Preventing Patient Falls in Hospitals: Nurses’ Perspectives on Fall Alarm Use

Posted: March 8th, 2024

Preventing Patient Falls in Hospitals: Nurses’ Perspectives on Fall Alarm Use

Patient falls in hospital settings pose significant risks to patient safety and well-being. Falls can lead to injuries, increased length of stay, and higher healthcare costs (Aranda-Gallardo et al., 2013). To mitigate fall risks, hospitals implement various interventions, including the use of fall alarms. These alarms are designed to alert nurses when patients attempt to get out of bed or move in a way that could increase their risk of falling. However, the effectiveness and implications of fall alarm use remain a subject of ongoing debate and research.

This essay explores nurses’ experiences with using fall alarms in subacute care settings, drawing from a qualitative study conducted by Considine et al. (2023) and other relevant literature. It examines the potential benefits, challenges, and unintended consequences associated with fall alarm use, as well as nurses’ perspectives on their effectiveness and impact on patient care.

Benefits of Fall Alarm Use

Fall alarms can provide several potential benefits in hospital settings. First and foremost, they aim to enhance patient safety by alerting nurses when patients are at risk of falling (Tideiksaar et al., 1993). This early warning system allows nurses to intervene promptly and potentially prevent falls from occurring.

Additionally, fall alarms may reduce the need for physical restraints or constant staff supervision, which can be intrusive and potentially harmful to patients’ dignity and autonomy (Growdon et al., 2017). By providing a less restrictive alternative, fall alarms can promote patient mobility and independence while still addressing fall risks.

Furthermore, the use of fall alarms may contribute to a safer work environment for nurses by reducing the physical strain associated with constantly monitoring high-risk patients (Hubbartt et al., 2011). This could potentially lead to improved job satisfaction and a lower risk of work-related injuries for nursing staff.

Challenges and Unintended Consequences

Despite their potential benefits, the use of fall alarms in hospital settings is not without challenges and unintended consequences. One major concern raised by nurses is the high volume of false alarms, which can lead to alarm fatigue and desensitization (Considine et al., 2023). Frequent false alarms may cause nurses to become complacent or ignore legitimate alerts, potentially undermining the effectiveness of the system.

Noise pollution is another issue associated with fall alarms. The constant beeping and alarms can contribute to a noisy hospital environment, which has been linked to decreased sleep quality and increased delirium risk for patients (De Lima Andrade et al., 2021; Sangari et al., 2021). This noise pollution can also negatively impact staff well-being and work satisfaction (Delaney et al., 2018).

Additionally, some nurses express concerns that fall alarms may inadvertently restrict patient mobility and independence (Growdon et al., 2017; Radecki et al., 2018). Patients may become hesitant to move or attempt to get out of bed due to fears of setting off the alarm, potentially leading to increased sedentary behavior and associated complications.

Nurses’ Perspectives on Fall Alarm Effectiveness

The qualitative study by Considine et al. (2023) provides valuable insights into nurses’ perspectives on the effectiveness of fall alarms in subacute care settings. The study found that nurses had mixed views on the usefulness of fall alarms, with some perceiving them as beneficial while others questioned their efficacy.

Some nurses expressed frustration with the high rate of false alarms and the constant noise pollution, leading to a sense of ambivalence or skepticism regarding the alarms’ effectiveness (Considine et al., 2023; Hubbartt et al., 2011). Others felt that fall alarms could be useful in specific situations, such as when caring for patients with cognitive impairments or those at high risk of falls.

Notably, the study revealed that nurses’ decision-making regarding fall alarm use was influenced by various factors, including their personal experiences, perceptions of patient risk, and organizational policies (Considine et al., 2023). This suggests that nurses’ attitudes toward fall alarms may be shaped by their individual contexts and circumstances.

Implications for Practice and Policy

The findings from the qualitative study and the broader literature on fall alarms in hospital settings have several implications for nursing practice and hospital policies.

Firstly, there is a need for ongoing education and training for nurses on the appropriate use of fall alarms and their limitations. This could help address issues such as alarm fatigue and ensure that alarms are used judiciously and effectively (Kaldy, 2018).

Secondly, hospitals should consider implementing strategies to reduce false alarms and minimize noise pollution. This could involve adjusting alarm settings, using alternative alerting systems, or implementing alarm management protocols (Cortes et al., 2021).

Thirdly, it is essential to strike a balance between fall prevention measures and promoting patient mobility and independence. Fall alarms should be used as part of a comprehensive fall prevention program that also emphasizes patient education, environmental modifications, and appropriate exercise and mobility interventions (Oliver et al., 2007).

