1. Leveraging Bed/Chair Alarm Removal for Falls Prevention
Actionmarguerite St Vital
April 18, 2019

2. OUTLINE Introduction Fall prevention Purposeful rounding
Pre-Implementation
Implementation Staff Resources
Family & Resident Education

3. Personal Care Home Francophone seniors in St Vital, Winnipeg, MB
Personal care – 115 beds
Dementia care – 39 beds
154 beds on 4 units

4. Acknowledgement Hebrew SeniorLife
Centre for Aging + Brain Health Innovation (CABHI)

5. Fall prevention Residents in PCH are at risk for falls
Old measures for preventing falls
Use of bed & chair alarms
Benefit: To alert staff when a resident gets up
Goal - create a home-like & safe environment for all residents

6. Purposeful Rounding
Structured format for rounding on residents at a set frequency to address specific resident needs
The goal
Proactively address resident’s needs
Improve resident satisfaction
Increase comfort and safety.

7. Address the 4 P’s Pain: “do you have pain?”
Position: “Are you comfortable?”
Personal Care: “Do you need to use the bathroom?”
Possessions: “Do you have everything you need within your reach?”

8. Pre-Implementation Objective Method Results
Determine the staff’s impressions of bed and chair alarms
Method
Survey – 2 questions
Do you think the noise from the bed & chair alarms increases the anxiety of staff?
Do you think the bed & chair alarms prevent falls?
Results
See following page

9. Pre-Implementation
Staff Survey Results

10. Recommendation from (initial studies)
Initiate a process for bed & chair alarm removal.
Cease use of bed + chair alarms for all new admissions.
Provide education to the interdisciplinary team + families about the value of removing alarms.
Individualize resident’s care plan for interventions to anticipate needs.
Continue to monitor the fall rate
Evaluate the outcome 3 months from initiation of the intervention.…

11. Implementation Inauguration:
Video conference training- Wed, Nov. 21
Marni’s presentation
Letters to residents & families - signed by CEO, CNO & ADOC sent on Nov 30.
Poster to residents & families
Fall Safety FAQs for Residents & Families
All new admissions received letters.

12. Implementation
Few families (4) had concerns. We met with these families.
General meeting with families held on January 22.
Present were CEO, CNO, ADOC, Mngers and SW

13. Implementation 53 residents had bed &/or chair alarms (20 on UM)
Staff members trained (only few casual remaining)
All night staff trained before the alarms start to be removed.
Working group meeting every 2 weeks
Purposeful rounding began on Jan 18th.
Alarm removal started on Mon. Feb 25th

14. Implementation: Process
When:
22 bed & chair alarms removed on February 25, 2019
14 bed & chair alarms removed on April 1
Remaining alarms – 15 alarms
Who: From least risk residents on the unit
How: Alarms will be removed in sequential rounds (groups).
Unit to decide on & make a list of residents with least risk,
can have bed /chair alarms removed safely.
Discuss with management.
Contact families
Documentation
Bed / chair alarms be removed by day staff only

15. Implementation - strategies
Promoting the project:
Working group members to be champions on their units,
Engage fellow colleagues
Encourage to do purposeful rounding
Education
> 100 employees trained + All night staff trained prior
Reminders –
Intercom announcements q 2hrs
4Ps small cards made for all staff

16. Implementation - strategies
Knowledge Testing: Starting with working groups
Case study discussions
Communication
Auditing –
Purposeful rounding
Post fall huddles
Evaluation –
The process & progress
Initiative evaluation to be done after 3 months

17. What’s working? Less stress on staff & less agitated residents
Less stress HCAs are more aware of where residents are
Less noise
Less falls
Actual # not known yet
More aware of residents’ needs
Staff is more alert, cautious. Don’t rely on alarm to alert them

18. What’s not working? Still need reminders
Sometimes HCAs forget to do purposeful rounding (PR)
Challenging to do PR with residents with dementia
Concerns from night, hourly rounding is not enough for some residents 15 minutes check re to restraints
HCAs forget to sign

19. What’s not working? Every 1 hour may me too be too much
Some residents may not need every 2 hour check - need for consistency
Some Residents don’t like more attention or get annoyed
Some residents may need 15 – 30 minutes check
Sometimes PR does not prevent falls. E.g. Fall happening 5 minutes after the rounding
Some residents don’t understand the question or able to respond

20. What to change? Education – we were not clear enough on the process
Start auditing before removing any alarm

21. Challenges Unable to have a consistent working group members
No slogan in French (e.g. 4Ps)
Communication of new changes to all employees
Dementia unit residents
Time to complete duties

22. Discussion How to do rounding on dementia unit?
How do you communication new changes to all employees for consistent care?
How long does it take to do rounding asking the 4 Ps?

23. Questions?