdisciplinary team in huddles, a shared mental model checklist, and an electronic health record (EHR) situational awareness navigator. Use of this new model decreased emergency transfers to the ICU and improved process measures, such as improved risk recognition before medical response team activation.

Missed or delayed diagnoses can lead to treatment delays and worse outcomes. This article describes a quality improvement intervention intended to improve physician reporting of suspected diagnostic errors affecting pediatric patients. Intervention components included a standardized reporting process and a systematic feedback and evaluation process, as well as efforts to increase physician engagement, awareness, and psychological safety.  

This article describes the use of “cold” debriefings performed more than one day after in-hospital cardiac arrest events at institutions participating in a pediatric resuscitation quality collaborative. Cold debriefings took place in one-third of events; the median time to debriefing was 26 days. The majority of comments arising from the debriefings involved clinical standards, cooperation and communication. 

… inclusion criteria, 45% had gastrointestinal symptoms (e.g., vomiting, abdominal pain, diarrhea). Five percent of …

Interruptions are common in busy clinical settings but carry patient safety concerns, particularly if they occur during medication administration. This retrospective cohort study examined one hospital’s timestamped telecommunications data to determine the effect of incoming mobile calls or texts on subsequent medication errors (based on barcode alerts) in a pediatric ICU. Medication administration errors were more common when nurses were interrupted by incoming telephone calls (3.7%) compared to when they were uninterrupted (3.1%), and error risk varied by shift, level of experience, nurse to patient ratio, and level of patient care required. Incoming text messages were not associated with medication administration errors; the authors speculate that this may be attributable to the fact that text message alerts do not require immediate response or that nurses have become accustomed to their frequent occurrence.

Secure text messaging has emerged as one method to improve communication between providers and nurses. This paper discusses concerns over alarm fatigue, communication errors and omitting critical verbal communication and provides proposed solutions to support appropriate and effective use of text messaging in a healthcare setting. 

The nursing work environment affects patient safety. This cross-sectional study surveyed nearly 2000 pediatric acute care nurses about their work environment and safety culture. Researchers measured the hospital work environment using a validated scale, and they assessed safety using the AHRQ Survey on Patient Safety Culture. A culture of blame and fear of speaking up remained prevalent among nurses participating in this survey. As with prior studies, investigators found an association between a high-functioning work environment and positive safety culture. The authors recommend enhancing pediatric acute care work environments for nurses in order to improve patient safety. A previous PSNet interview discussed how nurse staffing and the work environment can affect patient safety and outcomes.

Provider inexperience and frequent handoffs create unique safety hazards in teaching environments. This multilevel modeling study investigated predictors of pediatric adverse events at children's hospitals. Investigators noted more adverse events under the following circumstances: earlier in the academic year (the July phenomenon), in hospitals offering more technically complex services, and in hospitals with a higher number of resident physicians for each patient. A PSNet perspective discussed the appropriate balance between autonomy and supervision for training physicians.

Identifying incipient clinical deterioration is a prerequisite for rapid response and prevention of harm for hospitalized patients. This study tested a bedside pediatric early warning system, which included an illness severity score, standardized documentation, and monitoring protocols. In a cluster-randomized trial in several high-income countries, implementation of the bundle did not result in decreased in-hospital mortality compared to usual care. The overall mortality rate in the study was less than 0.2%. The authors suggest that this unexpectedly low mortality rate may have made it difficult to detect differences in intervention versus control hospitals. A related editorial suggests that artificial intelligence should be used to identify clinical deterioration and that outcomes beyond mortality should be considered in their evaluation.

These paired systematic reviews examined alert fatigue in the intensive care unit. The first systematic review found several strategies to reduce alerts including prioritizing alerts, developing multipart rules instead of simple alerts, and customizing commercial platforms with end-user input. The second systematic review found that alarm best practices from high reliability industries are not adhered to in intensive care unit settings.

Missed nursing care is common and has been linked to adverse events. This survey found that more than half of pediatric intensive care unit nurses reported missing care during their prior shift. Higher patient loads and poor working environments were associated with more episodes of missed care, corroborating prior research.

Bedside monitors alert nurses to clinical deterioration. This prospective observational study examined nurse responses to bedside physiologic monitors. The mean response time was over 10 minutes. Less than 1% of alarms were actionable, underscoring the importance of addressing alarm fatigue.