I
recently read a blog by KevinMD – a blogger I really enjoy following –
regarding the use of bed alarms and their lack of ability to reduce fall rates.
(http://www.kevinmd.com/blog/2013/01/bed-alarms-work-reduce-patient-falls.html)
I found his blog very interesting (especially
since we now interface more fully with smart bed technology). So being the nerdy geek I am – I did some
investigation. The blog is referring to
a study done that compared falls at a single ubran hospital over a period of
time. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3549269/
The simple summation is that “bed alarms” do not have a
significant impact on reducing falls in a hospital.
When someone says “Bed Alarms” they are generally
reffering to any type of technology that notifies the caregiver that a patient
has exited the bed. So the technology
itself is anything from a pressure pad to smart beds. The study referenced was conducted using
pressure pad type of alarm with two weight sensitivity settings.
Most pressure
pad looks similar to a strip of material that is laid under the patient on a
bed, to integrate it to a call light system (ie having the centralized
notification) you plug it into a quarter inch jack. (A quarter inch jack is
like a phone plug from the old operator based phone system where you crank the
phone the operator answers and then physically connects your call to
another) The technology is a contact
closure – it is “on” of “off”.
The study
used a pressure sensitive pad that is placed in the bed or chair. So, if you scoot to the edge of the bed but
keep the pressure applied to the pad then you will not trigger an alarm until
the patient falls on the ground. Or commonly when they are sleeping and the
patient arches their back to adjust their gown, the alarm goes off – thus
alarming and waking the patient. (which
would link to that whole “noise at night” issue with HCAHPS) Further, this type of technology is prone to
false alarms which can be linked to alarm fatigue situations.
However, more
modern “bed alarm” technology, such as Stryker’s iBed, allows the bed alarm to
be triggered based on zones and weight of the patient. There is an actual algorithm that evaluates
the patient’s weight to determine where the center of gravity is located. The cool factor here is that instead of an “on/off”
technology it uses the potentially varying weight fo the patient to engineer a
more precise alarm to indicate when the patient is moving TOWARD exit. This does two things, it notifies prior to
exit and reduces the occurrences of false alarms. Think of it like the Indiana Jones scene
where he replaces the idol with a bag of sand and it triggers the cave in.
Some of the smart
bed technology work on a similar assumption where a variation in weight
triggers the alarm, the reason I think that Styker’s is so effective is that
the “weight” is actual. Most beds look
for a shift of 20lbs or so but do not take into account the actual weight of
the patient. If a patient is 90lbs and
20lbs moves that significant if the patient is 300lbs and 20lbs moves that may
not be as significant.
In the Styker
product, the clinician determines the level of sensitivity. It can be based on acuity or a fall
evaluation. The level of sensitivity
will actually measure the movement of the patient TOWARDS egress not at the
point of egress.
So,
do I agree with the study – yes, it appears that the technology that was evaluated
in the study had little to no impact on the patients fall rate. Do I agree that “bed alarms” as a category
are ineffective? No, I don’t think technically that is the best assumption.
I do
agree fully with KevinMDs statement “Maybe
we need to rethink hospital fall prevention, and focus on more human and less
technical solutions.”
A
bed alarm – like any medical device or alarm notification technology should be
part of a more comprehensive plan – technology alone does not solve. Think of it this way – if you buy a treadmill
and just look at it, it won’t improve your health. If you buy a treadmill and walk on it every
once in a while….it won’t improve your health.
If you buy a treadmill and run on it every day but eat cupcakes every
day….it won’t improve your health. The
“treadmill” is not the answer – the “treadmill” is a tool to be used in
conjunction with behaviors and habits.
Check out our clinical blog.
(www.sphere3consulting.com) where CNO Lynn Barrett
discusses some of their holistic approaches to reducing falls.
