In a very interesting case study, one nursing home in Connecticut reported back on what happened when they made a conscious effort to remove all alarms from patients for two years. Not only was there no increase in injury like you might expect, but there was actually a substantial decline in the number of falls suffered by patients.
The director of nursing at Kimberly Hall South nursing home in Connecticut got an idea two years ago to have all the alarms from patients removed. The staff was immediately alarmed and skeptical about the idea, fearing that it would lead to danger and possible liability in the event of a resident falling.
The nursing director stuck to her guns and even had to lock up the alarms so that the staff would stop using them. It took almost a year to totally remove all of the alarms, but after that everyone has been surprised to see how much good it has done. Beyond a general increase in morale among patients who hated the annoying beeps and buzzes, the safety of patients have also improved as there have been significantly fewer falls.
Kimberly Hall is one of several nursing homes that are going “alarm-free” after doubts have been raised about the effectiveness of all the warning systems. That means staff are going around removing alarms from mattresses, wheelchairs and clothing that make noise whenever a patient tries to get up or move around. The reason is that there has been little evidence that the alarms actually prevent falls. Rather than work as a warning, they typically only sound when a patient is already either on the floor or up and moving. One study published last year in the Annals of Internal Medicine found that at a hospital in Tennessee alarms did nothing to reduce fall rates. In fact, the study said they might actually contribute to falls by disrupting patients’ sleep, which then makes them more tired and unsteady.
Some evidence is now being collected which shows that when staff no longer can rely on alarms as a kind of crutch, the response rate for falls actually improves. One study done at a rehabilitation center in Massachusetts found that the number of falls declined 32 percent after alarms were taken out of the facility. Another nursing facility in Waterbury, CT reported a 15 percent drop in falls after the alarms were eliminated a year ago.
Not only do the alarms not always help with avoiding falls, they also dramatically increase the tension in an already stressed out workplace. The constantly screeching alarms add stress to staff members and create anxiety in residents, especially those with cognitive issues. Homes that have removed the alarms report much calmer residents who appear less agitated.
This does not mean that alarms should be pulled from all nursing facilities immediately. On the contrary, if a home does go alarm-free, other procedures need to be put in place to assure patient safety. For one thing, frequent rounding needs to be done, especially checking on patients who are at a risk of falling. Detailed assessments of patients have to be done to identify those at serious risk and how increased staff attention can mitigate the possibility of a fall.
More than anything, those nursing homes that go alarm-free have to totally change their way of working. Rather than only reacting to problems, nursing homes have to become proactive and learn to anticipate trouble before it happens.
About the Editors: The Shapiro, Lewis & Appleton & Favaloro personal injury law firm, which has offices in Virginia (VA) and North Carolina (NC), edits the injury law blogs Virginia Beach Injuryboard, Norfolk Injuryboard and Northeast North Carolina Injuryboard as pro bono services.