Finally, hospital policies and guidelines should account for nurses’ perspectives and experiences when developing fall prevention strategies. Involving nurses in the decision-making process and addressing their concerns can increase buy-in and facilitate the successful implementation of fall prevention initiatives (King et al., 2016).

Conclusion

The use of fall alarms in hospital settings remains a complex and multi-faceted issue. While these alarms aim to enhance patient safety by preventing falls, their effectiveness and implications for patient care and staff well-being are subject to ongoing debate and research.

Nurses, as frontline caregivers, offer valuable insights into the practical realities of fall alarm use. Their experiences highlight both potential benefits and challenges, including alarm fatigue, noise pollution, and unintended consequences on patient mobility and independence.

Moving forward, it is crucial to address these concerns through ongoing education, policy refinement, and the implementation of innovative strategies to optimize fall alarm use. Additionally, involving nurses in the decision-making process and considering their perspectives can contribute to the development of more effective and comprehensive fall prevention programs that balance patient safety with patient-centered care and staff well-being.

References

Aranda-Gallardo, M., Morales-Asencio, J. M., Canca-Sanchez, J. C., Barrero-Sojo, S., Perez-Jimenez, C., Morales-Fernandez, A., … & Mora-Banderas, A. M. (2013). Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review and meta-analysis. BMC Health Services Research, 13(1), 1-16. https://doi.org/10.1186/1472-6963-13-122

Considine, J., Berry, D., Mullen, M., Chisango, E., Webb-St Mart, M., Michell, P., … & Boyd, L. (2023). Nurses’ experiences of using falls alarms in subacute care: A qualitative study. PloS One, 18(6), e0287537. https://doi.org/10.1371/journal.pone.0287537

Cortés, O. L., Piñeros, H., Aya, P. A., Sarmiento, J., & Arévalo, I. (2021). Systematic review and meta-analysis of clinical trials: In-hospital use of sensors for prevention of falls. Medicine, 100(41), e27467. https://doi.org/10.1097/MD.0000000000027467

De Lima Andrade, E., Da Cunha e Silva, D. C., De Lima, E. A., De Oliveira, R. A., Zannin, P. H. T., & Martins, A. C. G. (2021). Environmental noise in hospitals: a systematic review. Environmental Science and Pollution Research, 28(16), 19629-19642. https://doi.org/10.1007/s11356-021-13211-2

Delaney, L. J., Currie, M. J., Huang, H. C. C., Lopez, V., & Van Haren, F. (2018). “They can rest at home”: an observational study of patients’ quality of sleep in an Australian hospital. BMC Health Services Research, 18(1), 1-9. https://doi.org/10.1186/s12913-018-3201-z

Growdon, M. E., Shorr, R. I., & Inouye, S. K. (2017). The tension between promoting mobility and preventing falls in the hospital. JAMA Internal Medicine, 177(6), 759-760. https://doi.org/10.1001/jamainternmed.2017.0840

Hubbartt, B., Davis, S. G., & Kautz, D. D. (2011). Nurses’ experiences with bed exit alarms may lead to ambivalence about their effectiveness. Rehabilitation Nursing, 36(5), 196-199. https://doi.org/10.1002/j.2048-7940.2011.tb00195.x

Kaldy, J. (2018). The Buzz: Facilities Are Going Alarm-Free. Caring for the Ages, 19(12), 16-17. https://doi.org/10.1016/j.carage.2018.12.008

King, B., Pecanac, K., Krupp, A., Liebzeit, D., & Mahoney, J. (2016). Impact of Fall Prevention on Nurses and Care of Fall Risk Patients. The Gerontologist, 58(2), gnw156. https://doi.org/10.1093/geront/gnw156

Oliver, D., Connelly, J. B., Victor, C. R., Shaw, F. E., Whitehead, A., Genc, Y., … & Gosney, M. A. (2007). Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. BMJ, 334(7584), 82. https://doi.org/10.1136/bmj.39049.706493.55

Radecki, B., Reynolds, S., & Kara, A. (2018). Inpatient fall prevention from the patient’s perspective: A qualitative study. Applied Nursing Research, 43, 114-119. https://doi.org/10.1016/j.apnr.2018.08.001

Sangari, A., Emhardt, E. A., Salas, B., Avery, A., Freundlich, R. E., Fabbri, D., … & Boustani, M. (2021). Delirium variability is influenced by the sound environment (DEVISE study): How changes in the intensive care unit soundscape affect delirium incidence. Journal of Medical Systems, 45(8), 1-9. https://doi.org/10.1007/s10916-021-01752-5

Tideiksaar, R., Feiner, C. F., & Maby, J. (1993). Falls prevention: the efficacy of a bed alarm system in an acute-care setting. The Mount Sinai Journal of Medicine, New York, 60(6), 522-527.

