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Effects of an Intervention to Increase Bed Alarm Use to Prevent Falls in Hospitalized Patients: A Cluster Randomized Trial

Ronald I. Shorr, MD, MS; A. Michelle Chandler; Lorraine C. Mion, RN, PhD; Teresa M. Waters, PhD; Minzhao Liu, MS; Michael J. Daniels, ScD; Lori A. Kessler, PharmD; and Stephen T. Miller, MD
[+] Article, Author, and Disclosure Information

From the Geriatric Research Education and Clinical Center (GRECC), Malcom Randall Veterans Affairs Medical Center, and University of Florida, Gainesville, Florida; Methodist Healthcare and University of Tennessee Health Science Center, Memphis, Tennessee; and School of Nursing, Vanderbilt University, Nashville, Tennessee.

Disclaimer: Dr. Shorr had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Acknowledgment: The authors thank Daniel Clark and Danielle Squires from the Methodist Healthcare information technology staff, who determined patient-day information from hospital billing data, and the Methodist Healthcare nurse managers who performed the fall evaluations.

Grant Support: National Institute on Aging (R01-AG025285 and R01-AG033005).

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0804.

Reproducible Research Statement: Study protocol and statistical code: Not available. Data set: Available from Dr. Shorr (e-mail, rshorr@ufl.edu).

Requests for Single Reprints: Ronald I. Shorr, MD, MS, Geriatric Research Education and Clinical Center (182), Malcom Randall Veterans Affairs Medical Center, 1601 SW Archer Road, Gainesville, FL 32608; e-mail, rshorr@ufl.edu.

Current Author Addresses: Dr. Shorr: Geriatric Research Education and Clinical Center (182), Malcom Randall Veterans Affairs Medical Center, 1601 SW Archer Road, Gainesville, FL 32608.

Ms. Chandler and Drs. Kessler and Miller: Methodist Healthcare, 1265 Union Avenue, Memphis, TN 38104.

Mr. Liu: Department of Statistics, University of Florida, 102 Griffin Floyd Hall, Gainesville, FL 32611.

Dr. Daniels: Division of Statistics and Scientific Computation, University of Texas at Austin, 141MC Patterson Hall, Austin, TX 78712.

Dr. Waters: Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38104.

Dr. Mion: Vanderbilt School of Nursing, 424 Godchaux Hall, 461 21st Avenue South, Nashville, TN 37221.

Author Contributions: Conception and design: R.I. Shorr, A.M. Chandler, L.C. Mion, T.M. Waters, S.T. Miller.

Analysis and interpretation of the data: R.I. Shorr, L.C. Mion, T.M. Waters, M.J. Daniels.

Drafting of the article: R.I. Shorr, A.M. Chandler, T.M. Waters, M. Liu, M.J. Daniels.

Critical revision of the article for important intellectual content: R.I. Shorr, L.C. Mion, T.M. Waters, M.J. Daniels, S.T. Miller.

Final approval of the article: R.I. Shorr, A.M. Chandler, L.C. Mion, T.M. Waters, M.J. Daniels, S.T. Miller.

Provision of study materials or patients: L.A. Kessler, S.T. Miller.

Statistical expertise: M. Liu, M.J. Daniels.

Obtaining of funding: R.I. Shorr, L.C. Mion, T.M. Waters, S.T. Miller.

Administrative, technical, or logistic support: A.M. Chandler, L.A. Kessler, S.T. Miller.

Collection and assembly of data: R.I. Shorr, A.M. Chandler, T.M. Waters, L.A. Kessler, S.T. Miller.

Ann Intern Med. 2012;157(10):692-699. doi:10.7326/0003-4819-157-10-201211200-00005
Text Size: A A A

Background: Bed alarm systems intended to prevent hospital falls have not been formally evaluated.

Objective: To investigate whether an intervention aimed at increasing bed alarm use decreases hospital falls and related events.

Design: Pair-matched, cluster randomized trial over 18 months. Nursing units were allocated by computer-generated randomization on the basis of baseline fall rates. Patients and outcome assessors were blinded to unit assignment; outcome assessors may have become unblinded. (ClinicalTrials.gov registration number: NCT00183053)

Setting: 16 nursing units in an urban community hospital.

Patients: 27 672 inpatients in general medical, surgical, and specialty units.

Intervention: Education, training, and technical support to promote use of a standard bed alarm system (intervention units); bed alarms available but not formally promoted or supported (control units).

Measurements: Pre–post difference in change in falls per 1000 patient-days (primary end point); number of patients who fell, fall-related injuries, and number of patients restrained (secondary end points).

Results: Prevalence of alarm use was 64.41 days per 1000 patient-days on intervention units and 1.79 days per 1000 patient-days on control units (P = 0.004). There was no difference in change in fall rates per 1000 patient-days (risk ratio, 1.09 [95% CI, 0.85 to 1.53]; difference, 0.41 [CI, −1.05 to 2.47], which corresponds to a greater difference in falls in control vs. intervention units) or in the number of patients who fell, injurious fall rates, or the number of patients physically restrained on intervention units compared with control units.

Limitation: The study was conducted at a single site and was slightly underpowered compared with the initial design.

Conclusion: An intervention designed to increase bed alarm use in an urban hospital increased alarm use but had no statistically or clinically significant effect on fall-related events or physical restraint use.

Primary Funding Source: National Institute on Aging.


Grahic Jump Location
Figure 1.

Study flow diagram.

Mean and range of patient-days in individual nursing units over the 8-mo observation period (allocation) and 18-mo intervention period (analysis) are reported.

* Two units unexpectedly closed during the study and provided data for only 3 mo.

Grahic Jump Location
Grahic Jump Location
Figure 2.

Alarm days and falls per 1000 patient-days on control and intervention nursing units.

Error bars represent SDs.

Grahic Jump Location




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