When I informed my nursing staff that we were going to remove position change alarms, fear and panic set in. My staff looked at me in disbelief. They asked me if I was crazy. “Tell me, do alarms really keep our residents safe?” I asked my staff. “Too often the alarms do nothing more than tell us that our residents are already on the floor. How much time do you spend running into a resident’s room only to discover they were changing positions?” Most residents will tell you to throw that damn thing out! In my opinion, alarms do not decrease the number of falls. More times than not, they are annoying—not only for residents, but nursing home staff as well.
I shared with my team an experience I had during a recent hospitalization. I went to get up to use the restroom and guess who sounded the alarm? I thought, you have got to be kidding me! Ha! No worries, I work in LTC, I got this! Well, this ole gal had no idea how to silence this cutting-edge piece of equipment. For one thing, I couldn’t even locate the box! The nurse aide rushed in and jokingly scolded me, reminding me to use the call bell and wait for assistance. That’s when I told her what I really wanted to do with that alarm! She said, “Ah, but you can’t, only I have the power…it’s built into the mattress and only we can turn it on or off.” UGH! My staff was on the floor belly laughing, and I loved every minute of it…but, I got their attention!
If you have not “tapped” into the 696 pages of the “Revised Requirements of Participation and Interpretive Guidelines,” let me be of service to you.
I share my story with you because if you are not already aware, Section P of the MDS has been renamed “Restraints and Alarms.” Personal alarms have been added to item P0200 and the nurse performing the assessment must identify whether the device (chair/bed alarm) is 0, Not used; 1, Used less than daily; or 2, Used daily. I want to emphasize that under definitions, CMS has added:
“Position change alarms are alerting devices intended to monitor a resident’s movement. The devices emit an audible signal when the resident moves in certain ways.” And to add to the revised thinking, the “examples of facility practices that meet the definition of a physical restraint” now include “using a position change alarm to monitor resident movement, [where] the resident is afraid to move to avoid setting off the alarm.”
Position change alarms are any physical or electronic device that monitors resident movement and alerts the staff when movement is detected. Types of position change alarms include chair and bed sensor pads, bedside alarmed mats, alarms clipped to a resident’s clothing, seatbelt alarms, and infrared beam motion detectors. Position change alarms do not include alarms intended to monitor for unsafe wandering such as door or elevator alarms.
While position change alarms may be implemented to monitor a resident’s movements, for some residents, the use of position change alarms that are audible to the resident(s) may have the unintended consequence of inhibiting freedom of movement. For example, a resident may be afraid to move to avoid setting off the alarm and creating noise that is a nuisance to the resident(s) and staff, or is embarrassing to the resident. For this resident, a position change alarm may have the potential effect of a physical restraint.
Some examples of negative, potential or actual outcomes which may result from the use of position change alarms as a physical restraint include:
- Loss of dignity;
- Decreased mobility;
- Bowel and bladder incontinence;
- Sleep disturbances due to the sound of the alarm or because the resident is afraid to move in bed thereby setting off the alarm; and
- Confusion, fear, agitation, anxiety, or irritation in response to the sound of the alarm as residents may mistake the alarm as a warning or as something they need to get away from.
The way I see it is that you have two choices: get rid of the alarms, which is what I recommend, or keep them. Either way, you’ll need to retain the services of an experienced healthcare consultant to implement a plan to make sure you are in full compliance with the “Revised Requirements of Participation and Interpretive Guidelines.”
LW Consulting, Inc. provides staff education, reviews of policies and procedures, risk assessments, informed consents, and care planning. Make sure you are aware and prepared for any penalties the Department of Health may impose on you.