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Nursing homes phasing out alarms to reduce falls


    Jenna Heim, director of nursing at Oakwood Village Prairie Ridge in Madison, Wisc. has phased out use of personal alarms and other long-used fall preventions like fall mats and low beds in favor of more proactive care. The changes, which took effect in June, are part of a nationwide movement to eliminate such measures.

MADISON, Wis. >> Alarms no longer go off when a resident shifts in bed or rises from a wheelchair at Oakwood Village Prairie Ridge in Madison. Nurses no longer place fall mats next to beds or lower beds to the floor when residents sleep.

The changes, which took effect at the nursing facility in June, are part of a nationwide movement to phase out personal alarms and other long-used fall prevention measures in favor of more proactive, attentive care. Without alarms, nurses have to better learn residents’ routines and accommodate their needs before they try to stand up and do it themselves.

“We’re putting alarms on residents so we can forget about them,” said Jenna Heim, director of nursing at Oakwood Village Prairie Ridge.

The use of bed and chair alarms proliferated in the 1990s, when physical restraints were banned, and are intended to go off when a resident’s weight shifts, indicating they may be trying to stand without assistance. But a growing body of evidence indicates alarms and other measures, such as fall mats and lowered beds, do little to prevent falls and can instead contribute to falls by startling residents, creating an uneven floor surface and instilling complacency in staff.

Nursing professionals, advocates and regulators say such alarms will likely be phased out almost entirely within a few years, though a spokesman for the federal Centers for Medicare and Medicaid Services said there’s no timeline for any formal, widespread changes.

Some staff and family members have been hesitant to let go of the alarms, worrying the change will lead to an increase in falls.

“What we really need to do is understand why that individual is wanting to get up in the first place,” said Joan Devine, director of education at the Pioneer Network, which is pushing for national changes.

There isn’t clear data on how many Wisconsin facilities have gone alarm-free, but a letter from Lasata Senior Living Campus north of Milwaukee notifying families about its own transition to being alarm-free says it’s one of only a few facilities left in the state that haven’t made any changes.

About 1,800 older adults living in nursing homes die each year from fall-related injuries, according to the Centers for Disease Control and Prevention. Research shows a reduction in falls at multiple long-term care facilities that discontinued the use of the alarms and tailored fall prevention for individuals — things like altering bathroom schedules, room rearrangements or more mental stimulation.

At the Jewish Rehabilitation Center for the North Shore in Massachusetts, the Massachusetts Peer Review Organization found a 32 percent reduction in falls for the unit in the final quarter of 2005 as it went alarm-free, compared to the average number of falls for the first three quarters of 2005. At a long-term care facility in Ohio for those with Alzheimer’s disease or dementia, researchers also found a decrease in the rate of falls and staff members reported a “calmer, more pleasant environment.”

Heim said she started researching the potential move in February, but it took her a while to get staff on board. Other Wisconsin facilities, like St. Mary’s Care Center, are gradually phasing out the alarms but still use them for some residents.

Going alarm-free isn’t yet possible for every nursing home, but it’s generally becoming a best practice as nursing facilities work to create the most home-like setting for people who live there, according to John Sauer, executive director of LeadingAge Wisconsin, a network of nonprofit long-term care organizations.

“An alarm system doesn’t prohibit falls,” Sauer said.

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  • ● “We’re putting alarms on residents so we can forget about them,” said Jenna Heim.

    Similar increases in adverse outcomes ate seem when agitated nursing home residents, such as those with dementia, are “treated” with antipsychotic medications. Calming then allows staff to ignore them and the usual causes of the agitation – physical discomfort (hunger, thirst, need to use the bathroom, pain from an infection or other acute medical condition).

    In hospital settings this same approach has been taken with regard to giving many patients liberal doses of narcotic pain killers. This has allowed facilities to operate with reduced numbers of floor nurses, and reduced labor costs. This has been one factor in our national opioid addiction crisis.

    Overall, these harmful approaches reflect our society’s increasing preoccupation with computerized data entry and one size fits all technological fixes. In most cases, better outcomes come from focusing on getting to know one another. Strong relationships are necessary to properly care for patients – gadgets, protocols and computer data are secondary. The same is true for relationships between students and teachers in our schools, and for most other endeavors that involve one person helping another.

    Let us hope that we soon transition past the current digital ‘Information Age’ to the coming ‘Era of Relationships’.

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