running header: USE OF BED ALARMS ON FALL RISK PATIENTS 1

Use of Bed Alarms On Fall Risk Patients

Adam Bennett
Ferris State University








USE OF BED ALARMS ON FALL RISK PATIENTS 2

ABSTRACT:
This essay explores if bed checks are a valuable tool when it comes to preventing falls in
fall risk patients. The author explores three articles that pertain to this topic and finds a lot of
research on it. The research shows that there is no statistical significance when it comes to bed
alarms preventing falls. The author then looks at the how this relates to nursing.


















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INTRODUCTION:
There are many different methods on what is the best way to prevent falls from
happening on fall risk patients. Fall risk patients are patients who are believed to be at risk for
falling without certain precautions. These precautions include using a gait belt when transferring
a patient, using a bed alarm when a patient is in bed, and having a patient wear a bracelet so
every staff member can easily identify the fall risk patient. A major debate going on in nursing
right now is if the use of bed alarms is beneficial to fall risk patients. The purpose of this essay
is to explore whether or not bed alarms are useful in preventing falls within the population of fall
risk patients.
CLINICAL QUESTION:
The clinical question being asked in this essay is if bed alarms help in the prevention of
falls by fall risk patients. Some people believe that bed alarms are very useful in the clinical
setting. Bed alarms were invented in order to alert nursing staff if a fall risk patient was getting
out of bed without assistance. Once a member of the staff heard the alarm, they are supposed to
run to that bed in order to assist the patient with whatever they need. This is seen as a good idea
because it gives the nursing staff warning if a fall risk patient is getting out of bed on their own
so the staff would be able to prevent a fall from happening. Before bed alarms were invented
there were some fall risk patients who would get out of bed and fall and the nursing staff would
not be notified. This led to the patient either yelling for help or waiting for a member of the
nursing staff to come into their room and assist them.
There are others who believe that the use of bed alarms is not best practice when it comes
to preventing falls. Bed alarms have many advantages but there are some people who argue that
the benefits do not outweigh the disadvantages of bed alarms. These people argue that although
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bed alarms do alert nursing staff that a patient has gotten out of bed, there are times that the staff
does not have enough time to react to the alarm and the patient ends up falling. These people
believe that bed alarms are useful but there are better means that need to be found in order to
prevent falls.
This is where the debate comes in whether or not bed alarms are useful in preventing falls
in fall risk patients. The reason why this is a clinical problem is because it is not proven that this
is best practice when preventing falls. There are two sides to this argument and both sides
provide good points on this subject. This is a debate on patient safety and it is very important
that nurses use the best practice when it comes to patient safety. The reason why this is
important to nursing is because it is important to use best practice when it comes to patient
safety.
METHODOLOGY:
The way the scholar found the research for this essay starts with going to the NURS 350
home page through the library website. After that, the scholar used the database CINAHL to
research articles on this topic. The scholar used the words; fall risk, falls, bed alarm, and bed
checks when in this database. The author used the exclusion criteria of nursing research and peer
reviewed articles when searching for the research. Finally, the author found three articles that fit
the criteria for this assignment.
There are many aspects that the author included in the exclusion criteria for this essay.
The first exclusion criterion is that the articles used are nursing research. For an article to be
considered nursing research, it has to be by nurses, for nurses, or about nurses. The author chose
to only use nursing research because this is the research that is most important to the field of
nursing. This type of research will have the most impact on nursing practices. The author of this
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essay also only used peer reviewed articles. This makes the articles more credible which in turn
makes the research more credible.
There are also many different levels the evidence. The evidence based model (EBM) is
the model that is used for this article. The EBM model has 7 different levels with 7 being the
lowest and one being the highest. The lowest level is background information or an expert
opinion. The next three levels are considered unfiltered information. These levels include
random control trials, cohort studies, and case studies. The highest three levels include article
synopsis, evidence synopsis, and systematic reviews.
DISCUSSION OF LITURATURE:
The first article comes from the Nursing Clinics of North America which is a peer
reviewed journal and this information can be found on the journals webpage. Normally the
author of this essay would not use a journal article that was this old but this is some of the first
research the author was able to find on the topic. The title of the article is Technology to
promote safe mobility in the elderly. (Nelson et al, 2004) The authors of this article include;
Audrey Nelson, PhD, RN, FAAN, Gail Powell-Cope, PhD, ARNP, Deborah Gavin-Dreschnack,
PhD, Pat Quigley, PhD, ARNP, CRRNa, Tatjana Bulat, MDa, Andrea S. Baptiste, MA, CIE,
Shawn Applegarth, MSME, Yvonne Friedman, MA, OTR/L. The main subject of this study is if
technology can promote safe mobility in an elderly population. The literature review did report
a need for this study. There was not a lot of evidence at this time that supported the use of bed
alarms with fall risk patients. The main problem being investigated in this article is what
actually helps prevent falls in the elderly. (Nelson et al, 2004) This article has a level of
evidence at 7. This is due to the fact that this is just some experts giving their opinion on certain
