Validity of Bed and Chair Alarms in Preventing Falls

Dear Sir/Madam,

According to your request, I am enclosing the report I have prepared on the validity of bed and chair alarms for preventing falls in health care settings which should be submitted by [Date]. This report shows the necessity for identifying effective ways of preventing bed falls in healthcare settings. The reason is that bed alarms are not as effective as initially perceived.

It has been identified that bed falls account for one-fourth of the total falls in the healthcare settings. According to Centre for Disease Control and Prevention (CDC), the most vulnerable group is the elderly patients. It has been identified that some of the causes of such bed falls include weak muscles, medication, movement difficulty, etc.

Identifying the cause of such bed falls as well as defining the ways of their prevention will allow the health care givers to avert other injuries emerging from the falls. This will also allow the health care facilities to avoid litigations emerging from the cases of bed falls in scenarios where the facilities are assumed to be faulty.

Thank you for this opportunity and I hope that this report will be helpful in reducing bed falls in the healthcare settings. If you have any questions or suggestions regarding the recommendations or research, please contact me at [your number] or e-mail me at the address specified below.

Sincerely,
[Your name, email]

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This paper investigates the validity of bed and chair alarms for preventing falls. The report proves that sensor technology increases falls as opposed to decreasing them. Therefore, it evaluates the best approach of reducing falls in the healthcare settings. It is identified that there is no specific approach that is the most suitable for avoiding falls in the hospitals. It is identified that the best solution is to raise awareness among caregivers regarding the fall risk issue as well as incorporate policies that will allow constant evaluation of the risk of falls. Consequently, the best approach for a given scenario will be incorporated.

Through the review of various available literatures about the issue, the researcher will identify the best approach recommended as well as the manner in which bed and chair alarms have been disqualified as the most appropriate way of reducing falls in the healthcare settings.

The relevant issue of identified approach to reduce such falls is to avoid injuries and other negative outcomes. These outcomes include litigations affecting the healthcare facility and the staff as well as poor quality healthcare services from the caregivers to the patient.

Sensor Technology (Bed Alarms)

It has been reported that one-fourth of the total falls in the hospitals are categorized as bed falls (Healey et al., 2008). Some argue that sensor technology (bed alarms) play a significant role in reducing bed falls (Quigley et al., 2013). Other arguments indicate that they increase bed falls (Sahota et al., 2013). Another class of arguments indicates that they do not make any difference in increasing or reducing patient bed falls (Shorr et al., 2012).

Every time a patient falls from a bed or chair, he increases his chance of getting a serious injury or other related complications (Vass et al., 2009). In order to ensure that the caregivers as well as healthcare professionals are providing quality care to the patients, it is relevant to identify the approaches of reducing these falls.

This report attempts to prove that the best way of reducing the falls is not to incorporate bed and chair alarms as a part of risk management. Rather, it should be aimed at increasing awareness among the healthcare professionals as well as establish risk assessment measures and policies. Moreover, it attempts to prove that managing is more of an integrative process as opposed to a singularized solution.

Problem

It has been identified that hospitals have a potential of 170,000 court cases if the number of elderly people falling annually is considered. In nursing homes alone, every bed accounts for between 6.0 and 2.9 falls every year. This is an average of 600,000 falls per annum in the healthcare facilities in the U.S. It also means that the current methods used to prevent such falls are not effective. Consequently, there is a need to reduce them by identifying the right and effective approach.

There are examples of hospitals which have encountered litigations due to the patient falls from the bed/chair. In 2004, for example, Edward Hospital Naperville, IL encountered was faced by a medical malpractice case as Juanita Sullivan accused the hospital as well as Dr. Amelia Conte-Russian and a nurse of being negligent when treating Burns Sullivan, hence increasing his risk of falling. The court ruled in favor of the hospital as the plaintiff’s medical expert was categorized as incompetent. Although the hospital won the case, it is relevant to identify that it is not free from encountering other litigations.

Purpose

The purpose of this study is to show that bed and chair alarms are not effective in reducing falls in the healthcare settings. It, therefore, attempts to identify other effective ways of eliminating chances of patient falls. Failure to identify effective approaches increases the possibility of patients to have other complications or consequences of bed and chair falls in the hospitals.

Scope

This report will focus on the need of the hospitals and other healthcare settings to establish effective approaches of eliminating risks of the patient’s chair and bed falls in order to reduce the consequent outcomes. It will also provide the reasons for which the existing approaches are not effective in reducing these falls.

