Bed-Exit Alarms and Risk of Patients Falls with Cognitive Impairment

The use of bed-exit alarms to reduce the risk of falls among patients with cognitive impairment

Student’s Name: Dorcas Haruna

Reflection on the Importance of Bed-Exist Alarm

Every year, approximately 250,000 patients in the United Kingdom fall in hospitals (Morris, 2017). These falls have been identified to result in numerous problems such as fractures, lacerations, and even internal bleeding. Research has shown that about a third of the falls that take place in hospitals can be prevented (Morris, 2017). The prevention of falls is important as it plays a role in the reduction of the increased cost of hospitalisation, among other immense benefits. According to Jähne-Raden et al. (2017), the prevention of falls in the hospitals mainly involves managing the patient with underlying fall risk factors and optimising the hospital’s physical design and the environment. Therefore, different studies have suggested different strategies that seek to overcome the associated challenges with developing, implementing, and sustaining fall prevention programs. In their study, de Souza et al. (2019) argued that in-hospital falls are accidents that can be avoided. However, these falls have continued to be a highly prevalent patient safety issue that negatively impacts the healthcare system. One of the methods that have been used to prevent falls globally is reporting, which enables the care providers to attend to the patients. According to de Souza et al. (2019), these falls are reported through the institution-based or even the national patient safety incident reporting systems set in different countries across the globe.

Working in departments of cognitively impaired patients, the prevalence of falls was one of the major concerns and health risks that we had to deal with. It was evident from the surgical ward that older people with cognitive impairment and dementia tend to have an increased risk for falls and subsequent adverse events. Such patients tend to demonstrate postural instability, which is a common risk factor for falls identified by many medical researchers (Allali et al., 2017). Besides, the medication that is given to the patients with this condition and the risk for orthostatic hypotension puts these patients at increased risks for falls and other adverse events. Generally, the most prevalent falls for persons with cognitive impairment are among older people, compared to younger people (Lipardo & Tsang, 2018). This is also backed by literature that has suggested that older adults tend to demonstrate a higher possibility of impaired executive function. Additionally, among the falls in the older people, most of them were noted to have other risk factors like demonstrate dementia.

Recent studies have shown that it is a significant challenge for managing cognitively impaired patients, as there is a significant association between cognitive impairment and falls (Torres et al., 2017). A study by Allali et al. (2017) established that cognitive impairment is linked with an increased prevalence of falls in healthy older adults. Similarly, Lipardo and Tsang (2018) stated that mild cognitive impairment increases the risk of falling, especially in older adults. In this regard, the prevalence of falls in moderate to severe cognitive impairment is twice as high as for adults without cognitive impairment. The studies emphasised that the factors that increase the risk of falls in patients with cognitive impairment are the abnormal neural control of the cardiovascular system and postural instability (Montero-Odasso & Speechley, 2017). The consequences of falls for this group include head injuries, fractures, and mortality, and those who fall outside hospital settings are roughly five times more likely to be admitted to hospital (Montero-Odasso & Speechley, 2017). This has necessitated numerous measures such as reporting and bed-exit alarms to be taken in hospitals to improve the situation.

The presented evidence indicates that falls among patients with cognitive impairment are a major health issue requiring innovation to reduce falls in hospitals. The present study proposes bed-exit alarm innovation to address this issue. Bed-exit alarms are devices that alert caregivers whenever a patient is restricted to get out of bed without assistance but attempts to do so (Shorr et al., 2012). The present study proposes this innovation because caregivers can rush to the patient’s bed once an alarm sounds and assist him/her in getting out of bed, thus, preventing a fall. This innovation can also enhance swift help to patients who have already fallen. Types of bed-alarms systems include infrared bedside mirrors, clip alarms comprising a magnet and pull-cord activation, a chair alarm triggered by a patient’s weight, or a sensor alarm pad applied to the bed (Okumoto et al., 2020). During my clinical placement, wards using the bed-exit alarms would identify patients at risk of falling by leaving their beds unassisted and have caregivers go to these patients, reducing falls compared with wards without the invention. Wards using the innovation had fewer incidences of falls.