behaviors that have an influence on fall risk. The population of this study is the elderly. There
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are no exclusion criteria for this article. The design of this study is a review of technologies that
are available in helping prevent falls in the elderly. No statistical analysis was used in this
article. The author of this article stated the caregivers believe that they do not have sufficient
time to get to the patient to prevent a fall after the alarm is activated. (Nelson et al, 2004)
These results are clearly stated in the article and match other findings from other articles. These
results also answer the question proposed in the article and seem valid. There are a few threats
to validity in this article. The first threat is selection bias. The authors of this article need to
explain what their population was. The term elderly is too broad and parameters need to be set.
The next article comes from the Annals of Internal Medicine this is a peer reviewed
journal and this information can be found on the journals webpage. The title of this article is
Effects of an Intervention to Increase Bed Alarm Use to Prevent Falls in Hospitalized Patients: A
Cluster Randomized Trial (Shorr et al, 2012). The authors of this article include; Ronald I. Shorr,
MD, MS; A. Michelle Chandler; Lorraine C. Mion, RN, PhD; Teresa M. Waters, PhD; Minzhao
Liu, MS; Michael J. Daniels, ScD; Lori A. Kessler, PharmD; and Stephen T. Miller, MD. The
main subject of the article is To investigate whether an intervention aimed at increasing bed
alarm use decreases hospital falls and related events. (Shorr et al, 2012) The review of the
literature did support a need for this study. This is due to the fact that there are many falls that
occur in the hospital and research needed to be done in order to review the effectiveness of bed
alarms. The purpose of this article can be found on the first page. The purpose statement is To
address the utility of bed alarm systems as an approach to falls prevention in hospitals. (Shorr et
al, 2012) The problem being investigated is if bed alarms make a significant difference in the
amount of falls that occur in fall risk patients. The population consisted of 627 patients on 16
units. These units were categorized as either medical, surgical, or specialty units. The only
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exclusion criterion for this article is that the participant had to be a fall risk patient. This is not a
very strict exclusion criterion. The design of this study is a cluster randomized trial. This is an
appropriate design for this study because it does not exclude any patients who are considered fall
risk. The population size is also appropriate for this type of study. The level of evidence for this
article is considered a 4 based on the EBM model. This is due to the fact that this is a random
control trial and is considered unfiltered information. The statistical analysis used in this article
is the Wilcoxon test which was used to compare the distribution of falls and covariates between
intervention and control units during the baseline period. (Shorr et al, 2012) The level of
measurement and statistical analysis do match. The results of this article find that There were
no significant prepost differences in change in fall rates (Shorr et al, 2012). This is clearly
stated in the article. There were a few threats to validity in this article. The first threat to
validity is selection bias. There were only 16 units in a hospital used for this research. The
authors could have used an entire hospital and that would have been a better representation of the
entire population. Instrumentation was also a threat to validity for this assignment. The same
bed alarm was not used for every person in the study. There could be slight differences in the
timing of the alarms in the bed alarms. The results did answer the question asked in the article.
The results from the article seem valid. The results from this article seem consistent with
findings from other articles.
The final article the author used for this essay can be found in the Journal of
Rehabilitation Nursing which is a peer reviewed article. The title of the article is Nurses
Experiences with Bed Exit Alarms May Lead to Ambivalence About Their Effectiveness. (
Hubbartt et al, 2012) The authors of this article includes; Beth Hubbartt, MSN RN CRRN
Sarah G. Davis, BSN RN Donald D. Kautz, PhD RN CRRN CNE . The main subject of the
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study was how nurses are having mixed feelings about bed alarms and their effectiveness. The
background literature had conflicting research on this subject so there was a need for this study
to be done. The problem investigated in this study was if the uses of bed alarms are useful in the
clinical setting. The purpose behind this study was to find if the use of bed alarms is considered
best practice. The sample of this group consists of nurses who worked on two surgical floors in
a hospital. This is a very small population. The design of the study is a case controlled study.
(Hubbartt et al, 2012) This makes the level of evidence for the article a six based on the EBM.
This means that there is unfiltered data and that it is a low level of evidence. There was no
statistical analysis used for this article because it would not be appropriate. The results of this
article included nurses saying that they felt ambivalent about bed alarms. (Hubbartt et al, 2012)
The nurses also said in their surveys that they were experiencing alarm overload. (Hubbarrtt et
al, 2012). The results match other findings from different articles and are clearly stated. The
results also answered the question related to the article. There were a few threats to validity
relating to this article. The first one is selection bias. The population for this study was small.
The authors could have known that there was some ambivalence with the nurses that they chose
for the study. A larger population would have been more appropriate for this study. Another
threat to validity would be design contamination because the nurses knew they were going to be
a part of this study. This means that the nurses may have changed their attitude toward bed
alarms because they were taking place in the study.

