Carmen Bowman, co-author of Alarms: The New Deficient Practice? Eliminating Alarms and Preventing Falls by Engaging with … Life
Most professionals around the country now concur with the research that position change alarms cause more harm than good.
There are numerous physical harms. Alarms cause immobility. Immobility causes skin breakdown and pressure ulcers, edema, inadequate blood flow, inadequate pulmonary function, contractures, cardiac overload, bone loss, increased infections such as UTIs and cellulitis, constipation and fecal impaction, and then pain from many of these conditions. Decreased muscle strength and balance also occur from immobility and then, check this out, all of these make a person even more at risk for falls! Vicious cycles alarms have caused.
There are numerous psychological harms. Alarms cause increased confusion particularly to those living with dementia as they do not understand the loud sound. Confusion turns into increased “upsetness” and agitation. Once a person living with dementia becomes upset, it is very difficult to help them get “unupset.” This can also develop into aggression potentially causing undo harm to others. Alarms going off causes others to tell the resident with the alarm to “be quite” or “shut that thing off” which leads to social rejection, isolation and depression. Alarms mimic traumatic memories for some residents such as war sirens and fire alarms.
Residents have also expressed that alarms are undignified and degrading to them. Residents have asked “what have I done wrong to deserve this?” Most people’s response and experience with alarms is the opposite of how we have used them. An alarm in the morning “alarms” us to “get up;” a smoke or fire alarm “alarms” us to “get out.”
Unfortunately, most staff’s traditional reaction has been to run to a person with an alarm sounding, telling (maybe yelling at) them to “sit down.” When we do that, we react to the alarm, not the person. If we responded to the person, we would instead say something like “Can I help you?” or “Do you want to go for a walk perhaps?” recognizing that our bodies need to move. The design of alarms teaches staff to be reactive, to go to the resident after a loud sound “alarms” them to do so. In fact, alarms may even be teaching staff it’s okay to ignoreresidents. It is high time we become proactive in serving others.
Think for a minute, what causes most falls in your community? Trying to get to the bathroom is the number one cause of falls. Many just can’t wait, many forget to wait, and sometimes they feel they waited long enough. The unintended consequences of residents having to wait so much — the reactive approach instead of proactive — are incontinence or even worse, a fall, or worse yet, a fall with injury. (Please note the word toileting is not used here as it is very degrading, institutional, and not normal. How many of us say, “Excuse me I have to go toilet myself?”)
How do you suppose everyone is sleeping with alarms loudly ringing at all times of the day and night? Honoring sleep is so important it should be a regulation all unto itself. Although there is a regulation for comfortable sound levels, they are not comfortable with noisy alarms. A resident once told me “it is like your fire alarm going off in your home all the time and it certainly raises your stress level.” People living in nursing homes are some of the most sleep-deprived people in the world and then consider, sadly, that sleep deprivation is considered a war crime….
Alarms were never intended to harm people but like many other things, we have learned that is indeed what they do. And like restraints, we then make moves to eliminate something that harms the people we serve. Having studied, written about and taught on this subject for almost a decade, I can tell you there are much better replacements. So much better, you’ll wish you had implemented them long ago.
CMS regulations have supported not using alarms all along but now even more so, citing research of the harms of alarms. This is why the new CMS Physical Restraints Critical Element Pathway survey tool now prompts surveyors to observe for alarms and their potential negative consequences to residents.