Becoming cynical about bed alarms

[sistrmoon, BSN, RN]

We've had a huge increase in falls the past 2 weeks on my floor, worse than I've ever seen and one with the worst result. We have a lot of confused patients so I do think staffing is an issue, as 2 bed alarms will be going off at once and you can't split yourself in half. But all staff I've seen respond promptly to the alarms, running in immediately, so it's not a case of ignoring the alarms.

We aren't allowed to use restraints for this purpose and 1:1 sits work, but they are never covered like suicide sits are so we have to pull from our floor staff, leaving the other patients vulnerable to falls as the remaining staff on the floor are stretched thin. I have personally seen bed alarms stop working and have had to change the bed out. Honestly, with the increase of falls we've seen, I wonder if the alarms are malfunctioning as a couple of them didn't go off and everyone is obsessive about making sure they are on.

We do bedside rounding at change of shift, which another floor has touted as their method of having no fall in over 100 days, but it doesn't seem to be working for us. We use landing strips but there are very few available so they are only used after a patient has already fallen. I've searched other threads and am intrigued by the idea of the beds that say "wait! Your nurse is coming!"(can imagine they are expensive though.) But am wondering if you've found anything else that has really worked for you to prevent falls?

[ICURN3020]

I'm sorry, but I think this push for facilities to be "restraint-free" is BS. There are situations when they are necessary- hence the reason they exist in the first place.

Until the day that facilities start providing adequate staff to utilize sitters for those patients who require one, I will make the judgement call and place the patient in restraints if need be. We have to notify the supervisor who then reviews our rationale for doing so, and I've yet to have one tell me I'm using them inappropriately.

Getting an order for a sitter is the easy part - however, when supervisor is contacted we're told, "sorry, there are none available." So it's kind of pointless.

On any given day, quite a few of the patients in my unit need a sitter. We're told to use mitts, padded floor mats, etc.....WELL, THEN PROVIDE THEM!!! 4 floor mats (enough for 2 patients) are not adequate. Running out of mitts constantly is not helping either. We've been short staffed before and they tried to give me a 1:1 suicidal admission (along with my current patients) and I flat out refused citing how doing so would violate their own policy.

The talking beds sound neat, but not sure how effective they'd be with disoriented patients. I could see the voice aggravating or scaring them if they don't know where it's coming from.

I wish I had some good ideas for you. With not enough staff and limited supplies available to us, it's hard to come up with anything.

I must ask though....you said another floor states that bedside rounding/report touts that as their method of preventing falls. I get that communication is improved this way, but how does that directly affect the floor's fall rate?

[sistrmoon, BSN, RN]

I wish I had some good ideas for you. With not enough staff and limited supplies available to us, it's hard to come up with anything.

I must ask though....you said another floor states that bedside rounding/report touts that as their method of preventing falls. I get that communication is improved this way, but how does that directly affect the floor's fall rate?

Well, a lot of falls happen at change of shift when report is happening and everyone is busy with that, so doing report and bedside rounding at change of shift takes care of toileting and other needs that might lead to falls at that time otherwise. What I don't get is how it helps prevent falls at other times. We round hourly and it still happens.

[ICURN3020]

That makes sense. Staff is physically in the room versus at a desk. Thanks for the clarification :)

[Esme12, ASN, BSN, RN]

Sadly...more staff is truly the answer. I too think "restraint free" is ridiculous