Reducing and Discontinuing Resident Alarms. The False Reassurance of Personal Alarms

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1 Across the country, state health organizations, nursing homes, private and government quality improvement organizations have all been studying the impact of personal alarms on the lives of residents in skilled nursing homes. Our goal is to provide the best quality of care for our residents. We work to ensure that their safety, well-being and quality of life are what they wish it to be. Reducing and Discontinuing Resident Alarms The False Reassurance of Personal Alarms The findings, for the use of personal alarms, have not been positive: By keeping people from moving, restraints adversely affect people s respiratory, digestive, circulatory and muscular systems, contribute to depression and isolation, and inhibit sleeping. However, just as restraints cause harm by keeping people from moving, so do personal alarms. There is no evidence to support alarms usefulness in preventing falls and injuries. In spite of that, staff, and sometimes families, gravitated to the use of alarms. ~ Rethinking the Use of Personal Change Alarms. Quality Partners of Rhode Island, state Quality Improvement Organization, under contact with the Centers for Medicare & Medicaid Services, If you have any questions or concerns regarding our goal to reduce the use of personal alarms on our residents, please contact our director of nursing, administrator and/or social services at your convenience. Our goal is to provide the best possible care for our residents. A growing concern has been the continued use of personal alarms that attach to or are placed next to or near the body of the resident. We find this practice to be intrusive and undignified to the quality of life of our residents. We strive to maintain the safest environment possible, but the use of personal alarms has not proven to be of assistance in meeting this goal.

2 Personal alarms are alerting devices that emit a loud warning signal when a person moves. The most common types are: Pressure sensitive pads placed under the resident while they are sitting on chairs, in wheelchairs or when sleeping in bed A cord attached directly on the person s clothing with a pull-pin or magnet adhered to the alerting device Pressure sensitive mats on the floor Devices that emit light beams across a bed, chair or doorway Many states are now moving towards an alarm-free environment within their nursing homes: The noise produced by alarms agitated residents so much that residents fitted with alarms did not move at all to avoid activating the alarm. This put them at a greater risk for decline. Residents with dementia experienced an increase in agitation when fitted with an alarm. ~ Case Study, MASSPRO a Massachusetts Quality Improvement Organization Alarms contributed to a lack of sleep; they wake both the resident using one and the roommate. After staff removed all restraints, including alarms, falls decreased. ~Director of Nursing, Oakview Terrace Nursing Home, Freeman, South Dakota Falls management: the next step is moving beyond the use of alarms. ~ Indiana State Department of Health, Falls Management Conference, 2007 Alarms have been shown to have many negative effects on the lives of the residents. Alarms contribute to the immobility, restrictiveness, discomfort, restlessness, agitation, sleep disturbance, skin breakdown and incontinence of the resident. In light of this recent evidence and to improve the lives of our residents, we will conduct a systematic and careful assessment and evaluation for the successful removal and reduction of personal alarms in our care center.

3 Fall Report Resident Name: Medical Record # Room / Bed # Date of Fall Time of Fall AM PM Description of fall and fall scene: Location: Patient Room Patient Bathroom *(Contents of toilet: ) Hallway Dining Room Activity Room Shower / tub room Other (specify): Injury Severity: (Check highest level) No injury Minor injury (bruises, skin tear, minor laceration) / First Aid only Major injury (large laceration, closed head injury, fracture(s) etc.) Death Describe injuries if any: Treatment: (Check all that apply) None needed First Aid To Emergency Department Admitted to Hospital Indicate # of staff needed to assist resident up from the fall: Note: Use EZ LIFT to get up unless patient refuses. (Wipe-able Slings for EZ Lift to get up from falls are kept in bag behind 24 hour Desk in Unity Lobby) Immediate Actions Taken: YES NO (Send on Outlook BOLD Falls Notification Time: AM/PM (Include: Resident NAME, ROOM NUMBER, DATE, and TIME of fall, injuries, circumstances.) Name of Physician/ NP notified: Phoned Faxed Date Physician /NP notified: Time of Notification: AM/PM Family/ POA notified: Name of Contact: Date notified: Time Notified: AM/PM

