Phasing out alarms?!?

Specialties Geriatric

Published

At a recent employee meeting, I learned that my facility is going to start phasing out personal alarms for residents. (chair & bed alarms, TEDS, etc.) The powers that be want to head off the new regulations that are being passed in my U.S. state that will prevent the use off alarms as a "dignity issue." :eek: I can't IMAGINE the number of patients who will be injured from falls if we don't hear the alert of an alarm, warning us that the resident may be in danger! I feel this action has the potential to cause serious injury to the patients; many are suffering from dementia and are unaware that they cannot rise or walk without assistance. From past experience, all I can see resulting from this is an unending parade of fractures, brain injuries, and more..! I am seriously considering finding employment in another facility that makes patient safety a higher priority.

Is this happening all over the globe, just in the U.S, or only in my state?

I have worked in different areas of the country and found that in some people believe that they should be able to move about as they choose unencumbered by devices of any type..life liberty and the pursuit of happines... The patients who are capable sign releases and sometimes families are involved. They do this despite the fact that it may cause them an early demise. I can actually state that one of my patients died after a nite time fall on a tile floor. His family was not upset about this happening knowing that he lived his life to the maximum. Perhaps this is a choice that is right for some people.

Specializes in OB, HH, ADMIN, IC, ED, QI.

The question that needs an answer, seems to be whether patients who fall out of bed/wheelchairs, would not have done that IF they had pressed an alarm button.IF the response to the alarm was quick enough, the staff was astute enough, and strong enough to keep the patient / resident where they needed to be, or break the fall by assisting them slowly, would the fall have been prevented?The Safety Committee should have reviewed enough cases to know that the answer is "no", before changing to a non alert system. Many facilities don't give reasons for decisions made by the "powers that be", and doing that could lessen the aversion most people have to change.When staff receive information that makes sense, and become committed to the change, implementation of it is much easier. When there is the time old "us" versus "them" going on, and this is perpetuated by lack of communication, a current of animosity occurs, which makes everything more difficult!

I agree with others. Alarms don't prevent falls, and they annoy the h*** out of some residents and increases agitation, leading to falls. They also annoy staff, leading to increased staff agitation.:mad:

They also have a tendency to go off for no reason -- sometimes when the residents aren't even in the room. That has us leaving the floor, and then not watching the fall risk residents, to find out which alarm is going off.

At this point the only benefit I see to alarms is that if a resident falls, we can say to State that we were doing are part to prevent falls by using alarms. So I don't see any real benefit to that, it's mainly a paperwork issue.

Specializes in Gerontological Nursing, Acute Rehab.

My facility has just gone thru the process of phasing out alarms. We have a couple of residents with alarms on our Dementia unit, but the rest of the building is pretty much alarm free.

The units are so much quieter, the residents are less agitated, and our falls have not increased due to the elimination of alarms. Other interventions, especially when you involve other disciplines, are much more effective. In fact, our dementia unit has seen a sharp decrease in the number of falls simply by offering a group activity at shift change. Of course, it's a culture change, and every culture change involves a lot of staff education and changing the way we ordinarily do things. Frequent checks, more activities and assessing even the smallest changes in resident's status will all help decrease your fall numbers. Believe me, we didn't think going alarm free would work either, but it has. It's been a wonderful change to our environment and for the resident's peace of mind.

Specializes in Rehab, LTC, Peds, Hospice.

I think the problem may be too frequent use, improper use as a restraint, and disruptive, loud alarms. I find the push to get rid of them frustrating because I have prevented falls by responding to alarms, I've met confused Resident's needs by assisting them to the bathroom, walking with them for exercise, etc when they were incapable of verbalizing them or using a call bell. I work in a good facility that's fairly well staffed. We all responded to fall alarms immediately. No, we didn't prevent all falls but we definitely provided needed care and prevented quite a few. And I have seen serious trauma, fractures and even the death of several patients because of falls over the course of my career. If an alarm could've prevented those, I think its worth considering using when other interventions don't work.

Ours were programmed to alert our pagers. Now that our facility has ceased using them, and turned to frequent rounds and activities, evaluating patterns etc, our falls have gone up. The severity of injuries resulting from falls has gone up as well. It's very, very frustrating.

And although you hear the 'resident has a right to fall' in most cases that won't be much protection should you or your facility be sued. In fact, falls are known as 'never events.' A fact which I find amazing and frankly impossible to imagine. Only in a Pollyanna fictional world would any facility be able to prevent all falls, all the time. Many staff, including myself can recount times when they were right next to their patient and could not prevent a fall.

I'm experiencing alarm fatigue. It is constant where I work. I'm having to make myself pay more attention. Call lights, pages, phones, confused residents constantly yelling...you start to unintentionally drown out the noise. Then that becomes dangerous.

Specializes in LTC.

