Personal alarms are devices designed to emit a warning signal when a person moves in a way perceived to put them at risk, usually for falls. In nursing homes, a common type of personal alarm is a pressure-sensitive pad for chairs, wheelchairs and beds that activates by sounding an alarm when the person moves and there is decreased pressure.
Several years ago, nursing home staff came to understand the harmful effects of restraints, and stopped using them, because restraints cause decline in a person’s physical, mental, and emotional wellbeing. By keeping people from moving, restraints adversely affect their respiratory, digestive, circulatory, and muscular systems, contribute to depression and isolation, and inhibit sleeping as well as independent eating, drinking, toileting, and natural repositioning. Originally, personal alarms were used as temporary measures, to help staff learn more about the resident’s movement patterns. However, as staff began to stop using restraints and changed practice, the use of position change alarms became widespread, and they are now commonly used with residents for indefinite periods of time. Staff, and sometimes families, thought they might be helpful, and surveyors in many states began looking for them as part of the documented safety plan.
However, just as restraints cause harm by keeping people from moving, so do personal alarms. There is also no evidence to support alarms’ usefulness in preventing falls or injuries. In fact, in most cases, falls continue to occur. From a practical perspective, many residents dislike them and repeatedly hide or remove them, devices malfunction (the cord breaks or detaches, batteries die, alarms fail to go off or are slow to respond), and if too many are in use, the warning sound loses its effectiveness at alerting staff.
For residents, there can be numerous negative consequences to their quality of life and mobility:
- Alarms create noise, fear and confusion for the person and those around them. For example, one gentleman would duck down when he heard the alarm as he was interpreting the sound to mean incoming missiles, bullets from his World War II experience. For people who are cognitively impaired, the alarms can be particularly upsetting: they are disturbed by the noise and have no way of understanding why it is happening
- If staff tell the person to sit down when the alarm goes off, the underlying need causing them to want to move is not being addressed (do they need toileting, are they in pain, are they stiff and uncomfortable from being in one position?)
- As the use of the alarm decreases the person’s overall mobility, they may be more at risk for fracture when they fall since the person may have increased weakness and osteoporosis and decreased balance and endurance
- The alarms can be experienced as embarrassing and an infringement of freedom, dignity, and privacy
- Skin break-down can occur from being immobilized, and from being afraid to shift position or body weight while sitting for prolonged periods of time, or while lying in bed at night
- Sleep may be interrupted, or even impossible when residents lie still for fear of setting off the alarm if they shift their position, or are awakened by the alarm. Lack of sleep compounds agitation and contributes to loss of appetite and decreased balance and endurance. The medications used to treat agitation and sleeplessness often add to these problems
- Loss of independent bowel and bladder function can occur
One of the reasons alarms don’t work is that they are reactive rather than proactive, because they only indicate to staff that the resident has moved, or has already fallen. Further, CNAs responding to alarms are often distracted from other important duties, including ADL care and communication with residents. Without a doubt, there are many people in nursing homes who are at risk for falls and injury and who need to have a safety plan in place. However, these plans need to be highly individualized and based on a thorough assessment of the risk factors that exist for the person and her/his clinical condition, in the physical environment and also the organizational environment. The alarms provide a clear example of an intervention that, by attempting to prevent the risk of falling, may actually increase the risk of serious injury from falling. They give a false sense of security and at the same time, absorb an inordinate amount of staff time responding to the alarm.
Increasingly, nursing homes are eliminating the use of these alarms. Isabella Geriatric Center in northern Manhattan did so about three years ago, resulting in a reduction of the incidence of falls. They first eliminated the use of bed and chair alarms in 2009, and have maintained the reduction in falls all this time. They developed a careful plan to accomplish this, which involved assessing the needs of each individual resident. In the Bronx, Morningside House was also successful in eliminating the use of bed and chair alarms. The Jewish Rehabilitation Center for the North Shore in Massachusetts also recently eliminated the use of alarms, and they too discovered that they were able to reduce falls at the same time. The step-by-step approach they took to eliminating alarms is described in a Case Study published by the Massachusetts Peer Review Organization (MASSPRO, see link at left). As all of these facilities would agree, in most cases, the best way to prevent the risk of falls with injury is to promote residents’ balance, endurance, and overall mobility resulting in a reduction in the incidence cap.
Adapted with permission from “Rethinking the Use of Position Change Alarms” by Joanne Rader, Barbara Frank and Cathie Brady.