Not all alarms are equally important. Critical alarms, such as those on ventilators and smoke detectors are essential. Likewise, alarms on intravenous pumps and exit doors are often necessary. But, what about bed and chair alarms, also known as “personal alarms”?
Prior to the Omnibus Budget Reconciliation Act of 1987 (OBRA ’87), the use of physical and chemical restraints in long-term care facilities was widespread. Following OBRA ’87’s focus on quality of care and enhanced enforcement actions, the use of restraints diminished while the use of bed and chair alarms grew exponentially. The primary purpose of bed and chair alarms is to alert staff to a potential fall when a resident attempts to get out of bed or up from a chair. Bed and chair alarms are typically pressure sensitive devices placed in beds, chair pads and wheelchair seats that respond to changes in pressure with a warning signal. Other alarms are wearable or can be attached to a resident’s clothing, programmed to activate when the person attempts to move a certain way or beyond a certain distance.
However, the widespread use of personal alarms may not be justified, and, in some cases, may be more of a liability burden than a resident benefit. Surveyors frequently ask whether alarms are used and incorporated into the care plans of residents who either fell or are at risk for falls. There is no shortage of cases where the failure of an alarm to function properly resulted in a deficiency and a civil money penalty (CMP) imposed by the Centers for Medicare and Medicaid Services (CMS). In the 2008 case JFK Hartwyck at Oak Tree v. CMS, Administrative Law Judges held that “alarms that were not working properly would not have constituted adequate assistance devices as required.” More pointedly, said judges in the 2005 case Birmingham Nursing & Rehabilitation Center—East v. CMS: “Once [the facility] opted to utilize an alarm to protect the resident, it assumed the responsibility of making sure that the alarm worked properly.” Apart from concerns about survey deficiencies, facilities need to examine if alarms are more of a problem than a solution.
Approximately 1,800 nursing home residents die each year as a result of falls, according to Falls in Nursing Homes, published by the Centers for Disease Control and Prevention (CDC). The CDC notes that the “typical nursing home” with 100 beds reports between 100 and 200 falls each year, and of those falls, 10–20 percent are associated with serious injuries.
Research published in the Journal of Nursing Care Quality suggests that little evidence exists to demonstrate that alarms prevent falls. On the contrary, evidence is growing that personal alarms create confusion, anxiety and adversely affect the quality of life of residents. Worse, alarms can be counterproductive by fostering a false sense of security for staff and creating a reactive rather than proactive paradigm.