Our facility phased out alarms about a year ago and my first reaction was the same as the OP. I think when you have chair/bed alarms it give a false sense of security. Without alarms it has made us become more aware of resident needs and meet them. If Mr Jones is crawling out of bed mult times we get him up and offer food/fluids/ visits with staff ect. We don't have more falls and only one fall has resulted in a fx....but that is a whole nother story.

You will get used to not having alarms and everyone will step up to the challenge. We put fall risk residents in low floor beds so if they fall out it is only 6 inches they fall. We use floor mats next to beds of those who are prone to crawling out of bed. We chart outside of rooms where there are fall risk residents and we have even moved residents closer to the nurses station.

Our facility phased out alarms about a year ago and my first reaction was the same as the OP. I think when you have chair/bed alarms it give a false sense of security. Without alarms it has made us become more aware of resident needs and meet them. If Mr Jones is crawling out of bed mult times we get him up and offer food/fluids/ visits with staff ect. We don't have more falls and only one fall has resulted in a fx....but that is a whole nother story.

You will get used to not having alarms and everyone will step up to the challenge. We put fall risk residents in low floor beds so if they fall out it is only 6 inches they fall. We use floor mats next to beds of those who are prone to crawling out of bed. We chart outside of rooms where there are fall risk residents and we have even moved residents closer to the nurses station.

I'm assuming this is a place that is properly staffed. Anticipating needs such as toiletting can only be done so frequently when we have poor staffing ratios.

Specializes in Geriatrics.

We phased out tab alarms and bed alarms in my facility and everyone is just fine. My administraters noticed that CNAs, nurses and even activities people would just let the alarms sound and not actually address the problems as to why the patients were standing up? Maybe they need to use the bathroom or maybe they just want to stretch their legs and walk (with assistance.) Since we got rid of these alarms on my unit, I feel I am more alert to where my patients are and who is getting up. Patients will fall with or without that alarm, it is not preventing the fall, it is just a loud annoyance that scares and confuses the patients who have dementia and Alzheimer's.

Specializes in HH, Peds, Rehab, Clinical.

My facility is a "restraint-free" facility, and that means NO alarms, except for wander guards. No tab alarms, no bed alarms. Just the wander guards that make it so a locked door isn't supposed to open if a guard is within X amount of feet of the door. However, pushing against the door for 10-15 seconds will unlock it no matter if a wanderguard is in the area or not.

I had a LOL LAUNCH herself onto the floor twice on her day of admittance. Calling her POA of course was part of the follow up procedure. The daughter didn't answer either time I called, but did return my call hours afterwards. She demanded to know why the bed rails weren't up. Um, they don't exist here, that's a restraint. Why can't you tie her down? Um, that would be considered an even bigger restraint. She had NO idea what our policies were (Mom got dumped here, literally. She has been BEGGING for her eyeglasses and 3 months after admission Mom still doesn't have them and spends days/nights in a series of hospital gowns b/c daughter has brought no clothes for her).

My facility is a "restraint-free" facility, and that means NO alarms, except for wander guards. No tab alarms, no bed alarms. Just the wander guards that make it so a locked door isn't supposed to open if a guard is within X amount of feet of the door. However, pushing against the door for 10-15 seconds will unlock it no matter if a wanderguard is in the area or not.

I had a LOL LAUNCH herself onto the floor twice on her day of admittance. Calling her POA of course was part of the follow up procedure. The daughter didn't answer either time I called, but did return my call hours afterwards. She demanded to know why the bed rails weren't up. Um, they don't exist here, that's a restraint. Why can't you tie her down? Um, that would be considered an even bigger restraint. She had NO idea what our policies were (Mom got dumped here, literally. She has been BEGGING for her eyeglasses and 3 months after admission Mom still doesn't have them and spends days/nights in a series of hospital gowns b/c daughter has brought no clothes for her).

I had a famous actor (female) patient once that was best friends with Bette Davis, that had no shoes- her son, who is an 'infamous' defense lawyer/millionaire in L.A. told the social worker "I don't have money to buy HER shoes- go to Goodwill and get her some, if she 'needs' them!". Of course it was her millions that got him where he is. And of course he figured out a way to get his Mom on Medicaid (and out of his life), while keeping her fortunes.

Speaking of dumping. Sad.

It is sad. I had a patient who liked to drink a 4oz glass of wine every night. She had dementia and was always confused. The wine really helped her sleep at night. Her son wouldn't approve of us giving her anything to help her sleep so the wine was good to have. About a week before she was going to run out of wine her son (very wealthy man) was called and asked to bring her more wine. Well he didn't know if he would have time and he didn't bring her any for months. He was called multiple times and told how his mother was confused and would often sit up all night, rolling into others rooms and disturbing them at night, she would try to hit the staff when we tried to redirect her. We were finally able to get an order for prn trazodone, but he didn't want it given after 8pm. So if the nurse forgot to give it before 8, then to bad so sad. She was exhausted and always asking for her wine. I could never understand why it was so difficult to bring a bottle of wine to the facility.

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