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Sample Summary of research article:
Considine, J., Berry, D., Mullen, M., Chisango, E., Webb-St. Mart, M., Michell, P., Darzins, P., & Boyd, L. (2023). Nurses’ experiences of using falls alarms in subacute care: A qualitative study. PLOS ONE, 18(6), e0293822.
Nurses’ Experiences with Falls Alarms in Subacute Care: A Qualitative Study

In contemporary healthcare settings, patient safety is paramount, and preventing falls is a critical component of ensuring patient well-being. Despite the implementation of various falls prevention strategies, falls continue to be a significant challenge, particularly in subacute care settings. Bed and chair alarms are commonly utilized as part of multifaceted falls prevention interventions. However, recent research suggests that the effectiveness of falls alarms, when used as sole interventions, is limited. This essay delves into nurses’ experiences with falls alarms in subacute care, drawing insights from a qualitative study conducted in Melbourne, Australia.

Introduction

Reducing falls and preventing injuries resulting from falls in hospital patients is a global patient safety priority. Traditionally, falls prevention strategies in hospitals have centered around risk assessment and the implementation of preventive measures. However, the effectiveness of these strategies remains uncertain due to heterogeneity in study design and results. Numerous validated tools are available for assessing falls risk in older adults, yet many lack high predictive validity.

Background

The traditional approach to falls prevention in hospitals involves the assessment of patients’ falls risk and the implementation of preventive strategies. However, the efficacy of these strategies, particularly falls risk assessment tools, has come under scrutiny due to inconsistent results across studies. Moreover, the cost of falls prevention efforts in healthcare settings is substantial, highlighting the need for effective and cost-efficient interventions.

Effectiveness of Falls Alarms

Bed and chair alarms are commonly included in falls prevention interventions, yet their effectiveness as standalone measures remains questionable. Randomized trials have failed to demonstrate a significant reduction in falls or fall-related injuries with the use of falls alarms alone. Additionally, falls alarms have not been shown to alleviate patients’ fear of falling or improve functional outcomes.

Study Aim

The aim of the qualitative study conducted by Considine et al. (2023) was to explore nurses’ experiences with falls alarms in subacute care settings. By understanding nurses’ perspectives, the study sought to shed light on the challenges and complexities associated with the use of falls alarms and provide insights into potential areas for improvement in falls prevention strategies.

Methodology

A qualitative descriptive approach was adopted, utilizing semi-structured interviews with a purposive sample of 12 nurses working in a 32-bed Geriatric Evaluation and Management ward in Melbourne, Australia. Interviews were conducted between January and March 2021 and transcribed verbatim for analysis. Thematic analysis was employed to identify key themes and subthemes relating to nurses’ experiences with falls alarms.

Findings

Three major themes emerged from the data: negative impacts of falls alarms, juggling the safety-risk conflict, and negotiating falls alarm use. Subthemes under these themes included noisy technology, imperfect technology, nurse decision-making, and falls alarm overuse. Nurses predominantly expressed negative experiences with falls alarms, highlighting tensions between their limited impact on patient safety and the associated risks. Nurses emphasized the need for better support for decision-making regarding falls alarm use and expressed a desire for alternative approaches to managing falls risk.

Discussion

The findings of the study provide valuable insights into the challenges faced by nurses in utilizing falls alarms as part of falls prevention strategies. The negative experiences reported by nurses highlight the need for a critical reassessment of the role of falls alarms in subacute care settings. Furthermore, the study underscores the importance of empowering nurses to make informed decisions regarding falls prevention and exploring alternative strategies to mitigate falls risk effectively.

Conclusion
Nurses’ experiences with falls alarms in subacute care settings reveal significant challenges and limitations associated with their use. While falls alarms have been widely implemented as part of falls prevention interventions, their effectiveness as standalone measures is questionable. Moving forward, there is a need for a multifaceted approach to falls prevention that considers nurses’ perspectives and explores alternative strategies to enhance patient safety in healthcare settings.

References

Considine, J., Berry, D., Mullen, M., Chisango, E., Webb-St Mart, M., Michell, P., … & Boyd, L. (2023). Nurses’ experiences of using falls alarms in subacute care: A qualitative study. PLoS ONE, 18(6), e0287537.

Morris, M. E., Haines, T., Hill, A. M., Cameron, I., Jones, C., & Jazayeri, D. (2021). Divesting from a Scored Hospital Fall Risk Assessment Tool (FRAT): A Cluster Randomized Non-Inferiority Trial. Journal of the American Geriatrics Society, 69(9), 2598–2604.

Park, S. H. (2018). Tools for assessing fall risk in the elderly: A systematic review and meta-analysis. Aging Clinical and Experimental Research, 30(1), 1–16.