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Caley Dismore
Debra Kline

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Falls are a leading cause of mortality and morbidity among elderly patients in healthcare settings. Because falls may result in death or lifetime disability and the cost for post fall care is not covered by most  health insurers or Medicare and Medicaid, a fall prevention program is among the most important aspects of patient centered care.

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Among elderly patients, does the use of bed alarms with hourly rounding decrease the risk of falls when compared to using only bed alarms?

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Neuman’s Systems Model (NSM).
A guide for nurses and nurse managers to design care which will result in optimal standards and practice based on assessment of the following:
1. Intrinsic risk factors; ex., stiff joints and muscles, CVA, urinary tract infections, dementia

·2. Extrinsic risk factors; ex., medication, poor lighting, unfamiliar surroundings

·3. Stressors; combination of all factors which reduce the line of defense.
(Neuman’s Systems Model, 2016).

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Neuman's System Model

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Research for review of the literature was conducted through an online scientific inquiry which included a review of journals and theses in the following databases: ProQuest, Elsevier, Ovid, SAGE, Science Direct and PubMed. Search terms included: “falls”, “fall prevention”, “long-term care”, “bed sensor”, “bed exit alarms”, “bed monitors”, “rounding”, “intentional rounding”, “hourly rounding”, “safety”, “patient safety”, “fall risks”,  and “outcomes”.

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There are several studies that are statistically significant and indicate a reduction in falls when used as intended. Use of bed alarms and patient centered hourly rounding have both been shown as effective tools which can be easily incorporated into the individual care plan of a patient.
1. Fall alert systems provide additional surveillance and opportunities for immediate interventions to help reduce injury related to bed exits.  Potter et al. (2017), demonstrated that the use of bed alarm sensor technology reduced falls in an inpatient hospital setting.
2. Another study tested a specific modular bed absence sensor device and its effectiveness in preventing falls among a group of 31 patients >65 years of age who were admitted during the study period and 35 nurses caring for the patients during the study period. Chinna, K. et al. (2016) demonstrated there was a decrease in the fall rate.
3. Intentional hourly rounding (IHR) is shown to be an effective tool in the reduction of falls rates. IHR allows for nurses to anticipate patient needs and provide early intervention in the hopes of delivering optimal patient care (Ford-Johnston, 2014).  In 2016, Daniel’s randomized controlled study examined IHR and measured elements of patient safety including patient falls. The study was performed on a 28-bed medical surgical unit at a non-academic hospital in the United States where patient satisfaction and safety scores had declined (Daniel, 2016).
4. Another hourly rounding study used a Lean Six Sigma Implementation Improvement Project Model with a main goal of quality improvement. (Goldsacks et al., 2015) demonstrated a reduction in fall rates among one of two groups in its study. Pre-implementation fall-rates for mean 1-year baseline are 3.9 falls/1000 inpatient days on Unit one. Unit one, whose program included both leadership and staff in its design and implementation during the pilot study saw a decline in its fall rate to 1.3 falls/1000 inpatient days (p = 0.006). On Unit two pre-implementation fall-rates for mean 1-year baseline is 2.6/1000 inpatient days. Unit two whose program did not include leadership in its design and implementation saw a fall rate reduction of 2.6/1000 inpatient days (p = 0.799).

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For a fall prevention program to be successful more than one method has to be implemented.
1. Intentional hourly rounding (IHR) during the day and at least every two hour rounding at night.
2. Bed exit alarms are a useful tool in fall prevention and should be incorporated into the care plan.
3. Involve leadership and nursing staff in the planning and implementation of the program.
4.  Provide education to nursing staff on the importance of these fall reduction tools and how to use them effectively.

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Although both interventions have been associated with a decrease in falls, based on the information discovered through this literary review, there is not enough evidence to demonstrate that one method is better than the other.  Research studies involving a direct comparison of fall rates on patients where bed sensor alarms and IHR are used are required to strengthen this hypothesis.