SIGNIFICANCE TO NURSING:
There are many ways in which these findings can be integrated into the practice of
nursing. The first way the author looks at how this is significant to nursing is safety. According
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to QUSN, safety is defined as Minimizes risk of harm to patients and providers through both
system effectiveness and individual performance. (Dolansky, 2005) Falls are a huge risk in
patient safety. As the evidence from the articles above show, bed alarms do not create a
statistical significance in decreasing the amount of falls that occur in fall risk patients. However,
bed alarms are useful in the clinical setting because it notifies the nursing staff that a patient is
out of bed. There have been occurrences where a bed alarm has helped in the prevention of falls.
The data from the articles could be used to help find ways bed alarms could be improved to help
patient safety.
The next way this can be looked at is by evidence based practice. Evidence based
practice is defined as Integrate best current evidence with clinical expertise and patient/family
preferences and values for delivery of optimal health care. (Dolansky, 2005) The evidence in
the research articles show that bed alarms are not considered best way to prevent falls to fall risk
patients. The best way to prevent falls within the population of fall risk patients would be to
restrain them to the bed with all four bed rails up and to have a sitter in the room. This would
not be a humane way of taking care of patients. Also, many hospitals do not have the resources
to accomplish this. Therefore, when looking at the use of bed alarms, they are not considered
best practice, but are still helpful in the clinical setting. The data from the articles above could
be used to help find a way to improve bed alarms so it makes it harder for patients to get out of
bed without assistance.
Finally, one could look at this in terms of quality control. Quality control is defined as
Use data to monitor the outcomes of care processes and use improvement methods to design
and test changes to continuously improve the quality and safety of health care systems.
(Dolansky, 2005) The data from these articles could be used to help find ways to make bed
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alarms better. As the last article pointed out, many nurses felt ambivalent about using bed
alarms. They said this because they believed that they could not get to the beds in time and they
were experiencing alarm overload. Maybe this data could be used to find another way to
notify staff that a patient is getting out of bed.
Falling is a major risk for many different patients. It is important that nurses do
everything in their power to help prevent falls. Bed alarms should be continued to be used in the
clinical setting due to the fact that that they alert nursing staff if a fall occurs. Although bed
alarms are useful tools to use, they are not the best way to prevent falls from occurring in the
clinical setting.














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Reference
Dolansky, M. A. (2005). Pre-licensure KSA's. In QSEN Institute. Retrieved August 6, 2014
Hubbartt, B., Davis, S., & Kautz, D. (2012, March 27). Nurses Experiences with Bed Exit Alarms May
Lead to Ambivalence About Their Effectiveness. Rehabilitation Nursing, 36(5). Retrieved
August 6, 2014, from CINAHL.

Nelson, A., Cope, G., Gavin, D., Quigley, P., Bulat, T., Beptiste, A., & Applegarth, S. (2004,
September). Technology to promote safe mobility in the elderly. Nursing Clinics of North
America, 39(3), 649-671. Retrieved from CINAHL
Ronald, S., Chandler, M., Mion, L., Waters, T., Liu, M., Daniels, M., & Kessler, L. (2012, November
20). Effects of an Intervention to Increase Bed Alarm Use to Prevent Falls in Hospitalized
Patients: A Cluster Randomized Trial. Annals of Internal Medicine, 157(10). Retrieved August 6,
2014, from CINAHL.