Sample IT-Web Term Paper on The Use of Bedside Alarm in prevention of Falls in Acute Health Care Facility

The Use of Bedside Alarm in prevention of Falls in Acute Health Care Facility

Introduction

There are numerous cases of hospital falls that lead to injuries and even death of the inpatients in the healthcare facilities. To curb this problem, the recent advances in information technology have presented the institution with various options of using technology to detect the occurrences of these falls and arrest the situation before the damage happen. The most preferred and commonly used device to help in the prevention of inpatients falls in the health care facilities is the alarm system (Shorr et al., 2012). However, there have been issues arising from the use of this technology, as cases of falls continue to be reported in these institutions even when they are used. This then raises the question of whether these devices are effective in preventing inpatient falls in health care facilities.

Statement of the Problem

Bedside alarms are not effective in reducing inpatient falls in health care facilities

Rationale

It is significant to determine the effectiveness of alarm systems installed in hospitals in reducing inpatient falls because this intervention will relatively reduce the injuries related to falls and even death of the patients if it is appropriately utilized. However, the effectiveness of the alarm systems depends on other factors such as the human intervention to respond on time to save the situation, which has brought about the question of the efficiency of the alarm technology. The right IT must be applied to ensure that the alarm systems effectively achieve their intended purpose.

Review of Literature

Can bedside alarm systems be used to prevent falls in health care?

Inpatients’ falls are serious and jeopardize the safety of the patients and depict a quality problem. Medical experts define a fall as an unexpected event where a patient abruptly comes to rest on the floor or a lower level.  Most of the falls in healthcare facilities occur near the patients’ bed or in the bathrooms. It is shocking to note that the majority of the falls go unobserved, while many of them result in fatal injuries and others even death. Thus, admitting a patient in a healthcare facility is a risk in itself, and the age of the patients plays a big role in determining the level of the risk. Study findings show that there are about 1.9 to 3% of patients’ falls in acute care hospitals (Shorr et al., 2012).

About 2 to 15 percent of all inpatients experience at least one fall for the period of their hospital stay. From these falls, about thirty percent result in serious injuries on the patients often causing death for those aged 65 years and above. Ten percent of all fatal falls in the aged population happen in hospital institutions. Some of the factors leading to hospital falls consist of the environmental conditions of the institution and issues related to the medication given to the patient (Zhen et al., 2012). This proposal, however, will investigate whether the alarm system effectively reduces inpatient falls in an acute care facility.

Sometime back, the health care facilities used bed rails in attempts to reduce drugged and confused patients from falling until it was discovered that the rails caused more harm than good. The rails caused more deaths to the patients by making the falls more dangerous and trapping the patients until they died (Pearson & Coburn, 2012). Thus, in the last two decades, the alarm systems have increasingly been implemented in the hospitals to reduce the fall of the inpatients. However, it has been found that the bedside alarm systems have not successfully reduced the falls in the hospitals as it was anticipated when it was introduced into the healthcare facilities.

Most of the falls affect the aged inpatient population and the injuries caused by the falls cost the institutions a lot of money (Zhen et al., 2012). Medicare stopped to cater for the costs of injuries sustained from the falls, mainly if the assessment of the specific cases indicated that the accident could have been avoided (Shorr et al., 2012). Some research work has found significant proof that there is no much effect of the alarms in reducing falls, particularly to the people aged 65 years and above based on several variables such as demographic factors, response time, staffing levels and psychotropic drug administration. A study carried out at Methodist Healthcare-University Hospital in Memphis, over a period of one and a half years and on 349 beds indicated that the falls of patients that used alarm systems more often were just as frequently as those that did not use the alarm more frequently (Shorr et al., 2012).

How the Alarm Works

The alarm system is built in a way that when it goes off; it sounds in the room of the patient as well as make a call to the nurses’ station, to alert them of their required response to help the patient. It operates by using sensitive sensor pads, which are strategically placed on the patients’ bed or chair of the commode. Then the patient presses on the alarm system, and the contact between the sensor pads and the alarm breaks, making the alarm go off; thereby producing the sound and the call at the same time. For the case of patients who are the risk of falling off their beds, the alarm is placed somewhere between the buttocks and or the shoulder blades (Pearson & Coburn, 2012).