The prevalence of falls in hospitals has led to research and innovation for various measures that should be undertaken to reduce the falls and the adverse effects of the falls. One of the proposed methods is increasing awareness and easing patient identification at a higher risk of falls (Torres et al., 2017). This can be done using armbands and other identifications to easily help the healthcare personnel identify the patients at a higher risk. This should be done with safety rounds and providing safety companions that help identify the patients in a risky position for a fall. However, the most commonly used method that has demonstrated a lot of effectiveness, and the proposed intervention of this study is bed exit alarms. It is evident that adverse events like falls and mortality and morbidity tend to be considered negative outcomes associated with a poor quality of health care (Subermaniam et al., 2017). This study seeks to investigate the issue of falls, which is identified to take place due to the complex interplay between the predisposing or even the precipitating factors where some can be intrinsic and others extrinsic. The study will establish the effectiveness of the fall prevention strategies, focusing on the bed alarm exit method. Although it has been suggested as an appropriate method for fall prevention in hospitals, there is little research conducted on cognitively impaired patients. Therefore, it has not been adopted in this group of patients.

The Aim and Objectives of the Innovation

This research investigates the issue of falls among patients in hospitals and the measures that have been undertaken to ensure that the problem is mitigated in the hospitals. The study aims to identify the effectiveness of bed-exit alarms in the reduction of falls in hospitals. The innovation aims to reduce the risk of falls among patients with cognitive impairment in the surgical ward.

The aim of this innovation is to reduce the risk of falls among patients with cognitive impairment in the surgical ward. A bed exit alarm is an intervention that seeks to identify the attempt of a patient to leave the bed and send an alert to the nurses on duty, prompting them to take action to prevent a fall. In this regard, it is expected that implementation of the bed exit alarm program will increase awareness of the care providers regarding patients at risk and significantly reduce the falls in the surgical wards. The specific objectives are listed below.

  1. To find out the effectiveness of the bed-exit alarms in the reduction of falls in hospitals.
  2. To reduce the number of falls among the cognitively impaired patients in surgical wards.
  3. To study the effectiveness of bed exit alarms in assisting the nurses identify patients at risk of fall.
  4. To identify the best strategies for implementation of bed exit alarms in surgical wards for cognitively impaired patients.

Literature Review

The purpose of this research is to investigate the issue of falls among patients in hospitals and the measures that have been undertaken to ensure that the problem is mitigated in the hospitals. The aim of the study is to identify the strategies that can be used to reduce the problem in the hospitals. The innovation aims to reduce the risk of falls among patients with cognitive impairment in the cognitive geriatric ward. Therefore, the literature review aims to evaluate the written literature about the topic and identify the gap in research. In order to get the relevant literature, several databases were searched, such as CINAHL Complete, DynaMed, ProQuest, and PubMed, to find literature appropriate for the review. Some of the search terms used to search for the relevant literature include; risk of falls, patient falls, bed exit alarm, bed alert, cognitive patient fall, geriatric ward falls. Although a lot of articles can be identified from the search, it is important to have scrutiny to remain with the most relevant articles. Besides, only the current articles were identified to be included in the review.

In many hospitals across the globe, hospitalised patients’ falls have been a serious concern and a threat to patient safety. According to Shorr et al. (2012), accidental falls are the most prevalent accidents reported in hospitals, which lead to about 2% of the hospitals’ complications. It has been noted that about 25% of hospital falls lead to injury, while 2% lead to fractures (Shorr et al., 2012). In addition to the complications of the falls, there is an increase in hospitalisation costs, including the costs involved in the increased hospitalisation duration and liability. In the United States, the Centers for Medicare & Medicaid Services eliminated the hospitals’ payment resulting from falls and their associated treatment (Jähne-Raden et al., 2017). While falls are common in all hospital departments and all types of patients, studies have shown that the most common risk factor associated with hospital falls is cognitive impairment (Allali et al., 2017). These patient risk factors are problems with postural instability, medication, neuro-cardiovascular instability, and environmental hazards (Allali et al., 2017).

Although many approaches have been developed to find ways of preventing falls for patients in hospitals, bed exit alarms have been suggested as the main successful strategy that can help the caregivers (Shorr et al., 2012). According to Shorr et al. (2012), bed exit alarms notify the caregivers when the patients leave the hospital bed. Such alarms are installed in beds of the patients at fall risk and need to be aided. Through their engagement, it is possible to reduce the likelihood of falls and the promotion of speedy assistance to the patients who may fall. Additionally, Subermaniam et al. (2017) indicated that bed exit alarms were strategies advocated among older adults with increased risk for falls. However, the researchers noted that although numerous strategies have been established for the older adults in the community, the evidence regarding the intervention strategies for the falls has remained inadequate.

