Running Head: Do Bed Alarms Reduce Patient Falls in Medical Surgical Units?

Do Bed Alarms Reduce Patient Falls in Medical Surgical Units?

Jessica J. Calvert, Emily L. Flanagan, Danielle M. Hornbaker, Molly G. Kaufman, Ashley

N. Kim, Abigail T. Tallon,

James Madison University

Running Head: Do Bed Alarms Reduce Patient Falls in Medical Surgical Units? 2

Abstract

The effectiveness of bed alarms in relation to patient falls was assessed through the

research of twelve articles. The literature presented various studies about whether the reduction

of patient falls was correlated with bed exit alarms in hospital settings across the globe. The

articles included randomized controlled trials, observational studies, surveys, questionnaires,

quantitative and qualitative study designs. These studies contained various population sizes,

settings, and methods of data collections. While some of the literature provided evidence that

the use of bed alarms positively impacted patient safety, others demonstrated that there was

either no evidence or did not have a statistical difference associated with patient falls when

implementing these alarms. Throughout the paper, the question of Do Bed Alarms Reduce

Patient Falls in Medical Surgical Units will be explored. Patient safety is the priority of both

nurses and health care providers, and it is important to determine and implement successful

methods to prevent patient falls and injuries. In addition, patient safety ensures better patient

outcomes, decrease in patient’s length of stay, and reduces secondary complications. There is no

doubt that guaranteeing patient safety is a priority and continuing to explore programs that

promote such safety is a very important part of the healthcare system.

Running Head: Do Bed Alarms Reduce Patient Falls in Medical Surgical Units? 3

Do Bed Alarms Reduce Patient Falls in Medical Surgical Units?

Introduction

The frequent alarm sounds heard within hospital walls, more often times than not, go

unnoticed by numerous medical staff. In today's medical world, the second most common event

to occur within a hospital is patient falls, following medical errors (Dykes, 2010). When there is

an absence of bed alarms, or the ones in place go unnoticed by nurses, it can increase patient falls

within the given hospital. By researching both sides of the issue; having bed alarms versus not

having alarms, with the correlation of patient falls, nurses will gain insight on the effectiveness

of implementing these protocols. It is important for hospitals not only to utilize bed alarms, but

also to include additional precautions to increase patient safety.

Nurses are specifically assigned to patients and are responsible for both their care and

safety. By creating a trusting relationship and a safe environment for the patient, it will increase

their satisfaction of the overall experience within the hospital. By having bed alarms, it will

allow nurses to quickly respond to an emergent event happening within a patient’s room. By

exploring the question of Do Bed Alarms Reduce Patient Falls in Medical Surgical Units, nurses

can reduce and prevent the number of injuries, resulting in a shorter hospital stay. It is crucial to

include education about bed alarms for both the nurses and other hospital staff to not only reduce

patient falls but also increase patient satisfaction and decrease hospital expenses.

Synthesis of the Literature

Through the research that has been conducted, the conclusion of implementing bed

alarms to reduce patient falls varies. The studies presented either agree, disagree, or show no

statistical evidence that bed alarms reduce patient falls. Recent studies have shown that inpatient
Running Head: Do Bed Alarms Reduce Patient Falls in Medical Surgical Units? 4

falls are among the most common hospital-acquired conditions (Cuttler, 2017; Hill, In Press). A

study was conducted in four medical-surgical units that consisted of showing patients a four-

minute educational video and implementing a three-mode sensitivity exit alarm to try and reduce

patient falls within a given hospital setting (Cuttler, 2017). The results included that there was a

20% decrease of regular falls, 40% decrease of falls with injuries, and an 85% decrease in falls

with serious injuries (Cuttler, 2017). The statistics above demonstrate that educating patients

about their risks and placing bed alarms help to reduce patient falls. Another study was

conducted in East Asia that used a Modular Bed Absence Sensor Device (M-BAS) to reduce

patient falls by placing the device on the mattress of each patient’s bed. The study was

conducted in an acute geriatric unit and 83% of nurses reported it to be useful for fall prevention

(Subermaniam, 2017). By implementing bed alarms, it not only reduces the workload of nurses

but also helps to reduce patient falls which in return will enhance the patient’s safety and stay

within a hospital.

While there is evidence related to a decrease in fall numbers with the implementation of

bed alarms, there is also evidence that show there is no correlation to patient falls and bed

alarms. According to a study done in an Urban Community Hospital, an intervention was used

to increase bed alarm usage, but had no clinical effect on fall-related events. The study was

conducted on 16 medical-surgical units, with 349 beds total (Schorr, 2013). During the 8-month

baseline period, there were 182 patient falls, during the 18-month implementation period, there

were 315 falls. Of those falls, 77 of them resulted in injury, displaying no significant decrease in

falls before and after alarms were applied. In addition to this, the study also found that upon

implementing alarms, there was an increase in “alarm fatigue”, causing staff to respond

inappropriately to said alarms (Schorr, 2013).

Running Head: Do Bed Alarms Reduce Patient Falls in Medical Surgical Units? 5

Although bed alarms are intended to reduce patient falls, studies have also shown that

there is no statistical significance with the implementation of these alarms. The systematic

review conducted in fifty-nine, small, U.S acute care hospitals resulted that less than 0.001

percent of patient falls were affected by bed alarm interventions (Hempel, 2013). As well as, a

cluster randomized trial of 27,672 patients displayed similar data, showing that less than 0.004

percent of patient falls were positively affected by bed alarms (Shorr, 2012). The studies above

convey that other prevention methods could help reduce falls, just as well as bed alarms. Within

any given hospital, it is important to analyze the study itself as a whole and the limitations within

it to help improve them in the future.

