Going alarm-free

Nascar nurse, ASN, RN · Jun 27, 2013

I'm trying so hard just to get some of ours reduced & meeting horrible resistance at every turn. I can't seem to convince anyone that alarms do not stop falls AND tends to create behaviors because they annoy the heck out of folks (both those that have the alarm and the roommate of that person).

I answered an alarm of a new resident today that I had not met yet. Got to the room within seconds to find the gentlemen in the bathroom doing his business & seemed to be standing there pretty steady. When he was finished, he flushed and zoomed back past me on the way back to bed with only a grunt of acknowledgement that I was there. Went to morning meeting to discuss with IDT - even therapy argued with me that he was a fall risk and not completely steady. Well 99.5% of our people of fall risks - so that is our only option????

Luckily my administrator seems to be the only one on my side and told the team from this point forward I get the final say. It will still be an uphill battle. Most of these young chickies don't remember how horrified we were when we took physical restraints off everyone. We just knew back then that everyone was gonna have hip fractures or sub-dermal hematomas in no time but it never happened.

LittleMamaRomeoRN · Jun 27, 2013

I was concerned when the idea was first brought up, but it seems that more facilities are going this way, and the research does show that alarms do NOT decrease falls and just add more irritation and dignity issues for residents. I have a feeling we are going to meet resistance as well, but even our STNA's say, when we do have a fall, by the time they get to the alarm, the person is already on the floor. This may be something worth mentioning to your staff, perhaps it will make them see the alarms as a hindrance instead of a necessity.

Jeniele, ADN, RN · Jun 27, 2013

I just finished my CNA clinicals in a facility that does not use alarms. They utilize the super low beds (barely 6 inches off the floor), one side of bed against the wall, and fall mats on the floor bedside. Like you mentioned 99.5% of the residents are fall risk and during my time there, I was not aware of any falls reported. Residents always have their call lights when in bed and most all use them to request assistance when getting up. Additionally most have the footrests removed from the w/c so they can ambulate themselves when seated. I think precautions to minimize injury are prudent and most importantly to staff adequately and require prompt attention to call lights. This might give residents the the security that their needs will be met by staff rather than having to get up on their own and risk a fall. Not trying to sound naive here, I know it's rough and that staffing is sometimes limited but I've seen firsthand how this can work in a facility and it's been to the benefit of all. I have also seen that schedules of toileting at certain times, ADLs, and check-ins also helped for residents to anticipate times (in a general sense) when their caregivers will be available to help them. This was in a facility where caregivers and residents had a language barrier as well as those with dementia or are non-verbal. HTH.

BrandonLPN, LPN · Jun 27, 2013

I think (hope) that some day in the near future fall alarms will be a thing of the past. We'll all look back and chuckle that we used such silly things when they clearly didn't work.

Like Nascar Nurse said, we will look back on them with the same disdain we do the overuse of physical restraints.

amoLucia · Jun 28, 2013

Besides staff, you're going to prob meet mucho resistance from families who are under the impression that alarms PREVENT falls. I so hate making the phone calls to them when POP POP falls - "didn't he have his alarm on?"

I've worked facilities that were alarm-happy with some of the units 1/3 to 1/2 alarmed. Too chaotic with supervising/maintaining those alarms. And NO, they didn't stop the falls. So I do support eliminating them.

IMO, the problem with increased activities is the residents will tire and can't be in activities all day (and across the other 2 shifts). So you're back to your original problem. Among the activities, perhaps a good exercise program would be helpful as well as monitored pet therapy. But to meet the needs of the varying levels of functioning of pts is crucial. Too often I've seen activities attendance or participation with only the highest level of pts. The low level pts or problem ones get left out.

Personally, I HATE HATE HATE floor mats. They're major trip obstacles for ambulatory pts. Removing footrests from the whchs sounds good, but the pts must be 'fitted' to ensure that their feet don't dangle and they have to tippytoe to scoot around (State survey nabbed us at one place for that issue).

However, a key factor to safety is adequate staffing which is not a high priority for some administrations. You can't implement many of the safety measures without enough staff. More eyeballs and hands are needed!!! Specific DEMENTIA units have been developed. Perhaps we need specifically designated staffed and activities-enhanced FALLS units. The HIGHEST risk pts could be clustered here with intensified risk reduction techniques used.

On a similar thread, we still do need some kind of alarm/prohibitive system to diminish elopement risks; a system independent of falls risk measures.

duskyjewel · Jun 28, 2013

Read the CNA boards here and see the regular talk of patient ratios in the 20s to one CNA. Until that changes, I'm not sure how you can eliminate bed alarms.

DalekRN · Jun 28, 2013

More staff would be the only way to do it. Three cnas and two RNs to 30-40 pts in ny old facility were not adequate, I quit out of fear for my license.

BrandonLPN, LPN · Jun 28, 2013

Read the CNA boards here and see the regular talk of patient ratios in the 20s to one CNA. Until that changes, I'm not sure how you can eliminate bed alarms.

I get where you're coming from, but since alarms have been proven to simply not work under any circumstances I think staffing is irrelevant. A separate issue.

To some extent, family and staff need to resign themselves to the fact that some degree of falling is inevitable. Put 100's of demented, unsteady old people into one building and there's going to be falls. Not that we shouldn't try to prevent them, or that they couldn't be decreased through policy changes. But saying that having any falls is completely unacceptable is silly.

duskyjewel · Jun 30, 2013

I never said we could prevent all falls. But you try going into court as a LTC facility being sued for a fall, with the awful staffing levels most of them have, AND defending the idea of no alarms. You're gonna lose every time.

Besides, where I work, it seems to me that bed alarms do work. We catch people all the time working their way out of bed or chair but before they're on the ground. Sometimes people are steady enough to get a step or two before they buckle, but by then we're in the room. Bed alarms have prevented many, many falls in my workplace. The few falls I've been involved with have happened to people without alarms or who were crafty enough to take/turn them off.

Glycerine82, LPN · Jun 30, 2013

I would have to say more staff, for sure. The problem with no alarms for me is if I don't hear the alarm go off I don't know they are trying to get up. I have 14 patients and the nurse has 20ish. There is no way for me to be everywhere at once and for my high fall risk patients This can be really dangerous.

In addition to lower beds and more activities etc. one thing I used to do for certain patients on an individual basis was to cater to their needs. One woman would absolutely get out of bed no matter what you did, so we would put her chair right next to her bed so when she did get up she didn't have to walk across the room to get it. (In addition to an alarm) For some patients, this would be an encouragement to get up unassisted, but for her it worked. Things like that, and not seeing every situation as black and white are my advise. I really have to say though, for it to work extra staff is imperative.

CapeCodMermaid, RN · Jul 1, 2013

We are an alarm free facility. There has been no increase in the numbers of falls since we got rid of the alarms. We have some residents who respond well to a Call Don't Fall sign in sight. With some residents who we know are frequent fallers we play Let's Make A Deal.....YOU won't get up alone and we'll answer your call light within 2 minutes. Obviously we don't make that deal with very many people but on occasion it works. We have an activity on the 3-11 shift for people at high risk for falls, but, unfortunately, if there is a call out, that aide gets pulled to the floor. We also station our CNAs in the hallway outside/near the rooms of the high risk fallers. They do their books there instead of behind the nurses' station. I've been doing this for YEARS. We used to tie people down to their chairs and to their beds. Sure, they didn't fall, BUT they had skin breakdown, psychosis, more pnemonias, and overall decline. Old people fall. We try to make sure they don't injure themselves when they do.