Bed & Chair Alarms

[busy-bee]

If a chair/bed alarm is placed.......should it be a doctor's order or a nursing measure...if it is a nursing measure...should it not be still written on a physician order......how can we prove chair/bed alarms are in place if we are not signing that they are and there is no order for it.

[everthesame, LPN, LVN]

At my hospital we do not need an order for a bed alarm or a chair alarm. We do a fall risk assessment on all patients on admission, daily and prn. If a pt is a high fall risk, we have to implement all of the high risk measures according to our protocol. As far as charting goes, we have a spot on our safety rounds form to indicate the patient's fall risk and the fall risk prevention measures in place including bed alarms or chair alarms. We do not need to write an order for any of the protocol measures.

[captron74]

I find this discussion interesting, because at my wife's LTC facility the powers to be that are not involved in the pt daily care mandated that ALL alarms of ANY type be removed, because they are a form of restraint and are not of the best interest to the pt. It has only been a short while, but I wonder when the first lawsuit will come up after a resident falls out of a bed or chair, and the COD is head truma?? And this facility is a county run one at that.

Is this just something that is local, or has others seen this trend of removing alarms where they work??

[barbyann]

The issue of alarms is not as much one of restraint but of dignity. They should not be used unless the team has met and discussed the risk vs. benefit in relation to that individual client. The family is an important part of this team. In an acute care setting I use them liberally because of status changes, narcotics and unfamiliar surroundings. In LTC the team should be more thoughtful in the use of alarms. Fall risk assessments do not address issues of dignity or refusal of device. Again its a human rights issue.

[captron74]

I can see where you are coming from with the diginty side of the issue. An idea that I had would seem to satisify both sides of the issue. What if the alarms were of the silent type, something that would only sound at the nursing station, instead of the loud and attention getting audiable alarms that are currently in use?

This idea could even be expanded on through the use of smart algorithms in the control unit that would eleminate the nusisance alarms of just having someone shuffling around in their bed or chair by only sounding if the input signal (pt weight on pad) was absent for a preset duration, say > 1 minute.

I know that a lot of times there is not a person at the desk that would see the alarms, so what about a small pager type unit that staff could wear that would be programed for only the pts that they are responsiable for, say on their wing or floor?

Yes, I know I am dreaming, but a product such as this could very easily be made with the technology available today. Use of something like this would preserve the diginty of the pt by not having a loud alarm go off every time they move, thus not drawing attention to them and disturbing others, and would provide the relative rapid response of the nursing staff in a fall situation. As it stands now with no alarms, someone could be on the floor for several hours during the night before they are noticed.

So there is the idea, for any electrical engineers or medical product companies that might read this. Maybe it will be produced someday, maybe not, but all good products started with an idea.

[MAISY, RN-ER, BSN, RN]

We don't need an order for falls precautions, therefore, I wouldn't think we'd need one for alarms. Personally, I don't see dignity playing a part of not using alarms. I am sorry, safety should be #1.

If a person is cognizant of their behaviours, then they should obey orders and not get out of bed. If they cannot or will not follow orders, the staff needs to protect their patient, themselves and their facility. Obviously the patient's common sense is not functioning.

In the event, the patient is confused. Then there is no other option! Is the family going to stay there? Does the family have a 1:1 sitter? If neither, then that patient will be injured, or may injure someone else. Whose fault is that? Those cognizant members of the staff who worried about dignity.

Maisy;)

[Tweety, BSN, RN]

Alarms are not considered restraints at my facility because they don't restrict patient movement and we do not need a doctors order.

We just document in the nurses note that there is an alarm. Also our "Fall Precuations Protocol" allows for an alarm.

[Conrad283, BSN, RN]

Alarms are not considered restraints at my facility because they don't restrict patient movement and we do not need a doctors order.

We just document in the nurses note that there is an alarm. Also our "Fall Precuations Protocol" allows for an alarm.

I agree with Tweety. It's almost the same as 3 side rails up, just a precaution.

[pfongk]

we have one resident currently on a bed alarm and ours plug into the buzzer system. This means that yes there is a noise but it's no different to a resident pressing their buzzer. It also just comes up on the boards as the wing name and room number the same as if she'd pressed her buzzer.

[captron74]

As I am just going to start my clinical rotations, I really do not know what is out there as far as types of alarms. I do know what I have seen in use at different LTC facilities, and what they use where my wife works at. (noisemakers!)

Sounds like your system is a step in the right direction anyhow.