With regards to the research found presenting information on bed alarms and patient falls,

common limitations arose within the studies. The discrepancies found within the articles can be

related to the small sample sizes consisting of less than 100 (Capezuti, 2018; Cuttler, 2017;

Hemple, 2013; Hilbe, 2010; Shuchisnigdha, 2017; Tzeng, 2012). Another limitation that was

common within the studies was that they were conducted on a single unit instead of comparing

multiple units within the same hospital (Capezuti, 2018; Cuttler, 2017; Hemple, 2013;

Henneman, 2017; Hilbe, 2010; Hill, In Press; Sendelbach, 2013; Tzeng, 2012). Similarly, the

studies were directed at a specific age group, 65 years and older (Cutler, 2017; Subermaniam,

2017; Hill, In Press; Capezuti, 2010). Lastly, the limitations common among the studies was that

they consisted of short term studies, lastly less than 2 years. Further examination of these

limitations should be conducted to ensure the accuracy of the findings found in the studies.

Recommendations

After analyzing all of the studies, there were multiple recommendations that could be

implemented in future studies. Recommendations include having a larger sample size, using
Running Head: Do Bed Alarms Reduce Patient Falls in Medical Surgical Units? 6

different units with various age groups and implementing additional precaution measures to

ensure patient safety. Including a larger sample size will allow the data to be more accurate and

reliable when considering the use of bed alarms. By conducting studies in diverse units, it can

allow one to see which unit benefits the most from bed alarms and possibly help other units

improve their policies. It would also be important to use various age groups to compare the

outcomes and assess which age groups have the highest number of falls and require the highest

need of bed alarms. In addition to the above recommendations, it is also important to include

supplemental precaution measures such as leaving the patient’s bed in the lowest position,

locked, and the side rails up (Tzeng, 2012). By doing this, it will decrease the workload of

nurses and ensure patient safety.

Conclusions

After reviewing the literature, there were multiple results that concluded bed alarms were

successful in preventing patient falls. However, there were also studies validating that bed

alarms had no correlation to patient falls or showing no statistical significance. In future studies,

it is important to have specific standards that would include various age groups, larger sample

sizes, and diverse units. By upholding these standards, future studies will have more accurate and

consistent results that support the question of Do Bed Alarms Reduce Patient Falls in Medical

Surgical Units. With further exploration and implementation of this research, it will assist health

care providers with additional evidence based practice when creating hospital policies.
Running Head: Do Bed Alarms Reduce Patient Falls in Medical Surgical Units? 7

Reference page

Capezuti, E., Brush, B. L., Lane, S., Rabinowitz, H. U., & Secic, M. (2008). Bed-exit alarm

effectiveness. Archives of Gerontology and Geriatrics, 49(1), 27-31.

Cuttler, S. J., Barr-Walker, J., & Cuttler, L. (2017). Reducing medical-surgical inpatient falls and

injuries with videos, icons and alarms. BMJ Open Quality, 6(2),

e000119. http://doi.org/10.1136/bmjoq-2017-000119

Deb, S. & Claudio, D. (2015). Alarm fatigue and its influence on staff performance, 5(3), 183

196. doi:10.1080/19488300.2015.1062065.

Hempel, S. et al. (2013). Hospital fall prevention: A systematic review of implementation,

components, adherence, and effectiveness, 61(4), 483-494.

http://doi/full/10.1111/jgs.12169

Henneman, E. (2017). Recognizing the ordinary as extraordinary: Insight into the “Way We

Work” to improve patient safety outcomes. American Journal of Critical Care, 61(4),

483-494.

Hilbe, J., Schulc, E., Linder, B., & Them, C. (2010) Development and alarm threshold

evaluation of a side rail integrated sensor technology for the prevention of falls.

International Journal of Medical Informatics, 79(3), 173-180. doi:

10.1016/j.ijmedinf.2009.12.004.

Hill, A., Jacques, A., Chandler, A. M., Richey, P.A., Mion, L. C., & Shorr, R. I. (In Press). In

hospital sequelae of injurious falls in 24 medical/ surgical units in four hospitals in the

united states. The Joint Commission Journal on Quality and Patient Safety.

doi:10.1016/j.jcjq.2018.2018.08.005
Running Head: Do Bed Alarms Reduce Patient Falls in Medical Surgical Units? 8

Oliver, D., Hopper, A. & Seed, P. (2000). Do hospital fall prevention programs work? A

systematic review. Journal of the American Geriatrics Society, 48(12), 1679-1689.

doi:10.1111/j.1532-5415.2000.tb03883.x

Sendelbach, S., & Funk, M. (2013). Alarm Fatigue: A patient safety concern. AACN Advanced

Critical Care, 24(4), 378-386. doi:10.3897/bdj.4.e7720.figure2f

Shorr, R. I., Chandler, A. M., Mion, L. C., Waters, T. M., Liu, M., Daniels, M. J., … Miller, S.T.

(2012). 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),

692–699. http://doi.org/10.7326/0003-4819-157-10-201211200-00005

Subermaniam, K., Welfred, R., Subramanian, P., Chinna, K., Ibrahim, F., Mohktar, M. S., &

Tan, M. P. (2017). The effectiveness of a wireless modular bed absence sensor device for

fall prevention among older inpatients. Frontiers in Public Health, 4, 292.

doi:10.3389/fpubh.2016.00292

Tzeng, H. M., Yin, C. Y., Anderson, A., & Prakash, A. (2012). Nursing staffs awareness of

keeping beds in the lowest position to prevent falls and fall injuries in an adult acute

surgical inpatient care setting. Medsurg Nursing: Official Journal of the Academy

of Medical-Surgical Nurses, 21(5), 271-4.

Running Head: Do Bed Alarms Reduce Patient Falls in Medical Surgical Units? 9