The use of bed-exit alarms to reduce the risk of falls among patients with cognitive impairment Essay

Reflection on why to introduce the innovation

Recent evidence indicates a link between cognitive impairment and falls. Allali et al. (2017) suggest that cognitive impairment is linked with an increased prevalence of falls in healthy older adults. Lipardo and Tsang (2018) support this observation by stating that mild cognitive impairment increases the risk of falling, especially in older adults.  The prevalence of falls in moderate to severe cognitive impairment is twice as high as for cognitively normal adults. Factors that increase the risk of falls in patients with cognitive impairment are environmental risks, abnormal neural control of the cardiovascular system, and postural instability. The consequences of falls for this group include head injuries, fractures, and mortality, and those who fall outside hospital settings are roughly five times likely to be admitted to hospital (Montero-Odasso & Speechley, 2017).

The presented evidence indicates that falls among patients with cognitive impairment are a major health issue requiring innovation to reduce surgical wards’ falls. I propose bed-exit alarm innovation to address this issue. Bed-exit alarms are devices that alert caregivers whenever a patient is restricted to get out of bed without assistance but attempts to do so (Shorr et al., 2012). I propose this innovation because once an alarm sounds, caregivers can rush to the patient’s bed and assist him/her in getting out of bed, preventing a fall. I believe this innovation can also enhance swift help to patients who have already fallen. Types of bed-alarms systems include infrared bedside mirrors, clip alarms comprising a magnet and pull-cord activation, a chair alarm triggered by a patient’s weight, or a sensor alarm pad applied to the bed (Okumoto et al., 2020). During my clinical placement, wards using the innovation would identify patients at risk of falling by leaving their beds unassisted and have caregivers go to these patients, reducing falls compared with wards without the invention. Wards using the innovation had fewer incidences of falls. The use of bed-exit alarms to reduce the risk of falls among patients with cognitive impairment Essay.

Aims and objectives of the innovation

The innovation’s objective is to reduce the risk of falls among patients with cognitive impairment in the surgical ward. The invention will achieve this objective by identifying a patient’s attempt to leave the bed and send an alert to the nurses on duty, prompting them to take action to prevent a fall.

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The benefits of using bed-exit alarms to prevent the risk of fall

Bed-exit alarms avoid the risk of falls by alerting healthcare providers whenever patients at risk of falling attempt to rise from their beds without providers’ assistance (Mileski et al., 2019). Another benefit of this innovation is that the alarm sound distracts patients making them consider the risk, stop exiting the bed and wait for help, while prompting the nurse to assist the provider to help the patient (Chu, 2017). These alarms enhance providers’ surveillance of patients with cognitive impairment and serve as an alternative to the physical restraint methods (Shee et al., 2014). Providers may directly attach the alarms to the patient or be part of or adjacent to the bed. Therefore, bed-exit alarms prevent risk by notifying providers of a patient leaving the bed and enhancing patient surveillance at risk of fall, both avoiding fall risk.

The argument for change with evidence

A study by Subermaniam et al. (2017) on the efficacy of modular bed absence sensor device, a type of bed-alarm for preventing falls among older patients, reported that the device accurately detected bed absence by geriatric patients, alerting nurses. In this study, 98% of the true alarms were correct bed-exit tries. These bed-alarm devices recorded a sensitivity of 100% with a predictive value of 68%. Jähne-Raden et al. (2017) investigated the effectiveness of Inexpensive Node for bed-exit detection (INBED), a signalling system for detecting bed-exits and preventing falls. The author reported that the system detects different kinds of motions such as rising and falling and alerts nursing staff using the wireless infrastructure. The study also notes that this system supports healthcare workers in reducing falls and is effective and suitable for daily use. Another study by Torres et al. (2017) reported that battery-less and wireless wearable sensor systems for determining chair and bed exit detect bed and chair exits preventing falls in a hospital setting. The use of bed-exit alarms to reduce the risk of falls among patients with cognitive impairment Essay. The evidence from these studies indicates this innovation’s effectiveness in reducing falls among older adults in clinical settings. According to Shee et al. (2014), bed-exit alarms offer an effective and acceptable strategy for preventing falls among patients with cognitive impairment. Therefore, innovation would effectively reduce falls among patients with cognitive impairment in surgical wards.

Use of a change model: Lewin’s model of change

This model proposes that implementing change in an organisation involves three successive phases: unfreezing, shifting, and refreezing. Unfreezing involves destabilising the current state by informing organisational members of the need for change, the expected change, removing or reducing restraining forces and increasing driving forces (Batras et al., 2018). The step will involve informing the hospital’s staff about the proposed innovation, and using the invention will solve the health issue. Shifting step consists of moving the equilibrium to a new level by adjusting perspectives and beliefs and reshaping the procedures and structures. This step will involve changing staff attitudes and modifying hospital processes and systems to adopt the proposed innovation. Refreezing reinforces the change and establishes new ways of doing things and rewarding desired results (Mitchell, 2013). Concerning the invention, refreezing will involve strengthening bed-exit alarms use by healthcare staff to prevent falls in surgical wards until it becomes a hospital practice.

Barriers to change

Potential barriers to this change are technical, infrastructural, economic, and resistance by hospital staff. Technical barriers are difficulty selecting the most appropriate type of bed-exit alarm among the available options and lacking the technical expertise to implement the innovation. Infrastructural barriers will involve the hospital lacking the necessary healthcare infrastructure to support the selected bed-exit alarm. Economic barriers are inadequate finances for purchasing the alarms, installing the alarms in the wards of interest, training the hospital staff, and maintaining the alarms. Resistance to change by health personnel may include doubt about the change, demonstrative rejection, voiced disagreement, decreased participation in some activities, individual or group resistance (Mares, 2018). The healthcare facility may experience these barriers due to scarce resources, inadequate planning, poor organisational change culture, and insufficient staff communication about the proposed change.

Solutions to the barriers

The solution to resistance to change by health personnel involves identifying the source of and cause of resistance and implementing procedures to address the opposition. For instance, if resistance arises due to an inadequate understanding of the change, the best approach is to educate them and address their concerns. The use of bed-exit alarms to reduce the risk of falls among patients with cognitive impairment Essay.Other solutions to resistance to change are communicating with all stakeholders, creating readiness for change, engaging all stakeholders in the change process, selecting and empowering change champions, and providing positive reinforcement (Gesme & Wiseman, 2010). The strategy to overcome economic barriers includes budgeting for the change and sourcing for the financial resources required to implement and maintain the innovation. Budgeting would involve setting strategic goals, reviewing options, and monitoring adherence to the planned budget (Walsh, 2016). Overcoming technical barriers will include the hospital hiring experts in bed-exit alarms to decide the type of alarm. These experts can serve as change agents. The expert will also inform the hospital of the infrastructure to have before adopting the new technology. Implementing these barriers to change would significantly enhance the adoption of the proposed innovation of bed-exit alarms to minimise the risk of falls among patients with cognitive impairment in surgical wards. The use of bed-exit alarms to reduce the risk of falls among patients with cognitive impairment Essay.