PA PSRS Patient Saf Advis 2004 Sep;1(4):14-5.
Bed Exit Alarms to Reduce Fall Risk
Gerontology; Nursing
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Bed Exit Alarms to Reduce Fall Risk

Bed exit alarms warn caregivers when patients leave or attempt to leave their beds. While they can be an important component of a fall prevention program, they are not always used effectively. This article highlights the main considerations regarding bed exit alarms to help the clinical community get the most out of this technology.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) cites bed exit alarms as both part of effective risk reduction strategies and as one of the root causes of problems when they malfunction or are misused.1 Both situations are reflected in the reports submitted to PA-PSRS. In just the short period since mandatory reporting began in June 2004 through early August, PA-PSRS received over 145 reports of falls where bed exit alarms were in use, 20 of which were Serious Events.

The principle behind bed exit alarms is that they warn caregivers, and in some cases patients themselves, when a patient leaves or attempts to leave the bed. They are not restraints and do not prevent falls by themselves.

Here are some things they can do:

  • Warn the caregiver that the patient has changed position and is about to leave the bed. This may give the caregiver enough time to enter the room and assist the patient.
  • Warn the caregiver that the patient has already left the bed. This may give the caregiver enough time to intercept the patient before a fall or at least to respond more promptly if the patient has already fallen.
  • Warn the patient that they are “doing something that they shouldn’t.” In some cases the sound of the alarm may remind the patient to call for assistance and prompt them to sit back in bed.

Bed alarms are made in many forms. A common form is a pressure-sensitive pad that is placed beneath the patient, usually in the shoulder area or in the area of the buttocks. The pad is attached to a control unit that is generally mounted on the bed or the wall. Placing the pad beneath the buttocks reduces the incidence of nuisance alarms for some patients but may provide the caregiver less “lead time” in responding to activated alarms. Other forms of bed alarms include:

  • Cords and garment clips consist of a control unit mounted on the bed or the wall and a cord that is attached to the patient’s clothing. The alarm is activated when the patient exits the bed and detaches the cord from the control unit.
  • Patient-worn alarms are attached directly to the patient (for example, by means of a leg cuff) and are activated by changes in the patient’s position.
  • Floor mats are pressure-sensitive mats placed alongside the bed.
  • Bedside infrared beam detectors are typically set up next to the bed or on the wall to send a beam over the top or alongside the bed. They are activated when the patient breaks the beam.

The control units for these devices vary in the features they offer, including latching and non-latching alarms, alarm delay and standby features to temporarily disable the alarm. Some of the units can also activate the nurse call system.

Some keys to properly using bed alarms may include:

  • Knowing what your bed exit alarm is and how it works.
  • Using the right type of alarm for your patient. Many reports describe patients removing alarms clipped to their garments or otherwise deliberately deactivating their alarm. Also, remember that some patients with hearing deficits may not hear their own alarms.
  • Understanding that bed exit alarms may improve the timeliness of your response to a situation but do not prevent falls by themselves.
  • Following your protocols for assessing the risk of patient falls and considering the use of bed exit alarms as part of an overall fall reduction program.

Resources

Agostini JF, Baker DI, Bogardus ST. Prevention of falls in hospitalized and institutionalized older people. Chapter 26. In: Making health care safer:  a critical analysis of patient safety practices. Evidence report/technology assessment no. 43. Rockville (MD): Agency for Healthcare Research and Quality; 2001 Jul. AHRQ 01-E058.

ECRI. Bed-exit alarms a component (but only a component) of fall prevention. Health Devices 2004 May;33(5):157-168.

ECRI. Bed-exit alarms evaluation [in press]. Health Devices 2004 Sep;33(9).

Department of Veterans Affairs, National Center for Patient Safety. Tips on fall prevention [online]. 2002 Mar 29 [Cited 2004 Apr 23]. Available from Internet: http://www.patientsafety.gov/falls.html.

Notes

  1. Joint Commission on Accreditation of Healthcare Organizations. Sentinel Event Alert [online] 2000 Jul 14;14. Available from Internet: http://www.jcaho.org/about+us/news+letters/sentinel+ event+alert/sea_14.htm.
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