Few studies have evaluated the effectiveness of the alarms, with some studies even showing that there is no impact on the reduction of falls (Mileski et al., 2019). However, Subermaniam et al. (2017) argued that numerous factors could affect the effectiveness of the bed exit alarm in the prevention of the fall. Among the factors identified include the basic design of the alarm sensors, the likelihood of the health care providers responding to the alarms, and the selection of the patients. A study by Subermaniam et al. (2017) on the efficacy of modular bed absence sensor device, a type of bed-alarm for preventing falls among older patients, reported that the device accurately detected bed absence by geriatric patients, alerting nurses. In this study, 98% of the true alarms were correct bed-exit attempts. These bed-alarm devices recorded a sensitivity of 100% with a predictive value of 68%.

In another study, Jähne-Raden et al. (2017) investigated the effectiveness of inexpensive Node for bed-exit detection (INBED), a signalling system for detecting bed exits and preventing falls. The authors reported that the system detects different kinds of motions such as rising and falling and alerts nursing staff using the wireless infrastructure. The study also noted that the system supports healthcare workers in reducing falls and is effective and suitable for daily use. Another study by Torres et al. (2017) reported that battery-less and wireless wearable sensor systems designed to determine chair and bed exit effectively detected bed and chair exits, thus preventing falls in a hospital setting. The evidence from these studies indicates this innovation’s potential effectiveness in reducing falls among cognitively impaired patients in clinical settings. According to Shee et al. (2014), bed-exit alarms offer an effective and acceptable strategy for preventing falls among patients with cognitive impairment. Therefore, innovation would potentially effectively reduce falls among patients with cognitive impairment in surgical wards.

The Benefits of Introducing the Innovation

Bed-exit alarms are devices that alert caregivers whenever a patient leaves or attempts to leave their beds (Shorr et al., 2012). Studies have shown that bed exit alarms can be effective in the reduction of the likelihood of falls. Additionally, they can promote speedy assistance to the patients who have already fallen. There was an implementation of bed exit alarms for some patients who were at an increased risk of falling in my workplace. However, there was a quick response among the health care workers for the patients who had bed exit alarms installed. This implies a reduced prevalence of falls among such patients compared to those who did not have bed alarms.

Therefore, this intervention is proposed based on its effectiveness. The analysis shows that the use of bed exit alarms can help better patient care since once an alarm sounds, caregivers can rush to the patient’s bed and assist them, thereby preventing a fall. It is also evident that the innovation can enhance a swift help to patients who have already fallen. Additionally, Chu (2017) noted that the alarm sound distracts patients who avoid leaving the bed, thereby allowing the healthcare personnel to attend to the patient. Types of bed-alarms systems include infrared bedside mirrors, clip alarms comprising a magnet and pull-cord activation, a chair alarm triggered by a patient’s weight, or a sensor alarm pad applied to the bed (Okumoto et al., 2020). The objective of the innovation is to reduce the risk of falls among patients with cognitive impairment in the surgical ward. The invention will achieve this objective by identifying a patient’s attempt to leave the bed and send an alert to the nurses on duty, prompting them to take action to prevent a fall.

Bed-exit alarms avoid the risk of falls by alerting healthcare providers whenever patients at risk of falling attempt to rise from their beds without providers’ assistance (Mileski et al., 2019). Another benefit of this innovation is that the alarm sound distracts patients making them consider the risk, stop exiting the bed and wait for help while prompting the nurse to assist the provider in helping the patient (Chu, 2017). These alarms enhance health care providers’ surveillance of patients with cognitive impairment and serve as an alternative to the physical restraint methods (Shee et al., 2014). Providers may directly attach the alarms to the patient or be part of or adjacent to the bed. In this regard, the study will offer recommendations regarding the best systems and the effectiveness of bed exit alarms in the prevention of falls among cognitively impaired patients. The recommendations will help in decision making that seeks to improve the overall quality of life.

The Barriers to Change

Potential barriers to this change are technical, infrastructural, economic, and resistance by hospital staff. Technical barriers are difficulty selecting the most appropriate type of bed-exit alarm among the available options and lacking the technical expertise to implement the innovation. Infrastructural barriers will involve the hospital lacking the necessary healthcare infrastructure, such as motion sensors to support the selected bed-exit alarm. The physical layout of the hospital is also another problem associated with the implementation of bed-exit alarms. If the bed-exit alarms are installed in the normal wards, they may interfere with the other patients. Economic barriers are inadequate finances for purchasing the alarms, installing the alarms in the wards of interest, training the hospital staff, and maintaining the alarms. Resistance to change by health personnel may include doubt about the change, demonstrative rejection, voiced disagreement, decreased participation in some activities, individual or group resistance (Mares, 2018). The healthcare facility may experience these barriers due to scarce resources, inadequate planning, poor organisational change culture, and insufficient staff communication about the proposed change.

