The Boston Globe had an article claiming that safety alarms on beds and wheelchairs may not be as effective as nursing homes wish. Typically, care facilities attach alarms to beds and wheelchairs of patients considered at risk of falling. The pressure-sensitive devices have been used since physical restraints were outlawed in the 1990s.  Removing alarms is part of an effort by Hebrew SeniorLife and other innovative caregivers to change the culture of nursing homes. Nationwide, it has been spearheaded by the Pioneer Network, a consortium of geriatric professionals that since 1997 has promoted greater autonomy and more personalized care for seniors.

But do alarms really keep residents safer? Are they worth the price of leaving them in fear of making the slightest move, interrupting their sleep and that of their roommates, and driving nurses and nursing aides to distraction every time one goes off?

Hebrew Rehab has virtually eliminated alarms from its rehabilitative and long-term care facilities in Roslindale and at NewBridge on the Charles in Dedham. Previously, 30 percent to 40 percent of the 600 patients had bed alarms, chair alarms, or both.  Since fully implementing the program a year ago, Hebrew Rehab has not seen an increase in falls or serious injuries, said Tammy Retalic, chief nursing officer at Hebrew Rehab. And as residents free themselves from the tyranny of alarms, more are walking, eating, and dressing without help.

“This is a movement away from arbitrarily restricting people,” said John N. Morris,director of social and health policy research at HSL’s Institute for Aging Research, an affiliate of Harvard Medical School. “It’s about giving them dignity and independence in terms of functions in their life.”

Genriyetta M. Sitnikova is among those freed from alarms. Sitnikova, who had been very independent, wouldn’t get up at night to use the bathroom, worried that the alarm would wake her roommate, said her daughter, Sofia Verbitsky of Stoughton. During the day, she feared making a move in her wheelchair.

If somebody has a very high risk of falling, we monitor them very often.’ said Bozhena Kogan, nurse, Hebrew Rehabilitation Center.  Instead of just poking their heads in a room to make sure patients were OK, nurses and nursing assistants would pose a series of questions: “Would you like to go to the bathroom? Would you like a drink? Do you feel comfortable? Do you have any pain?”  Unless a staff member is nearby, the patient is on the floor by the time help arrives, with or without an alarm.  “If anything, the alarms gave staff a false sense of security,” said Lynda Crandall, executive director of the Pioneer Network and a gerontological nurse practitioner in Oregon.

The nursing staff must be proactive, addressing patients’ needs before they would try to get up on their own. The staff found that even patients with serious dementia displayed patterns of behavior that could be anticipated.  Based on their observations, the nursing staff refined care plans. “If somebody has a very high risk of falling, we monitor them very often,” said Kogan.

At shift changes, nurses and aides would meet briefly to discuss changes in patients’ emotional and physical health. After the pilot program proved itself over five months, Hebrew Rehab phased in purposeful rounding throughout its facilities. It all comes down to adequate staffing based on the needs of the residents.

 

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