elimination of bed/chair alarms?

[lauriannsmith]

I walked into my work at a Long Term Care Facility, I am the evening RPN in the locked dementia unit, and I get hit with the Management telling me that my unit will be the guinea pigs for Purposeful Rounding. I had been to work two evenings prior and no one in Management even mentioned this, much less the incredibly stupid second part to this nonsense. Now, the Purposeful Rounding idea sounds OK, what do they think we have been doing on the floor? But keep in mind that my unit has the least amount of staff in the facility. I have 2 full PSW's and one 1/2 to 32 dementia residents. All the other units have 2 full PSW's and 2 1/2 PSW's per shift. (could it be because these people cannot complain to family and family involvement can often be less with dementia residents?) I have been begging management for months for more help and nothing, I'm on the floor all the time answering bells and dealing with aggression, falls, and constant behaviours. We are drowning on this unit and they threw us a brick. We do have a Behaviour Champ Nurse who is only on during the day shift (significantly less falls and behaviours on day shift and we deal with sundowning) and provides no assistance for me and my staff whatsoever. Myself and my staff are so burnt out and I fear I will lose good staff that I really depend on the care for my resident's. Ok, so now we will have to find the time to 'Purposefully Round' our resident's but my main concern is that not only was this not discussed utilizing staff input, the people who do the real work, they also told us they are taking the bed and chair alarms away at the same time! Management's answer to my horrified staff was "Well, bed checks don't prevent falls". That is not true, myself and many staff members of my team have caught people before they fell as they were trying to get out of bed or rising from a wheelchair by being alerted to their need for help by the ringing of their bed/chair alarm. I agree that these alarms should be silent, so the noise does not agitate or frighten the resident's, but for God's sake we need them. Purposeful Rounding alone means worst case scenario one of my frail dysphasic residents could be laying on the floor bleeding out, unconscious, or suffering from a painful fracture for up to 59 minutes. Not to mention the risk of clots from time wasted as they lay there hoping someone will come randomly and help them. This is unacceptable and morally irresponsible. Bring in all the crazy, half baked ideas you want and pile one more straw on the camel's back, but do not take away the tools we need to keep our residents safe. When I have to tell families I am unsure how long their loved ones were laying on the floor will probably be my last shift in Long Term Care.

[smf0903]

No way I would ever EVER take away bed and chair alarms for those who need them!!! That is the stupidest idea I have ever heard. You have every right to be upset. We do purposeful hourly rounding on our floor (MS at hospital) and even there I would start a riot if they took away bed and chair alarms. We get sundowners and a lot of AMS pts and those alarms prevent a LOT of falls. Good lord, what are they thinking?!?

[blondy2061h, MSN, RN]

I would try and annimously get in touch with risk management at your facility.

[CanadianAbroad]

What are they going to replace the bed alarms with? I know at our hospital, they have the camera system that will tell the patient to go back to bed and then will alarm the RN and Tech of a potential fall. I prefer the bed alarm. I can hear that and run down and have enough time to prevent a patient from harming themselves. If your facility is not replacing it with anything, I would remind them that they will have a potential **** show of lawsuits due to lack of care and allowing the residents to be harmed. This sounds like the potential for people to die from their injuries.

[dishes, BSN, RN]

There is current research that recommends removing the alarms and conducting hourly rounds, see Agency for health care research and quality, Preventing falls in hospitals a toolkit for improving quality of care (2013) AHRQ gov

[CanadianAbroad]

There is current research that recommends removing the alarms and conducting hourly rounds, see Agency for health care research and quality, Preventing falls in hospitals a toolkit for improving quality of care (2013) AHRQ gov

You should be doing hourly rounding even with the alarms in place. If you have a confused patient or someone who is likely to fall, an alarm or monitoring device is needed on top of the hourly rounding.

[TriciaJ, RN]

This just gets more absurd. The whole reason for bed and chair alarms in the first place was so staff could be cut. Now they're taking away the alarms but not adding staff. The reason: alarms are noisy and unpleasant so they just eliminated the unpleasantness. Aren't managers genius?

I don't think anyone is against "Purposeful Rounding" (Although I love the buzzwords. What were you doing before? Schmoozing?). But if it's all you can do to walk around and make sure that no one has fallen, who is supposed to give the baths, do the treatments, feed the meals and administer the meds?

This is right out of George Orwell's 1984: "Big Brother has raised the chocolate ration from a gram to a half a gram. Hooray for Big Brother!" For anyone who hasn't read anything by George Orwell, I find the resemblance to modern day health care extremely chilling.

[Anonymous865]

This has been done in LTC facilities all over the country. Many states have alarm elimination initiatives for LTC.

The evidence shows that falls did not increase when facilities eliminated alarms. In fact many facilities reported that falls decreased when they eliminated position-change alarms. (The evidence on whether it decreases falls is weak. The evidence that falls do not increase is strong.)

To quote one study "We took a tiered approach to removing positio-change alarms from our facility, monitoring the fall incidence rate for a period before, during, and after the elimination of these alarms. After discontinuing their use, we found a decrease in the rate of falls, and a decrease in the percentage of our residents who fell. Staff has easily adapted and reports a calmer, more pleasant environment."

Another study says "Using real-time information provided by falls incident reports the ADON tracked and trended data on a monthly, quarterly, and annual basis. During the final quarter of 2005, that encompassed the months of alarm reduction and increased resident monitoring on the target unit, there was a 32% reduction in the quarterly average of falls for this unit, when compared to the average number of falls for the first three quarters of 2005.

Incidentally, this unit also experienced a reduction in the number of pressure ulcers identified for the final quarter 2005, as compared with the first three quarters of 2005. This could be the result of residents' toileting in advance of need, and more frequent ambulation and positioning, which were a part of the residents's individualized fall prevention plans.

In addition, there was a 21% decrease in the CMS 'Prevalence of Falls' quality measure when comparing July 2005-December 2005 to October 2005 through March 2006. Both six-month periods shared the two-month intervention interval and subsequent evaluation. Additionally, the Director of Nursing has reported that the increase in activities on the unit has had an impact on the 'depression quality measure.'"

From MASSPRO a Massachusetts Quality Improvement Organization, "The noise produced by alarms agitated residents so much that residents fitted with alarms did not move at all to avoid activating the alarm. This put them at greater risk for decline. Residents with dementia experienced an increase in agitation when fitted with alarms."

Quality improvement in nursing homes: testing of an alarm elimination program. - PubMed - NCBI

Elimination of position-change alarms in an Alzheimer's and dementia long-term care facility. - PubMed - NCBI

Interventions designed to prevent healthcare bed-related injuries in patients. - PubMed - NCBI

Nursing Facilities

Nursing homes find bed, chair alarms do more harm than good - The Boston Globe

http://c-hit.org/2013/03/20/state-nursing-homes-pilot-alarm-free-initiative-carefully/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3549269/

http://m.ageing.oxfordjournals.org/content/early/2013/10/17/ageing.aft155.full

The problem isn't that the facility is eliminating alarms. It is that they did not take a planned, systematic approach.

[TriciaJ, RN]

That is fascinating that alarms do not decrease the fall rate. So all this time they were nothing more than a nuisance.

[heron, ASN, RN]

The only thing alarms are good for is to let you know a resident is on the move. You may or may not be able to prevent a fall by responding immediately. The trade off is agitated residents and lots of noise.

There is really no substitute for adequate staffing for frequent toileting, comfort care and, most important of all, monitoring. The only thing standing between our residents and the floor is us.