4 1. Type of fall: Witnessed fall Unwitnessed fall Intercepted fall Self (or other person)-reported fall 2. Factors observed regarding the fall: Equipment malfunction (describe): Bed height not appropriate : Too high Too low Environmental Factor: (clutter, furniture, floor, lighting, etc) describe: Environmental noise (describe): 3. Surface resident on prior to fall (if known) Stationary chair Wheelchair Pedals : On / Off ; Foot Plates: Up / Down Brakes: locked / unlocked Anti-roll back device in place: working not working Toilet Bed Bed wheels: locked / unlocked Mattress properly positioned yes / no UNKNOWN. 4. Resident mental status prior to fall: Baseline Other: 5. Vision status: N/A vision good. Vision impaired Has glasses: were on / were off Impaired vision diagnosis: Contrast assist in place: Neon tape on: Black toilet seat Other: 6. Was resident observed falling? No Yes If yes, Print name of witnesses and phone number (if not staff member) Name of witness: Phone number(s): Obtain Statement from any non-staff person: write on Yellow FSI form under Fall Huddle 7. Is resident currently being seen by PT and/or OT? Yes, PT Yes, OT No, Neither Is resident currently participating in a walking program? Yes No Does resident lean or slide down in wheelchair? N/A No Yes Has resident s gait or posture declined recently? No Yes If you have identified a new problem ask Nurse Mgr. for referral to PT or OT. 8. Baseline Transferring Assistance: Independent Supervision (observe or cue) Limited Extensive EZ Stand EZ Lift/Hoyer Indicate # of staff needed: 9. Baseline Ambulation Assistance: Non-Ambulatory Independent Supervision (walk beside or follow with w/c) Limited (hand hold or gait belt hold) Extensive (weight bearing assist) Indicate # of staff needed: 10. Indicate gait devices resident has available to use: None (Does not have walker or cane) Walker was in use was not in use Other: was in use not in use 11. Was call light on at time of fall? N/A Yes No 12. Footwear at time of fall: Bare feet Plain socks only (or TED socks only) Gripper socks Slippers Shoes Amputee Off load boots One on/ one off

5 13. Medications given in last 6 hours before the fall: Anti-anxiety Anti-depressant Anti-hypertensive Anti-psychotic Diuretic Hypnotic Cardio-vascular Narcotic Seizure Laxative New med /dose change last 30 days 14. Describe resident s level of pain prior to fall: Pain not well controlled ( /10) Pain medication being adjusted Pain is well controlled No symptoms of pain observed (incl. non-verbal) 15. Vital signs taken immediately after the fall: Temperature: Pulse: Respirations: BP: O2 Sats: on: Room Air / LPM O2 Blood Glucose (if diabetic) WNL for resident Abnormal for resident Most recent Hemoglobin: Date: NOTE: Orthostatic Blood Pressure readings must be obtained for resident who fell within 5 feet of transfer surface, ie chair, bed, toilet. BP obtained above is NOT considered PART of the Orthostatic BP reading. 16. Orthostatic Blood Pressures: N/A (if checked, indicate why it is N/A): Lying: (at least 5-10 minutes) P Sitting: (Take 1 min after sitting up) P Standing: (Take 1 minute after standing) P 17. Has the resident had a recent change in condition? No Yes :Describe: 18. Could this fall be the first indication that the resident is at the early stages of an acute illness? To assess for this, please review the following signs and symptoms and check any that are new that may be the first indication of illness starting. More fatigued in last day or so SOB more than baseline Gait more unsteady in last several hours More confusion/agitation than usual Sudden appearance of/ or increase in edema Urinary frequency or dysuria Nasal congestion, cough, hoarse voice Decreased food or fluid intake New nausea, vomiting, or diarrhea Other: 19. Other pertinent factors: (Such as recent abnormal labs, new diagnoses, recent death of family member, or Change in usual routine, such as absence of usual visitor, or MD appointment, etc.) NURSES, 1. PLEASE REMEMBER THAT THIS FORM DOES NOT BECOME PART OF THE MEDICAL RECORD. ALL PERTINENT INFORMATION FROM THIS REPORT AND THE FSI REPORT MUST BE ENTERED IN A NURSES NOTE. DO NOT REFER TO THESE FORMS IN THE NOTE. 2. MARK THE MAR WITH A BOX FOR THE 5 TH DAY AFTER THE FALL (Day after the fall is day 1) FOR THE SAME SHIFT AS THE FALL, AND PLACE A LABEL FROM THE SHEET IN THE FRONT OF THE MAR DESCRIBING THE DOCUMENTATION NEEDED IN THE IPN REGARDING ANY DELAYED INJURIES FROM THE FALL.

