What’s New in the Patient Safety World
January 2013
Bed Alarms Fail the Test
Many hospitals have invested
in bed alarm system to help reduce patient falls. The theory behind them is
simple: a sensor responds to the weight of the patient in the bed. If the
patient attempts to get out of the bed, the sensor detects the reduction in
weight/pressure and alarms in the nursing station. But, much to our surprise,
such bed alarm systems had never been studied using well-designed scientific
methodology to determine whether they truly reduced falls or injuries.
Now a study has
demonstrated that an intervention designed to increase bed alarm use in an
urban community hospital increased alarm use but had no statistically or
clinically significant effect on fall rates, fall-related events or physical
restraint use (Shorr
2012). Using a cluster randomized methodology the “intervention” nursing
units received education, training and technical support on use of the bed
alarm system. The “control” units did have bed alarms but received no training
or support on their use. The study
population included over 27,000 inpatients in general medical, surgical, and
specialty units. Prevalence of alarm use was 64.41 days per 1000 patient-days
on intervention units and 1.79 days per 1000 patient-days on control units. But
there was no difference in change in fall rates per 1000 patient-days or in the
number of patients who fell, injurious fall rates, or the number of patients
physically restrained on intervention units compared with control units.
Our only prior column
that mentioned bed alarms (June 19, 2007 Patient Safety Tip of the Week “Unintended
Consequences of Technological Solutions”) noted a case when a hospital
purchased a new alarm system that would send an alarm when the patient got out
of bed. It turned out that on some units there were not enough electrical
outlets for both the new bed alarms and the nurse call buttons. So a decision was
made in some cases to swap out these two devices. You can guess what happened:
nursing staff responded to the “out-of-bed” alarm only to find the patient
lying on the floor with an injury because he tried to get out of bed after no
one responded when he pushed the nurse call button!
Like so many other
things in medicine, what sounds good often turns out not to be so good.
Unfortunately, because we often adopt interventions without appropriate
scrutiny we end up spending much time, money and other resources without
reaping the expected benefits.
References:
Shorr RI, Chandler AM, Mion LC, et al. Effects of an Intervention to Increase Bed Alarm Use to Prevent Falls in Hospitalized Patients: A Cluster Randomized Trial. Ann Intern Med 2012; 157(10): 692-699
http://annals.org/article.aspx?articleid=1392191
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