The literature demonstrates that there is conflicting evidence concerning the effectiveness of any single intervention like bed exit alarms in the prevention of falls. However, bed exit alarms tend to be widely used in the healthcare setting as an important part of the comprehensive fall-prevention program, although there are no large-scale randomised controlled trials demonstrating their effectiveness. There are challenges to implement physical restraints. It should be noted that, in principle, physical restraints, including the bed exit alarms, should be prohibited in healthcare situations. This has been a challenge in implementing the bed exit alarms that should be considered physical restraints. According to the study by Okumoto et al. (2020), physical restraints are considered a violation of human rights. Although the bed alarms are being implemented as an alternative to the physical restraints in the acute health care setting, they have still faced ethical issues and concerns that have prevented their effective implementation in many health care settings.

Additionally, there has been contradicting reports regarding the effectiveness of bed-exit alarms (Mileski et al., 2019). It should be noted that bed exit alarms are not a cheap technology or project that any institution can undertake, with the cost of a single system averaging around $6000. Such financial constraints, coupled with the fact that some reports indicate that they are not helpful in fall prevention, face laxity in their implementation (Shorr et al., 2012). The study by Shorr et al. (2012) suggested that the use of bed exit alarms do not have statistically or clinically proven effects regarding fall-related activities. Additionally, the researcher suggested that there are not important or better compared to the physical restraints that have previously been used by different institutions in fall prevention. In this regard, many studies have suggested alternative approaches on the alarms based on the innovation of the novel techniques of restriction that can be seemingly gentle to the patient. The criteria regarding the use of bed alarms is not completely established. Such challenges, coupled with the fact that bed exit alarms have faced ethical concerns among the population and the healthcare system. In some countries like Japan, there is a problem regarding how the bed exit alarms can be implemented (Jahne-Laden et al., 2019). In some hospitals, nurses have been forced to make decisions without any standardised guidelines, while in some hospitals, the family members have written requesting detailed explanations for the merits and demerits of the alarm system, which has increased controversy regarding their application (Jahne-Laden et al., 2019).

The Solution to the Barriers

The solution to resistance to change by health personnel involves identifying the source and cause of resistance and implementing procedures to address the opposition. For instance, if resistance arises due to an inadequate understanding of the change, the best approach is to educate the nurses and address their concerns. Other solutions to resistance to change are communicating with all stakeholders, creating readiness for change, engaging all stakeholders in the change process, selecting and empowering change champions, and providing positive reinforcement (Gesme & Wiseman, 2010). The strategy to overcome economic barriers includes budgeting for the change and sourcing for the financial resources required to implement and maintain the innovation. Budgeting would involve setting strategic goals, reviewing options, and monitoring adherence to the planned budget (Walsh, 2016). Overcoming technical barriers will include the hospital hiring experts in bed-exit alarms to decide the type of alarm. These experts can serve as change agents. The expert will also inform the hospital of the infrastructure to have before adopting the new technology. Implementing these barriers to change would significantly enhance the adoption of the proposed innovation of bed-exit alarms to minimise the risk of falls among patients with cognitive impairment in surgical wards.

Implementation Plan: Lewin’s Model of Change

This model proposes that implementing change in an organisation involves three successive phases: unfreezing, shifting, and refreezing (Batras et al., 2018). Unfreezing involves destabilising the current state by informing organisational members of the need for change, the expected change, removing or reducing restraining forces and increasing driving forces (Batras et al., 2018). The step will involve informing the hospital’s staff about the proposed innovation and how using the innovation will solve the health issue. It is evident that people tend to naturally resist change in any environment. In most circumstances, it is the people’s mindset, their mental and physical capacity that could be reached. Therefore, the model of change suggests that there must be a particular emotional stir that seeks to disturb the group’s dynamics and the forces that are associated with the self-righteousness within the members of the group (Pathak, 2012). Therefore, it will be important to ensure that the healthcare providers are educated regarding the need for medical technology and especially the use of bed exit alarms in the reduction of falls. It is evident that in hospitals, most of the accidents that occur are due to falls (Morris, 2017). It should be emphasised that besides the immediate dangers, the sequelae also tends to increase the burden on the caregivers and the healthcare at large. In this regard, it is evident that education to the caregivers regarding the challenges associated with falls and how the bed exit alarms will seek to improve the situation for the patient and the health care workers.

