Bed Alarms Don't Work??

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.  

Sphere3® announces partnership with Stryker

Sphere3®, the industry leader in medical device alarm and alert analytics, has partnered with Stryker to provide a next generation bed-related compliance and safety alarm management tool.  Stryker’s new iBed Wireless system uses state-of-the-art sensory and communication technology to provide real-time smart bed data about patient position and bed configuration to enable determination of bed compliance with hospital safety standards and safety risk conditions.  The iBed Wireless system also produces and alarms wirelessly for notification of potential patient falls.  Additionally, data about siderail position, bed exit, brake, bed height, and more will be visually displayed and combined with other medical alarm and alert data to provide better insight into the patient's safety and other aspects of their stay.

“We are excited to partner with Stryker beds.  It's powerful for our clients as they build a non-filtered view of the patients stay through their movement, request patterns, and physiological alarms.  Stryker beds produce data and combined with our analytics tool it's amazing to see the picture of the patient stay.”  CEO, Kourtney Govro.

Cerner Health Conference

Living here in Kansas City everyone “knows” or more accurately claims to know something about Neal Patterson.  As the iconic entrepreneur walked by my second row seat and took the stage for his Keynote at the Cerner Health Conference,  I wasn’t sure what to expect.    I tried to brush aside all the good and bad I’ve heard and just listen to see if I could connect to him and Cerner.  

I expected a politician – slick with perfectly constructed and managed content.  A more accurate description is comfortable, confident and owning the content.   Dressed casually, he appeared more approachable than intimidating. His speech style was more conversational than choreographed.  The “picture in his head” is much more detailed than what he could share in the time frame.   He was funny and entertaining – much more than I expected.  I take time to describe him because when you read about what he said I want you to see this picture of him.   These are sound bites with my interpretation. 

“We must separate Health and Care”
Cerner, throughout the conference, delivered the next frontier of their ambitious goals: Managing health as opposed to maintaining a sick society.   The Solutions Gallery Floor was split into three areas Foundation, Organizational Excellence, and Community.  When you entered the solutions gallery floor the first thing you see is Foundation.  Many times when I have talked to people about being able to interpret data we have to step back and look at the way it’s collected and the model in which it is stored.  The Foundation is representing the “Care”.  How hospitals document and gather the information that improves the care of the patient.   Though the pods were a little fragmented and hard to see the vision of how they all played together the message was one foundational platform to collect data.

If you think about the future of care it’s built on the foundation of data.  Think of it this way – if you build your house on sand there is no way to maintain the stability of the structure.  If you build your house on a solid foundation then expansion and stability are givens.

Across from Foundation is the next frontier the “Health” what Cerner noted as Community.  I thought the visual was quite nice – the past was facing the future.   We MUST start managing the wellness the health of not only an individual but of entire populations. 

“What Steve Jobs did in regards to music – Cerner is doing with health data”

I found this statement extremely bold, but accurate. The challenge with most leaders is to be able to drive vision, growth and domination in an industry you are often seen as prideful.  While I agree with some of the pundits – a self comparison to the actions of Apple, the benchmark for transformational innovation, is not the most humble of statements – the only thing I would throw back – isn’t it pretty accurate?   Cliff and Neal took the documentation of processes and have systematically transformed it into a billable standard. And amazingly have driven such change into the industry that the government has seen the benefits of this documentation and will now subsidize their growth through mandates to their core customers.

The thing I would challenge Cerner on is this – Apple has the unique ability to take a complex idea and make it simple to use, visually appealing, and extremely easy to understand.  On the BI side - I didn’t quite see that in Cerner yet – not saying they won’t get there.   They have built a firm foundation – collection and storage of data.  The hard part is the presentation of the data in a useable manageable format. 

The center of their Solutions Gallery was the Organizational Excellence.   I stopped in to see their dashboards and examine their process.   My take away and I hope this isn’t too harsh – they are just not there yet….a little bland and canned.   My encouragement to them – the people who will be successful in the BI space are those who can take the data and do what Neal told the audience Cerner will do “We will future proof your organization” he said that in regards to how the government will change reimbursement based on the collected data.   Somehow you have to take your incredibly complex data set and deliver it to leaders in the hospital in useable fashion.   Most people are not data junkies.

I will say this as a note to the other EMR companies – my money is on Cerner to do this first and from being first they will build the standard.  If you are not all ready in the space you are all ready behind and if you are looking at only the EMR data set – you won't catch them.

The final two statements hit home for me and if you listened to what Neal Patterson was saying they were actually quite revealing to who he is as a person.  

“We are all mortal with a huge instinct to survive.”

There is an underlying ambition to extend life and improve the quality of life.  While not the most personable way to put this thought to the audience – it was a directive.   From a technical standpoint this is the push to build PHR and build it well.  Driving home the point that we must manage health creating a foundational platform like Cerner has done in the “Care” space for the “health” space.  Fixing PHR.  

 “If we know something and we know how to predict it in the future why aren’t we doing it?”

I am not sure if the crowd heard it, but I heard frustration in this statement.   When you hold great power, knowledge, data……when you can see the future and you are pulling those around you to understand it…..when your mind understands that all the pieces of the puzzle are there and all we have to do is put them together….. it’s almost excruciating.  It’s a blessing and a curse to have a vision. 

When that type of driving vision is mixed with a personal experience it intensifies in a way that many won’t understand.  Neal’s top 4 things he wanted to accomplish in this decade – one was “Save Linda’s Life”.    Linda, his sister in law, died from Sepsis.    Can you imagine being one of the most powerful people in healthcare and losing a loved one to a preventable medical error?   Knowing that the data contained in your servers holds a key to change possibly annihilate this and other preventable medical errors?   With great understanding, knowledge, and blessing comes great responsibility - great responsibility engages great pressure.

In closing - Cerner is not Disney World – not what I would describe as “friendly” place but they are knowledgeable and they are incredibly capable and powerful.  They will find answers and save lives.   I am not sold on them as an organization, but after this speech I do see that the leader has passion and purpose.