Bed alarms don’t work and won’t reduce patient falls

Many older patients fall in the hospital and these falls often lead to injury.  Hospitals are under a lot of pressure to reduce falls.   Generally, these falls happen when patients transfer such as when an older person tries to get out of bed or get up from a chair.   While hospitalized, many patients are weak, dizzy, or confused, and they can be at risk of falling when ambulating without assistance.

To reduce this risk, bed alarms have become ubiquitous at hospitals throughout the US.  When a patient is deemed to be at high risk of falling, weight sensitive pads are applied to the bed, chair, or commode.   When a patient tries to get up, an alarm sounds in the room and at the nursing station.  The alarm reminds the patient to wait for assistance, and alerts nursing staff to assist the patient.

Remarkably, these alarms have become widely used with virtually no evidence that they actually reduce falls, let alone any studies that examine the adverse consequences of restricting mobility.  I am not aware of any studies that ask patients how they feel about being attached to these devices. In general, hospitalized older patients are not even asked permission to apply these devices.

This context makes a study by Geriatrician Ron Shorr at the University of Florida particularly remarkable.  In a well done study, Shorr provides compelling evidence that these bed alarms fail miserably at their core purpose of preventing falls in high risk hospitalized patients.

To test the usefulness of bed alarms, they did the following.  They took 16 medical surgical units at a Memphis teaching hospital and randomly assigned 8 units to a bed alarm intervention and 8 units to usual care.  On the intervention unit, the staff received extensive training on the use of the bed alarms and was strongly encouraged to use the alarms on patients felt to be at high risk of falling.  Shorr and colleagues compared the rate of falling and fall injury before and after the bed alarm intervention was introduced on both the intervention and the control units.

The findings were as follows:

  • On the bed alarm units, there were 5.76 falls per 1000 patient days. About 1/4 resulted in injury
  • On the usual care unit, there were 4.56 falls per 1000 patient days.  About 1/4 resulted in injury
  • The trend towards higher fall rates on the intervention units was not statistically significant, so the study does not show that bed alarms lead to more falls.  But this trend almost certainly rules out any meaningful chance that this bed alarm system, as implemented in this study, can reduce the risk of falls.

This study raises serious questions about the growing use of bed alarms in US hospitals.  As the authors note, these systems are not cheap.

Maybe we need to rethink hospital fall prevention, and focus on more human and less technical solutions.  Bed alarms have the potential to be activity restricting.  This activity restriction can actually increase the risk of hospital acquired disabilities that are very common in hospitalized elders.

Frail older patients need to be encouraged to get out of bed and ambulate.   Solutions aimed at getting high risk patients the assistance they need when they need it are likely to be more effective than bed alarms.  Also, we need to learn how to make environmental modifications in our hospitals that make it safer when patients actually do fall so that these falls are less likely to cause injury.

So, add bed alarms to the long list of medical interventions that have been widely used despite no evidence that they actually work.

Ken Covinsky is Professor of Medicine, University of California, San Francisco who blogs at GeriPal.

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  • Ferkham pasha

    Need a better system


    As a neuro nurse with several high fall risk pts and as someone who uses bed and chair alarms quite often, I would have to disagree with this. We round hourly on our pts to prevent falls but when an alarm is going off we run to that room to assist the pt. several almost falls have been prevented due to our bed and chair alarms. I know our hospital will continue to use them.

  • Warren Roth

    The type of alarm aparently discussed doesn’t work. The so-called Tabs alarm, named after the original manufacture, does in fact restrict the wearer and is easily defeated. It’s also annoying and as a result provides an impitus to defeat it for all but the most demented individual. However, there are many other types of alarms available today that don’t affect the wearer and in fact, may not even alert the wearer at all. These may be the only types of effective alarms on the market, but are more costly. Integrated with the Nurse call system, the infrared, motion or pressure types of non contact alarms do not restrict the patient in any way and can be set to be silent locally, yet alert the staff in many different ways including sophisticated technologies, such as paging and wall lights and select sounds in the department. The author complained that no study had been conducted to determine the effectiveness of the alarms in the LTC setting, but if we waited for a group of studies and started where he did with the technology, we would still be waiting for the first intervention to be introduced. Go ahead an study the issue, but instead of trying to tell the industry what it already knows, that the string alarm is annoying, easily defeated and restrictive, why don’t you look into what we don’t know, which of the better technologies works best.

  • John Mitchell

    As a hospital administrator I installed bed alarms built in the bed after a patient fall and death. The staff appreciated the devices and were very responsive to the alarms. We had no further falls from bed to floor while I was at that hospital. Patient families also preferred the alarms. Built-in bed alarms also help to protect a hospital against law suits due to falls.

  • Dorothygreen

    Probably is a better system is needed. Camera + alarm? Arrangement of nurses station (maybe not even a station) but rather like a cop – moving around and here have a scanning video on a small computer. The entire set-up in a hospital is rather archaic.
    Probably costs too much to change so continue to put on bandaids like everything else. What do hospitals do in other countries. Since we are so far behind them in so many ways perhaps this is one area from which we can learn,

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