Alarms Hurt More Than Help in Fall Prevention

senior woman lying on the floor after accident
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It’s a myth that alarms prevent falls. It turns out that they contribute to falls and to serious injuries. How can that be when they are supposed to help prevent falls?

The best way to prevent falls is to keep people moving. When we don’t use it, we lose it—our muscles weaken, and our balance is compromised. Bones get brittle when they are not weight-bearing so fractures are more likely to occur when someone who has been immobilized by alarms falls.

Alarms create other problems. Skin breakdown can occur from being immobilized and afraid to shift position or body weight while sitting for prolonged periods of time, or while lying in bed at night. Loss of independent bowel and bladder function can occur.

Alarm Fatigue

When staff hear so many alarms going off all the time, they are desensitized to the sound. The sound also contributes to agitation for residents and families. Alarms create noise, fear and confusion for the person and those around them. The alarms can be an embarrassing infringement on freedom, dignity, and privacy. And certainly, that is not the intent of MDS 3.0 guidelines.

Alarms Startle and Annoy People

Sleep may be interrupted, or even impossible when residents lie still for fear of setting off the alarm if they shift their position or being awakened by the alarm. Night- time alarms wake other residents who then try to go to the bathroom and fall.

The common response, “sit down,” doesn’t get at what residents actually need. Having alarms in place often prevents residents from taking care of their own needs, for a tissue, a glass of water, or other items slightly out of reach.

Former Special Focus Facility Solves Problem

One special focus facility in Indiana, that had been cited for too many falls, actually reduced falls by removing alarms. What did they do instead? The staff at Sycamore Village in Kokomo, IN, offers three keys to their success:

  1. Engaging their front-line staff—CNAs are consistently assigned and they huddle every shift to talk about residents’ needs.
  2. “Out of the box” thinking by their rehab staff who helped figure out better seating, grab bars and ways to support residents’ mobility.
  3. Getting to know each resident’s patterns—when they were tired or needed help to the bathroom—so that they could anticipate the needs.

They took a deliberate approach working with a few residents at a time. They started with residents who hadn’t had a fall but still had on the alarm and discovered that the reason for the alarm could easily be addressed in other ways. Each week they met as an interdisciplinary team and decided which people to work with next. They met with CNAs and nurses to discuss each resident. They used an “antecedent log” to track what had happened to trigger the alarm. They learned more about people’s patterns. Therapy evaluated residents’ seating, and how they transferred from bed to chair, often putting in a grab bar to assist with transfer. Slowly but surely they eliminated alarms.

In short, the facility embraced the tenets of true culture change (knowing your resident) and applied to a specific area of concern.

Falls Cut in Half

They reduced their falls by 50% and reduced their falls with injury by over 60%, all while reducing their alarms by 90%. In less than six months, they went from 52 residents with one or more alarm, down to 5 residents, whose alarms never go off, but whose families felt strongly that the alarms were needed.

Working with families is another key. So many families have come to expect that alarms are a safety measure and don’t realize that they are counterproductive. At Sycamore’s sister Golden Living facility, in Greenfield, IN, working with families was key especially in their Alzheimer’s wing where so many family members were able to offer clues about what interventions would work. As families were brought into the alarm elimination process, they problem-solved together with staff to figure out when a resident was tired and needed to rest, when it was hunger or a need to go to the bathroom.

Now at both Golden Living buildings, not only do they not hear alarms all the time. They don’t have as many call bells either, because the staff anticipates residents’ needs, and residents are more able to take care of their needs themselves.

The alarm elimination process produced other benefits at Sycamore Village. They reduced turnover from 50% to 22%, and increased morale through better teamwork - staff appreciated being included in the process and having their understanding of residents be valued. Everyone is thinking critically now, and communicating better.

Needless to say, Sycamore Village graduated from the special focus facility list and credits their work with alarm elimination for helping everyone step up and work better. A Pioneer Network webinar series explores this topic in-depth.

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