According to Lewin’s model of change, when the process is unfrozen, it is the right time to begin implementing the change process (Batras et al., 2018). It should be noted that organisational change tends to be complex, implying that executing the change requires a well-planned process that does not always guarantee the anticipated results. The shifting step consists of moving the equilibrium to a new level by adjusting perspectives and beliefs and reshaping the procedures and structures. In this regard, to implement the much-needed change, it will be important to prepare various approaches on a trial and error basis. Mainly, this step will involve changing staff attitudes and modifying hospital processes and systems to adopt the proposed innovation. Firstly, an evaluation will be done at the clinic to establish whether there is the right infrastructure to facilitate the implementation of the program. This will be done in consideration of Lewin’s two most important steps regarding change: the flow of information and leadership (Pathak, 2012). For this process, the information flow will entail sharing the important information about the bed exit alarms with the relevant stakeholders, including the statistics that demonstrate the difference they are likely to make into the institution.

It will also be important to provide the necessary information regarding change requirements with the organisational management and hierarchy, thereby making available various skills and expertise. The process will also involve coordinating the staff regarding the problem-solving approaches across the health care facility. It will be important to come up with the project leaders who will lead the entire process implementation. It should be noted that leadership in the change process entails the influence of particular individuals in the required group to achieve common goals (Pathak, 2012). In order to achieve a well-planned change process, it will be important to develop a proper plan that defines the vision and the motivation of the process. Throughout the implementation plan, it will be required to communicate widely and clearly regarding the planned implementation of the bed exit alarms. This communication should be done throughout the process about the benefits of the system and the stakeholders affected by the change process. Considering that it might be a new process that people have not experienced, there will be many questions, especially for the nurses who will be majorly involved in monitoring the alarms. Therefore, the leadership team or the implementation team will answer all the relevant questions, clarify the misunderstandings, and dispel any rumours that could be bothering the team of stakeholders. This will ensure that the healthcare personnel have the right information and infrastructure to support the change process.

Refreezing reinforces the change and establishes new ways of doing things and rewarding the institutions that manage to reduce the falls through innovation (Mitchell, 2013). According to Lewin’s description, this final step is important for the organisation to sustain the change that was enacted. In this regard, the process aims to ensure that the people involved consider a new status quo and operations at the organisation and not resist the forces engaged in implementing the needed change. Concerning the innovation, refreezing will involve strengthening bed-exit alarms use by healthcare staff to prevent falls in surgical wards until it becomes a standard hospital practice. It should be noted that there must be appropriate steps that seek to sustain and also reinforce the change with the previously dominant behaviour trying to reassert itself. To ensure that the change process is adopted effectively, the implementation team will need to ensure that all processes are adopted for the new changes that the bed exit alarms will bring to the hospital’s surgical wards. Continuous monitoring of the utilisation processes and the attitude of the nurses who will be monitoring the patients using the bed exit alarms will be imperative to ensure that the process is a success.

The entire team in the organisation, especially the internal stakeholders, will be engaged in tying the new operational changes using the bed exit alarms into the organisation’s culture. This will be achieved by identifying the support for the bed exit alarms together with the change barriers so that they can be solved by all stakeholders together. As indicated in the previous section about the barriers that hinder the effective implementation of the bed exit alarms, it is noted that lack of organisational support is a problem that needs to be addressed. Some of the health care providers are not interested in the technology as it seems to be a nuisance to the existing operations at the health care facilities. Therefore, it will be important to involve the stakeholders throughout the process to ensure that they are positive about the entire process. Additionally, this step will include developing and promoting different ways to ensure that the bed exit alarm technology is sustained for a long time (Batras et al., 2018). First, it will be important to ensure that the organisation’s leadership always supports the new method for monitoring the patients from falls and adapts the entire organisational structure to the change process where necessary. This will also include a feedback process, especially for the nurses who will be majorly involved in the entire process. By establishing a feedback system, it will be possible to monitor the program’s success and ensure that all the challenges are considered to improve its operations. The system will also include the creation of a reward system for the stakeholders who improve the process and successfully implement the process. Additionally, the organisation at large should be rewarded for implementing the bed exit alarm process and reducing the overall number of falls.

In conclusion, patient falls have been a major problem in the healthcare system, contributing to a high number of injuries in healthcare systems. These falls are a major cause of morbidity, nonfatal injuries, and trauma-related hospitalisations across the globe. It is even a major problem for the cognitively impaired patients in the surgical wards, who have numerous predisposing factors. Therefore, the innovation to include the bed exit alarms as a strategy to reduce the falls among the cognitively impaired patients is noted to improve the number of falls, hence reducing the falls’ related ramifications. By using the bed exit alarms, the health care staff, especially the nurses who are tasked with implementing the change and monitoring the patients, will be in a better position to monitor the patients who are likely to fall. This process will involve all stakeholders and a lot of information to be shared to ensure that they understand the needs and goals for the process.

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