A Culture Change Pathway to Person Centered Care: Take Action Beyond Alarms

Sunday, November 1, 2009

Linda C. Bifano, RN, MN, MPA
Cedar Sinai Park, Portland, OR

Learning Objective 1: identify key factors influencing nursing practice changes to promote person centered care at one long term care facility.

Learning Objective 2: identify methods utilized to eliminate the use of electronic alarms or passive restraints in nursing home residents/patients.

Patients/residents in nursing homes have the right to receive services with reasonable accommodation of individual needs and preferences and be directed toward assisting to maintain and/or achieving independent functioning, dignity, and well being in accordance with their own needs and preferences in a home like setting. This poster will provide information about an organizational pathway created to change nursing practice regarding use of electronic alarms that decreases institutional character of nursing home environment and increases/improves individualized care.

Culture change movement in long term care emphasizes an environment that promotes benefit of a social model including strength of relationships between/among caregivers; residents/patients, family members and the physical environment. 
Although federal regulations ban mechanical/chemical restraints, use of electronic alarms or "passive" restraints continues to be utilized when nursing home residents are assessed to be at risk of injury due to falls. “Tab alarms" or "personal alarms" (audible alarm) attached to the resident by a clip at the end of a cord connected to a bed/chair pad that sound when movement away from the seated or lying surface occurs. Likewise floor pad alarms placed at bedside to signal “out of bed” status.  Reliance on electronic alarms does not correlate to fall/injury prevention and often places residents at risk for injury and further decline when alarms sounds cause anxiety, startled behavior, lack of sleep, restricted movement, immobility with adverse affects to respiratory, digestive, circulatory and muscular systems. Alarm restraints interfere with residents’ independence,dignity and desirable level of both individual and community (other residents) function.  
This poster presentation  describes methods to promote alternative interventions to alarm use in a nursing home.Measures of success include reduction of alarm use, increased individualized plans of care along with resident responses, behavior monitoring, PRN medication use for pain/ anxiety as well as family and staff satisfaction.