Discussion

The Centre for Disease Control and Prevention as well as American Nurses Association amongst other bodies/institutions interested in the patient safety matters have identified various ways of preventing patient bed and chair falls in the healthcare settings such as sensor technology on beds and chairs. Unfortunately, this approach is not effective, hence the need to identify other solutions.

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Several researches prove that sensor alarms on beds and chairs do not reduce the respective falls in the hospitals. Schorr et al. (2012) argued that sensor technology has any impact on the reduction of bed and chair falls., There was dominance of the use of alarm during 64.41 days in every 1000 patient days on the intervention units. Concerning the control units, the use of alarm was 1.79 days in every 1000 patient days. The results indicated that there was no variance in the change of fall levels in every 1000 patient days. There was also no variance in the change of the physically retrained students, injurious fall rates as well as the patients who fell as compared to the control group.

In another study, Sahota et al. (2013) incorporated 1,839 participants. 918 individuals were in the intervention group while 921 were categorized in the control group. The bed falls recorded in the intervention group were 85 and the falls recorded in the control group were 83. This translates to fall rates 8.71 in every 1000 patient days in the intervention group and fall rates of 9.84 in every 1000 patient days. It further translates that alarms increase bed falls. The researchers conclude that bedside and bed alarms as a single approach of reducing bed and chair falls cannot be effective.

It is, therefore, relevant to identify other avenues of reducing such falls. This includes evaluating bed rails and other models used by the nurses in accordance to the available literature for reducing these falls. When evaluating these optional approaches, the report involves the objective aspect, since it has been already identified that sensor technology (alarms) are not effective.

Bed rails, for example, have been put as one of the approaches to avoid such falls. Healey & Oliver (2002) indicate that bed falls still occur despite the presence of bed rails. Although there is a negative association of bed falls and bed rails, Healey & Oliver (2002) statey that reducing bedrails will increase the risk of bed falls. In other words, although bed rails will not reduce the number of bed falls, removing the rails will increase the patient’s risk of falling.

Regarding bedrails, the ethical issue has been revealed (Horse, 2002). It relates to the infringement of patients’ autonomy as well as their dignity. This approach, therefore, becomes maleficent. Moreover, this issue can be considered in the use of bed and chair alarms. Alarms are accepted as restraints, hence depicting patients as restrained (Horse, 2002).

While identifying the ways of preventing the bed falls, another aspect of the issue is introduced by Hampel et al. (2012). These researchers indicate that it is necessary to evaluate first the ways of introducing the falls prevention resource guide. It has been identified that there is fall risk education and assessment for the patients and staff as well as their families. Moreover, there was a wide variance of organizational implications and intervention complexity. Hospitals falls should be, therefore, formulated through evidence-based tools and interventions. The best tools are mainly assessed in the context of individual needs resources and existing approaches. Some of the tools which were constantly used included STRATIFY scale and the Morse Fall Scale (Hampel et al., 2012).

Grant (2013) presents another solution to reducing such falls by stating that nurses can avoid the falls if they have one-on-one interactions with the patients. However, she identifies that the patients are so busy fulfilling their routine duties that they do not have the time or energy to have such interactions. However, Grant (2013) identifies that this time can be provided by integrating electronic records in the hospital systems. The electronic records will facilitate nurses’ efficiency in their clerical routines, hence creating more time to conduct the one-to-one interactions.

Grant (2013) further identified that such electronic records reduced errors in medication and boosted nursing documentation, which further improves nurses’ work satisfaction as far their environments are concerned. It was further defined that the nurses working in HER environments had lower chances of reporting poor safety to the patients as compared to the environments that were non-EHR.

Pearson & Coburn (2011) identify that such falls cannot be prevented using one single strategy. There is a need be incorporate various strategies. Some of the approaches, as identified by Perason & Coburn (2011), which can be used to reduce the respective falls, include gaining experience from the critical access hospitals (CAHs). The various organizations offering this experience include the Illinois Critical Access Hospital Network and Maine Quality Forum. Montana State Flex Program and Montana Performance Improvement Network are also part of the CAHs experience programs.

Other intervention strategies include physiologic changes, environmental changes, education, and training. The physiologic changes include considering toileting regimens and medication review. The environmental changes include alarms and restraints while education and training includes staff education.

Willy (2014) affirms the perception of the previous researchers indicating that the best approach is to ensure succinct evaluation. Willy (2014) indicates that it should be done on the first day of the patient care. While conducting such an evaluation, the risks leading to such falls will be identified singularly, hence providing specific approaches of dealing with such problems. In other words, there is no definite solution that can be provided in advance in order to cater for all potential risks of falls.

