Evidence-Based Strategies for Transitioning to an Alarm-Free Facility

Resident advocates and SNF regulators speculate that alarms will eventually be phased out as regulations continue to evolve and the industry fully embraces the modern, homelike SNF model.

Editorial note: This post is an excerpt taken from an article published in the July issue of PPS Alert for Long-Term Care, the industry’s leading resource dedicated to helping long-term care professionals navigate through continual shifts in regulatory compliance, the MDS and PPS processes, and keeping you up to date on industry news. Interested in subscribing? Click here to sign up!

Change associated with alarm use doesn’t look the same for all residents or even all facilities. Several factors should be considered before implementing methods to eliminate alarms–and providers shouldn’t expect it to happen all at once. Root cause analysis and planning are essential to implement successful culture change that wins staff buy-in and delivers quality care.

Conducting a controlled study in your facility before eliminating alarms is a great way to create data in order to determine the best method for change. The following steps outline one approach to prepping residents and staff for alarm elimination.

Step one: Begin by selecting a control group of residents. Some facilities might choose a certain number of residents per unit, select particular residents, or only try eliminating alarms with new, incoming residents. Long-term care consultant Bonnie Foster, RN, BSN, MEd, recommends selecting residents who trigger their alarms most often or those with multiple alarms, as these are the ones likely suffering the most from the devices’ negative effects. Foster also recommends removing bed alarms first. “Many residents aren’t getting four to six hours of uninterrupted sleep because every time they turn over, their alarm goes off.”

Step two: Make sure everyone in the facility is on board. Presently, there isn’t much literature on methods for changing the usage of alarms. Doing so depends on several factors unique to your facility, including:

• Size of facility
• Staff availability
• Acuity
• Trial replacement intervention

“Old habits die hard, and staff have a hard time getting away from long-standing practices,” says Joan Devine, RN, director of education at Pioneer Network. She notes that families need convincing, too; often family members will request that an alarm be used as a safety measure for their loved one because they know hospitals use them but are misinformed about their purpose. In the short term, says Devine, “putting an alarm on a resident is an easier solution than doing the type of individual assessment needed to determine what is motivating a resident to get up and determining how we can meet that need. We are getting better, but it takes learning new assessment and observation skills [to solve the bigger-picture issue].”

Step three: Establish a time frame. Will you conduct the controlled study during one shift or for only three hours at a time? It’s important to keep in mind that you don’t necessarily need more staff; instead, it’s essential to re-educate staff on how to approach the situation differently. Be proactive and ask residents beforehand, “Do you need to go to the bathroom?” or “Would you like to be repositioned?”

Step four: Conduct your study. Foster and Devine agree that taking it slow is key. “Don’t just implement a ‘tomorrow we eliminate alarms’ approach,” says Devine. “The approach needs to be individualized.” Foster recommends that facilities “show success with a small group of residents.” This will help gain staff buy-in and raise morale among staff, families, and residents.

Step five: Once you’ve executed your study and collected your data, you can determine goals for your facility by conducting a performance improvement project (PIP). During planning, administrators should review the facility’s statistics, including:

• Quality measures
• Fall rate and interventions
• Was there an improvement in fall rate with alarm use?
• Correlation between falls and noise levels in facility and time of day

In setting goals for elimination, providers should avoid scaring residents away from practicing safe mobility while also conducting a root cause analysis to identify the most common reasons residents trigger their alarms, as well as the needs that can go unmet if these individuals limit their mobility. Considerations should include reasons such as:

• Toileting
• Fatigue
• Curiosity
• Discomfort
• Repositioning
• The desire to participate in a different activity

Once staff can anticipate residents’ wants, barriers between resident needs and staff understanding can be lifted.

Join Post-Acute Care Regulatory Specialist Stefanie Corbett on Tuesday, September 12 as she discusses interventions for transitioning to an alarm-free facility without compromising resident safety, including how to utilize your QAPI programs to understand root causes for falls, regulatory guidance, and how to achieve culture change through alarm elimination. Sign up today!