Placing the alarm system in an upper position such as the shoulder blade, it allows the caregivers enough time to reach the patient before they completely try to get off the bed and increasing their risks of falling. To exclude false alarms, the sensing interval is increased from 4 to 8 seconds on the pressure pad (Shorr et al., 2012). When the alarm system is used on patients’ chairs, it immediately sounds when the patient attempts to raise their bodies off the sensing pads. These alarm systems have been used significantly in maintaining patients’ privacy by being wrapped around the edge of a toilet seat to monitor patients that are rising from the toilet unassisted.

Management of Clinical Alarm Systems

It has been reported that patient injury from falls still occurs even with the alarm systems in place in the health care institutions. The reason for inpatients to still suffer from falls is due to inappropriate use of the alarm systems, ineffective alarm coverage or delayed response after the alarm goes off. According to the National Patient Safety Goal for 2004, the issue of clinical safety was lifted to a higher priority in the hospitals that were certified by the commission (Zhen et al., 2012). The commission recommended that the hospitals had to address their culture, technology, and practices to effectively and efficiently manage the alarm systems.

The recent advances include the physiological monitors that network the system so that it does not only sound in the patients’ rooms, but also sends the signal to the nurses’ station. Other initiatives include the enunciators, which provide audible alarms in places that would however be difficult to hear the alarm. Alarm management should be incorporated into the system so that there are rescued cases of alarm fatigue and missed events to reduce the falls and consequently curb the issue of falls-related injuries (Shorr et al., 2012). The roles of the facilities leaders, funding, and the IT personnel in the planning process is crucial to ensure the proper wiring of the hospital units with the alarm systems is a success.

Findings of the Effectiveness of the Alarm System

According to study findings, Thurston, 1957, stated that falling incidents among patients are not very high, the individual consequences and risk of litigation offer incentive to curb these incidences. On October 2008, Medicare reimbursement to treat injuries arising from inpatient falls was denied to hospitals in America that reported falls that could have prevented. Research works have indicated that most falls occur in hospital units that provide elder care, neurology, and rehabilitative care. A meta-analysis study that involved 17 published articles with randomized controlled trials between the years 2000 and 2009 revealed that the combined risk ratio for the number of the falls in these institutions was 0.855 (Capezuti, Brush, Lane, Rabinowitz & Secic, 2009).

When programs to combat falls were introduced, there was a fourteen percent fall rate reduction, even though, with considerable heterogeneity. Appropriate assessments provide a means of identifying the patients who are at risk of falling and the opportunity to implement proactive interventions that are geared to reducing these occurrences. The Aperum is a computer system that was innovated to be connected to the bed call light system so that it would capture all the occurrences that were happening before a patient fell (Shorr et al., 2012).  This device would monitor the incidences that lead to the fall of the patients, and this real-time data would help in coming up with the best solution to counteract the incidences before they happen (Bridi, Silva, Farias, Franco & Santos, 2014). This data will enable the management to know when to assign staff that would be closest to help the patient by preventing the fall whenever the patient would exhibit the signs leading to a fall.

Research has also revealed that this technology has been successful in limiting falls among inpatients during their hospital stay. However, conclusive research to evaluate the effectiveness of this software to determine its performance in the correlation to its accuracy in helping the management to determine the possibility of a patient having a fall and its effectiveness in helping the management take the appropriate measures to reduce the incidences of falling (Capezuti, Brush, Lane, Rabinowitz & Secic, 2009). Thus, there is a need to carry out this study to determine the effectiveness of this software in reducing falls in hospitals, more so those that happen when the patient is on the bed. There is a need first to determine whether this software can proficiently intervene in ensuring that evidence-based practice is provided. Research findings have shown that most people who fall in the health care facilities are the aged and mostly are 60 years and above(Zhen et al., 2012).