The various ways of preventing such falls, as indicated by Willy (2014), include recognition of movement desire, discomfort and pain by the nurses. Use of environmental and visual factors to deal with deficits in cognitive and visual issues is another way of preventing falls. Avoiding auditory clutter and use of gravity-assisted seating are other fall elimination/reduction approaches. Consideration of calcium supplementation and vitamin D as well as offering protective gear to the residents may also reduce the falls. Promotion of appropriate exercises as well as addressing staff issues has been categorized as a manner of reducing falls.

In a report of Rand Corporation, Boston University and ECRI Institute (2013), it has been identified that preventing falls requires an interdisciplinary method. There are such fall preventions that are highly routinized. Moreover, a respective caregiver, despite his talent, cannot prevent all cases of falls. It is, therefore, relevant to incorporate operational practices and organizational culture that boost communication and teamwork inclusive of individual expertise.

The technological approach of preventing these falls appears to be weak. This may be due to various reasons. First, the patients are dynamic people. It, therefore, becomes challenging to envisage their reactions or outcomes. Although the prediction in the elderly patients may be more anticipated than those with the younger ones, it is a challenging task.

The overall perception of bed and chair alarms is their technical aspect. While some may be operated through pressure sensors, others appear to be operated manually. It, therefore, becomes a challenge to the poor patients who have weak muscle movement, for example, to be assisted using this technology. If the alarm is pressure sensitive, the time it takes for a nurse or healthcare professional to come and assist the patient may not be necessarily efficient in helping the patient or preventing his fall.

According to the afore-mentioned findings, it is clear that a more comprehensive approach is needed when reducing or eliminating patient’s fall in the healthcare settings. It is clear that there is no specific type of patient care that will address all the issues connected with the employee and patient management. It is, therefore, relevant to ensure that there is the required integration in such settings.

Through the integrated approach, healthcare givers may decide to include the alarms or fail to incorporate them. Professionals should ensure that such scenarios are avoided in the first place. Both ladies have gone through traumatic experiences. However, they were successfully defined.

If everybody is aware of the issue and makes his particular contribution, financially or otherwise, it becomes a corporative affair. The people should have a chance to raise from the bed, leave the house, hence being able to have continuous outings. Although it may be a challenge identifying the role of each member, the final outcome makes sense.

In certain cases the patients are more prone to falling as compared to the others. For example, one of such situation may happen during the religious festivities. If people are in a jovial mood during their walks, this same atmosphere may be created in the hospitals, especially in the wards where the patient’s mental capacity and voice is fully experienced.

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It is relevant to note that the approaches of reducing bed falls are flexible. Such an approach should be reviewed in accordance to changing times, technology and patient perception of the healthcare (Sahota et al., 2013). Identifying an effective approach does not only entail achieving a goal (in this case, reducing patent’s bed falls in the hospitals), but it should also ensure that the processes of achieving the aims are ethically and legally strong in relation to the specific time.

Conclusion/Recommendation

Consequently, it can be concluded that using pressure alarms or sensor technology is not the best approach of reducing bed falls. Moreover, even if it was effective, using this form of technology cannot be solely useful. Due to the research it may be concluded that using a more integrative approach will be the most effective in reducing these falls. When an integrative approach is mentioned, this means that it is a solution that incorporates several other approaches.

First, it will include an evaluation process. The hospitals or healthcare facilities must establish a way of ensuring that this approach is conducted pertaining to the risk of bed falls in hospitals. It is worth noting that it should be performed using the appropriate toll suiting a given approach. As indicated in the research, there is no specific tool that suits all hospitals. Moreover, raising awareness amongst healthcare professionals, such as nurses, should be added to the approach. Some falls occur due to nurses’ ignorance of the surrounding situations.

The other issue includes ensuring that the nurses have ample time to handle the patients on a one-to-one basis. Consequently, the facilities should be equipped with technological systems that will ensure realization of the efficiency. As mentioned earlier, having electronic records is one way of implementing such efficiency.

The other step is to include already existing approaches of reducing these falls. Some of these approaches include bed rails and sensor technology. However, this part of the integration process is not compulsory, especially if it raises such issues as those ethically related. It is relevant to identify that these two approaches have been highly criticized as ineffective. However, if they raise ethical concerns even when integrated into other approaches, they can be eliminated from the process and still lead to effective outcomes (Shorr, 2012).

Moreover, the presence of institutional policies and assessment frameworks is relevant for ensuring that the approaches are well formulated. The policies may be developed through the guidance of the nurses or other bodies concerned with the patient safety in the healthcare facilities.