Fall alarms are used in many long-term care facilities as part of a safety plan to decrease or eliminate the risk of falls. Alarms serve as an "early warning system." They alert nursing staff when “at-risk” residents are engaging in activities such as leaving their bed or chair—which likely results in falls. Fall alarms can play a vital role in helping staff to prevent falls. However, the inappropriate use of fall alarms may actually incline residents to falls and injuries. The effective use of fall alarms is dependent on several factors that can serve a variety of useful functions.

Fall Alarm Functions
       Fall alarms can serve as various useful functions:

• Alarms can warn staff that the resident has changed position and is about to leave their bed, chair or wheelchair. This may give staff enough time to best assist the resident.

• Alarms can warn staff that the resident has shortly left the bed, chair or wheelchair. This may give staff enough time to intercept the resident before a fall.

• Alarms promote rapid assistance for residents who have already fallen and are in need of assistance. This aids in reducing fall complications that can ultimately result from the amount of time that a resident lies unaided.

• Alarms serve as an alternative to nurse call bells for residents who are noncompliant or unable to use a call bell due to cognitive and/or physical impairments.

• Alarms may serve as an assessment or planning tool by monitoring the frequency of resident attempts to leave the bed, chair or wheelchair, which help identify emerging trends and interventions. For example, a resident may consistently attempt to rise at a certain hour to go to the bathroom. As a result of this patient “history,” staff is able to adjust their attention and care to this specific resident need.

• Alarms can allow staff to better utilize time (avoiding constant supervision of residents at risk). This may eliminate the need to continually check on residents who have a tendency to fall. This provides nurses more opportunity to work with residents as opposed to spending time on surveillance or being frequently interrupted to observe residents.  

Which Residents May Benefit From Fall Alarms
       Certain residents benefit more than others with the aid of a fall alarm; these include individuals with:

History of falls
       Falling is one of the most reliable predictors of future falls. Residents with a history of recurrent falls often repeat the circumstance or characteristics of their falls, such as leaving their bed and toileting.  

Balance or gait problems
       Residents with problems walking or standing without the assistance of a walker or they require staff assistance.

Muscle weakness
       Any weakness or impairment of the legs and/or arms—eg, from arthritis, muscular weakness, and stroke can inhibit the safety of a resident’s transfers, ambulation, and balance.

Bladder problems
       Residents who have bladder problems may get up without necessary assistance to use the bathroom. Residents with nocturia, incontinence and those requiring toileting assistance are especially at high fall risk.

Cognitive problems
       Altered mental status (confusion, disorientation or impaired memory) is one of the most important risk factors for falling. Cognitive losses can cause errors in judgment (inability to recognize the difference between safe and hazardous transfers), forgetting to use the nurse call bell or not recognizing the purpose of the call bell (not making a connection between pushing a button and getting help), and not recognizing a need for assistance (overestimating the ability to transfer and walk safely, or denying any mobility limitations).

Mobility problems
       A major mobility issue is the inability to ambulate and transfer safely and independently. Diseases directly affecting mobility such as, strength, flexibility, and balance include acute and chronic conditions that affect the muscular or neurological systems and limit the resident’s ability to function more safely.


Frequently Asked Questions
Q: Our residents with frequent falls are equipped with fall alarms, but I have not found the alarms to be useful. The nurses report that every resident whose alarm is ringing was already on the floor—it’s frustrating. Can you offer any suggestions?

A: Effectiveness of fall alarms depends on the ability of staff to reach the resident in a timely manner. Sufficient response time to sounding alarms may be achieved by:
• Adjusting the sensitivity of the alarm. For instance, some fall alarms are equipped with a delay function that adjusts the amount of time between a resident’s change in position and the sounding of the alarm. A short delay can provide staff with adequate response time, whereas a long delay may be inadequate to reach the resident in time.  
Determining the Reasons for Alarm Activations
• Staff should try to find out why the resident attempted to exit the bed or chair.
• Immediately determine if the reason is hunger/thirst, boredom, or tolieting.
• Provide anticipatory care in response by meeting the resident’s needs—this may ultimately reduce the number of alarms.
Relocating the Resident’s Bedroom or Location with the Nurse’s Station
• This alternative may provide staff with adequate response time.
• Fall alarms are not for “at-risk” residents. It is important to target fall alarms for those residents who need them—eg, individuals who need assistance with ambulation and who can not be relied on to seek or ask for assistance.

Q: We are starting a “bed alarm program” in our nursing home. When assigning residents an alarm, what criteria should we use?

A: • Resident experiences fall(s) from bed.
•Resident experiences fall(s) shortly after leaving bed, or  is found on bedroom floor after an unwitnessed fall.
• Resident has impaired mobility and demonstrates unsafe bed transfers.
• Resident has a history of cognitive/communicative problems—eg, forgets to use call bell, ask for assistance, or cannot remember to follow instructions.
• Resident has a history of nocturia (excessive urination at night).

Q: I have been asked to write a resident assessment guideline for the use of chair alarms. Can you provide some guidance?

A: Before initiating use of a chair alarm:
Conduct a mobility assessment. Chair alarms are not for all residents. When getting up from a chair, falls are due to lower extremity muscle weakness and poor balance, which results in “sit-to-stand” failure. When attempting to get up some residents simply fall back down again onto the chair (they don’t have enough muscle strength to stand). Others may step forward, lose their balance, and fall to the floor. Chair alarms are most suitable for residents who attempt to sit back down. Chair alarms are also appropriate for residents who stand up from a chair and are capable of maintaining their standing balance by holding onto the chair for a short period of time. For those residents with sit-to-stand failure that fall forward, while chair alarms can alert staff to a fall, other strategies to prevent falls may have to be considered.

       After initiating use of a chair alarm:
use of the alarm should be continually re-evaluated. If the resident is no longer mobile or has ceased attempting to stand, and the situation seems likely to remain unchanged removing the alarm must be taken into consideration.