Contrary to the findings of using the bed alarms have been reported by some researchers where it is said that some patients use the alarm system just because they are agitated, confused, or do so in the presence of a health care provider, which all send an altered analysis and deter the effectiveness of making an observation that would help in devising a strategy to prevent a fall. Thus, in addition to the use of alarm system, the institutions still utilized the hourly monitoring to effectively help the patients (Bridi, Silva, Farias, Franco & Santos, 2014). When the alarm system was put into test during the study, the nurses cited that they were becoming “alarm fatigued” because of the energy they used to respond to all alarm rings (Shorr et al., 2012). Thus, most of these nurses confessed to stopping to respond to the alarm overtime, which raises another need for further research to identify when the use of the alarm technology is helpful for both the nurses and the patients.

Counteracting findings indicated that during a study to determine the risks of falling and the use of alarm systems to counter the risks of falling, there was no correlation to the medicine given to the patients two hours before the study and the actual risk of falling. This finding counters those that find that the medication given to the patient plays a big role in increasing their risks of falling. According to studies supporting this notion indicated that 62 percent of the patients who fell following the administration of a particular drug, fell from the effects of antidepressants that they were receiving before they got admitted into the healthcare facilities (Zhen et al., 2012).

Research done by Elizabeth et al. (2008), described the effectiveness of two types of bed-exit alarms detect the movements that were displayed by the patients while trying to exit their beds. In their investigation, the researchers used the pressure sensitive alarm systems and the dual sensor system that has both the pressure sensitivity and infrared beam detectors. Their study also looked into the issue of alarm nuisance, which occurs the alarm goes off, but the patient did not intend to leave the bed. This study included a sufficient number of participants for a total of 14 nursing homes were investigated, and this research went on for 256 nights (Zhen et al., 2012). Their research findings indicated that the dual sensor alarm was more accurate in detecting the patients who were at higher chances of falling and showed a positive feedback over the correct numbers of those patients that left their beds. The dual sensor produced fewer false alarms as compared to the sensor pad alarm, but they were not eliminated for the purpose of the study. It is important to note however that the alarm systems are not intended to substitute for staff, and thus there is a need to have adequate staffs that are available to help the patients when they need and wish to exit the bed.

The use of the alarm system has been cited to largely increase the surveillance of the patients that are mentally and or physically challenged when attempting to exit their beds, chairs or rising from the toilet seat.  The alarm systems, whether located on the bed, on the patients’ garment as a clip and as pressure sensitive mat, the staff is informed when the patient intends to leave the bed, has left the bed or has already fallen (Capezuti, Brush, Lane, Rabinowitz & Secic, 2009). Despite the wide use of these devices by many healthcare institutions around the world, there is no conclusive evidence to fully support the reliability of these devices in detecting the resident movement out of bed.

Discussion

Conflicting research findings have shown that the introduction of the alarm system in the health care institutions has helped reduce the rate of inpatient falls by alerting the caregivers before the incidence of falling occurs, while others have questioned the effectiveness of the alarm systems (Zhen et al., 2012). There are several ways the alarm are designed such as the use of the sensory pads or the sensory pads alarm used concurrently with the infrared beams to help detect when a patient is about to leave their bed, chair or the toilet seat. For the healthcare to understand the occurrence of events that finally lead to the fall of a patient, they first do a study by monitoring the alarm sound patterns and observing their relation to the events that lead a patient to fall, then this is the routine they put into consideration when they finally put the alarm system into operation (Bridi, Silva, Farias, Franco & Santos, 2014). 

Research has found that even with the introduction of the alarm system into the healthcare facilities, cases of falls have continued to be reported raising the question of whether the systems are effective in detecting and help the nurses arrest the situation before a fall happens (Shorr et al., 2012). Some of the reasons cited for the continued fall include the increased rate of false alarm, which leads to “alarm fatigue” making the nurses ignore most of the alarm sounds which lead to the falls. The other reason is poor management of the alarm, which has led to missed events causing the falls to occur undetected (Capezuti, Brush, Lane, Rabinowitz & Secic, 2009). The delay caused in responding to the alarm as well as a total non-response to the alarm compromises the safety of the patient. This, however, has not ruled out the importance of the use of the alarm system to reduce inpatient falls as the method has continuously been used and the positive effects noted.

