Fulfilling the Promise

Eliminating Restraints & Alarms

Melissa Jackson CEO/Administrator

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Some Facts:• In 1991, 69% of residents in nursing

homes in the U.S. were restrained. (CMS)

• In 2011, the national average of residents in nursing homes who were restrained was 3%.

Restraints

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Restraints

Nationally, restraint usage has been recognized as significantly contributing to the deterioration of the residence physical and mental status. Potential negative outcomes of restraint usages include, but are not limited to:

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Continued• Decline in the resident’s physical functioning;

Ambulation, and muscle condition • Contractures• Increase in the risk of infection • Development of pressure ulcers, delirium,

agitation and • Incontinence

Restraints

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Alarms

• Alarms became a mainstay of the nursing home industry after the federal government cracked down on the use of physical restraints in the early 1990s

• The idea that by putting a restraint and alarm on a resident, I’m keeping them more safe. ….I’m preventing falls

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Alarms

• While most nursing homes still use alarms, in part to protect against state and federal penalties for inadequate fall-prevention measures

• We ask, what is the evidence to prove the use of alarms prevents falls and injuries? There really isn’t any

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Restraint Free 1st Nursing Home in Vermont 2005

Vermont Health Care Association

VVH Policy developed in 2004On Use/Non-use of Alarms &

Restraints

Audible Alarm free January 2014

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HOW DID WE

Well…..it wasn’t easy…

Full Facility buy-in Inter Disciplinary Team (IDT) approach One neighborhood at a time

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Education was/is key Full staff education prior to

launch Seminars Conferences Trade ShowsVeteran, member, and family

education during the process

Implementation

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Carmen Bowman, MHS Conference Calls Thinking outside the box

• “What if they never invented alarms, what would you do?”

Implementation

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Considered in process Room Care Plans Fall history Position Personal needs/toileting All else

Implementation

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LNA’s (CNA’s) from the Neighborhoods highly involved

Care plans updated at time of review

Finance- involved in new purchases

Consistent Staffing

Implementation

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Alarms – Mixed Messages Most tell us to get up & take action Can be associated with military

sounds No research supporting alarm use &

fall prevention – Reactionary devices

Implementation

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Change the mindset….. Proactive vs Reactive Anticipate needs vs Respond Documentation = Analysis

• Decision Tree• Assessment forms• Audits• IDT staff input forms

Implementation

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Things to think aboutRegulations – Why vs why not

Restraints• Alarms can be restraints• Convenience

o For staff, not Veteran safety• Accidents F323

o Alarms do not replace supervision• Homelike environment

o Do we use alarms on our children?

Implementation

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Early Nursing Policy

Implementation

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Engagement is the Key Know your Veterans

• Life story• Favorite activities/what brings joy• Institutional routine vs their routine

o Ask and forgotten

• Simple pleasures• Use Their abilities to benefit others

o Do not focus solely on disabilities

• Community calendar vs My day

Implementation

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Behaviors What are they trying to tell us Is it even fair to call them behaviors What would someone need to know

about you now, to take good care of you later

Implementation

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Our Accident & Investigation Process developed from this program Meeting with a “Huddle” Reviewing Incident/s Root Cause Analysis-Data Example-Grab bars initiated from this

data to enable self positioning Lower beds Landing strips

Implementation

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Sound reduction Overhead paging discontinued

• Noise level greatly decreased• Pagers issued to staff• Veterans with dementia reduced stress,

not searching for voices

“Whisper Hours” “Passive” call bells

Rehab brought in early Balance Program

Implementation

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Alternate therapy's derived from this study Music in Memory Namaste Room Activities

Prior- One central location Pushed to neighborhoods- Variety and Frequency expanded Evening activities

Implementation

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Restraints &

Alarms

Activities

Implementation

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ChallengesOld school

Full Facility buy-in Resistance

Families- understanding whyNo Alarms added w/o IDT meeting3rd shift

Difficult to educate/train

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ChallengesFull circle- “it’s their right to fall”Administrations-new leadership

desired a return to alarmsFamilies – fear of falling, they tried

everythingBuilding full of alarms

Noise Level Falls Behaviors “Vet to Vet”

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Conclusion

Pick a date &Stick with it!

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Questions…….

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