6 Rule out Abuse/ Neglect 1. Was care plan being followed? Yes No: 2. Based on assessment of resident, resident statements, environmental evidence, witness statements, and other data, is there any suspicion of abuse or neglect? No Yes: 3. If any abuse or neglect suspected contact ADMINISTRATOR or designee IMMEDIATELY. Initiate further investigation immediately. Call to ADMINISTRATOR at AM/ PM N/A Root Cause Analysis From the information you gathered on the previous pages, check all factors that contributed to the fall: Medical Status / Physical Condition / Diagnoses Vital Signs abnormal or significant Medication side effects / doses / interactions Pain Management Toileting Status Mental Status or mood Beginning symptoms of new acute illness Gait Assistive device in use or not in use Amount of assistance in effect Footwear Environmental factors: lighting, noise, floor status Placement of items (including W/C or Walker) Vision / contrast Events in previous 3 hours Change in resident s or patient s usual routine Based on contributing factors you checked above, what seems to be the ROOT CAUSE of THIS FALL? Describe interventions you are putting into place NOW as a result of THIS fall, to prevent future similar falls: Care Plan Updated NAR Assignment updated Signature of NURSE Completing this Fall Report Date Follow-up Actions Taken: Interdisciplinary Team: Date:. Attendees: Recommendations in addition to those put in place above, or changes to above: Care Plan Updated: Date: NAR Assignment Updated Date: Next Fall Committee Date: DON: Administrator: Med. Director: Final Root Cause Determination: Date: Signature of Fall Coordinator: Date: On line Report to OHFC: No Yes: Submitted by: Date: Time: Revision Date: 9/21/15

7 MN Masonic HCC Bloomington Fall Scene Investigation (FSI) Report Resident Name: Room #: Date of Fall: Time: AM PM PART 1: NAR assigned to resident must complete this part (Questions 1 8, and part 2 if witnessed fall and part 3 if found resident after the fall.) NAR assigned to resident at time of fall: (PRINT) 1. Describe the last time you saw resident before they fell? Time: am/pm Location: Last time you did POM rounds was: AM PM 2. Resident was: Ambulating In bed In Chair/wheelchair Other: 3. If resident was in w/c, check items that were in place: anti-roll back Other: Was device functioning correctly? Yes No: if no, what did you do about it? Were foot pedals up or down? Up Down Was call light turned on? Yes No 4. If resident was in bed: Were positioning rails up? Yes No N/A Were bed wheels locked? Yes No Was bed at correct height? Yes No Was call light turned on? Yes No Was Call light in reach Yes No Was walker by bed? Yes No N/A Was W/C by bed? Yes No N/A 5. If ambulating was resident using a device? N/A No Yes (Indicate type below) Type: R/W Straight Cane Quad Cane Other 6. Footwear: Bare feet Plain socks Gripper socks Slippers Shoes 7. Last time Toileted: AM/PM Last time brief changed: AM/PM Was resident incontinent when found? Yes No Was resident taken to toilet after fall? Yes No Did resident void after fall? Yes No Did resident have BM after fall? Yes No 8. Was resident different in any way today (more pain, more restless, more withdrawn, more acting out)? No Yes: Describe: 9. Who else was providing care to or interacting with the resident before the fall? (This would include anyone who was in the area; housekeeper, dietary aide, social service, family, etc.) Print Names, Titles How were they assisting the resident? A. B. C. Your Signature: Date: RETURN THIS REPORT TO THE NURSE

8 PART 2: Witness Account of the Resident Falling (use additional paper as needed): Name(s) of witness(es) (1) (2) Whom did you notify? Time AM/PM Describe what you saw including the surrounding environment: (1) Staff Signature: Date: (2) Staff Signature: Date: PART 3: Person Who Found Resident: Name of person who found resident: Whom did you notify? Time AM/PM Draw a picture of the area and position resident was found. Remember to include: was the resident face down, on their back, on R or L side, position of their arms and legs, placement of the furniture, equipment and devices, indicate head & foot of bed, location of any doors and hallway. 1. What did the resident say he/she was trying to do? 2. How were you alerted to the fallen resident? Call light was on Resident called out Heard sound of resident falling Found while doing rounds Staff informed you Family informed you Resident informed you Other Signature of staff who found resident:

9 PART 4: Recreate the life of the resident prior to the fall (use additional paper as needed): Give a description of how you were involved with the resident BEFORE (up to three hours) and AT TIME of the fall. What did you observation regarding the resident and their surroundings? Name of person and position or relationship to resident: Staff Signature Date: Name of person and position or relationship to resident: Staff Signature: Report completed by (signature): Date: Date: REV 9/9/10

10 Fall Huddle: Date: Time: Attending: Person who pulled this huddle together: Insights gained: Revised 10/28/11