Even with the application of the alarm system in the healthcare facilities, there should be a heightened focus on ensuring that enough personnel is available to help work together with the systems in reducing the falls. For instance, just like the old days before the advances in technology, there should always be people close by and on the look out to help patients at higher risks of falling. It is sad to consider admitting a patient to a hospital a hazard is in itself when these facilities should be entrusted with providing security to the patients (Shorr et al., 2012). The risks of falls, falls-related injuries as well as the deaths from the falls should be further reduced by having the personnel work very close to the patients other than the normal way that they are required to walk from the nurses’ station to the patient’s room since this wastes more response time (Pearson & Coburn, 2012). The monitors should be increased to include visuals such as the CCTV so that the nurses can see the cases that cannot be ignored and respond as fast as needed.

Research has shown that the continued reports of the inpatient falls have led to reduced funding to treat the injuries related to these falls as a way of encouraging more care of the patients. There is a need to impose penalties and punishment to the facilities in cases of inpatient falls such as firing the nurse responsible for the ignored alarms that lead to fatal falls. This can instill a more responsible attitude to the health care providers who deliberately ignore the alarm sounds just because they want to assume it is a false alarm (Capezuti, Brush, Lane, Rabinowitz & Secic, 2009). More surveillance can help in resolving these cases, by helping the nurses monitor their patients’ maximum as well as help the management to assess the response efforts and speed of the nurses in reducing falls in the hospitals (Bridi, Silva, Farias, Franco & Santos, 2014).

Conclusions and Suggestions for Future Research

With many study findings citing that the alarm systems help in reducing inpatients falls in hospitals and other healthcare facilities, there is a gap in the effectiveness of this technology in curbing the cases of falling (Shorr et al., 2012). For instance, there are still reported cases of falls related injuries as well as deaths resulting from the falls. The technology of the alarm system is designed in such a way that the sensory pads make a sound when the contact between the systems break, which means that unless the alarm system is faulty, it will automatically make the sound when it is necessary (Zhen et al., 2012). The problem of the continued reported falls, therefore, comes from the delayed response time from the nurses, the ignored alarm sounds from the nurses, and the blame of false alarms leading to “alarm fatigue,” and total misconducts of refusing to attend to the patients by the irritated nurses. Therefore, emphases ought to be placed on the health care providers to urge them to effectively play their role in reducing inpatients falls.

Further research on the effective use of the alarm system should be done after ensuring that the healthcare providers efficiently respond to the alarm and adequately help the patients to reduce falls in the healthcare facilities (Bridi, Silva, Farias, Franco & Santos, 2014). Proper management of the alarm systems is the only way that research findings can produce conclusive findings of the effectiveness of the alarm systems. Thus, the gap that exists between the effectiveness of the alarm systems and the human errors in avoiding responding in time or avoiding responding at all can only be closed when these factors are addressed separately to adequately determine the effectiveness of the use of alarm systems (Shorr et al., 2012). Therefore, there is need to fully understand that the alarm systems alone cannot curb the rates of inpatient falls and that there are other factors that need to be considered such as the reliability of the healthcare workers. When all these factors are put into consideration, then the actual report of the effectiveness of the alarm technology can be determined.

References

Bridi, A. C., Silva, R. C. L. D., Farias, C. C. P. D., Franco, A. S., & Santos, V. D. L. Q. D. (2014). Reaction time of a health care team to monitoring alarms in the intensive care unit: implications for the safety of seriously ill patients. Revista Brasileira de terapia intensiva26(1), 28-35.

Capezuti, E., Brush, B. L., Lane, S., Rabinowitz, H. U., & Secic, M. (2009). Bed-exit alarm effectiveness. Archives of gerontology and geriatrics49(1), 27-31.

Pearson, K. B., & Coburn, A. F. (2012). Evidence-based falls prevention in critical access hospitals.

Shorr, R. I., Chandler, A. M., Mion, L. C., Waters, T. M., Liu, M., Daniels, M. J. & Miller, S. T. (2012). Effects of an intervention to increase bed alarm use to prevent falls in hospitalized patients: a cluster randomized trial.Annals of internal medicine157(10), 692-699.

Zhen, W., Tanja, P., Hempel, N., Wang, P., Shanma, A., Erry, D. & Johns, N. (2012). Review On The Evidence Of Falls Prevention In Hospitals. Task 4 Final Report.