Power-Up Friday

Speaking at the Life Services Network’s annual meeting in Chicago…

I caught part II of a nice session on Nursing Strategies for Culture Change, facilitated by Barbara Frank. Barbara framed the session around the concept of moving culture change forward by encouraging critical thinking. She encouraged nurse managers to convene daily team meetings, to facilitate communication and provide an avenue for collaborative, creative problem-solving (i.e., helping staff take charge in managing change).

The fun really began when she applied the critical thinking concept to the use of alarms in nursing homes. Bed and chair alarms have replaced restraints in the care of people at risk for falls. But do they work? Using a critical thinking discussion, punctuated by the testimonials of volunteers who wore “tab alarms” for 15 minutes (setting them off with even slight shifts in position), Barbara basically showed the futility of this approach.

Alarms do not prevent falls. They are annoying and even frightening when they go off, and embarrassing to those who wear them. The volunteers felt more tense and anxious wearing them (so much for using them for people who are agitated). Barbara remarked, “Isn’t it ironic that we ask staff to turn and position people every two hours, then put an alarm on that basically forces them to be immobile?”

We saw an interview with Brenda Davison of the Jewish Rehabilitation Center of the North Shore, in Swampscott Massachusetts, who took the bull by the horns (full video here). Faced with a high fall rate AND a high alarm usage on one of their dementia-specific floors, they decided the solution was to stop the alarms, in order to reduce the falls! After a 3-week education period, the alarms were removed by one shift per day, till they were gone 24/7. The fall rate dropped significantly.

Ms. Davison remarked that the presence of alarms caused people to see the alarm as the problem, and react to it by simply saying, “Sit down”, instead of looking for the underlying need. In other words, the alarms had become a crutch that actually discouraged critical thinking about the issue of falls.

It’s time to face facts – alarms must go. For those who are nervous about withdrawing them, an even more individualized approach might be to remove the alarms one person at a time. In other words, start with Mr. Smith and discuss what he needs to have his alarm removed, then do it. The move on to Mrs. Jones and decide how to care for her safely without her alarm. The learning curve will improve with each success.

Go get ‘em!