HillRoms bed exit system with audible alarm used

Hill-Rom's bed exit system with audible alarm, used in conjunction with falls protocol: Reduces falls on a Medical -Surgical inpatient unit: A Process Improvement Project Lydia Albuquerque, DNP, ACNP-BC, CCRN Assistant Professor College Of Science and Health Department of Nursing William Paterson University, Wayne, NJ 10/24/2021 1

Disclosure • None to disclose 10/24/2021 2

OBJECTIVES • To assess the bed functionality on a medical surgical unit. • Assess knowledge of registered nurses and certified nursing assistant with regards to zeroing and setting of bed. • Implement an education intervention and skills demonstration to zero beds and set bed alarms. • Evaluate falls rate Post-intervention 10/24/2021 3

CTION INTRODU § Falls are a growing public health concern and source of injury for older adults. § Approximately 1 in 5 older adults in Untied States experience a fall. 1 § 3 million emergency department visits are related to falls 2 3 § Fall death rates among adults age 65 and older has increased more than 3. % from 2007 to 20162 § In 2016, $50 billion was spent on non-fatal falls injuries and $754 million is spent on fatal falls 3 § Medicare and Medicaid shouldered 75% of these costs 3 1. Centers for disease control and prevention (CDC). National center for health statistics. (2020). Fall facts. Retrieved from https//www. cdc. gov//fall/adultfalls. html. 2. Burns, E. , & Kakara, R. (2018). Deaths from falls among persons Aged ≥ 65 Years- United States, 2007– 2016. Morbidity and Mortality Weekly Report 67(18), 509– 514. doi: http: //dx. doi. org/10. 15585. 3. Florence, C. S. , Bergen, G. , Atherly, A. , Burns, E. , Stevens, J. and Drake, C. (2018), Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc, 66: 693 -698. doi: 10. 1111/jgs. 10/24/2021 4

BACKGROUND • Increase in falls rate on a medical surgical unit 5. 8 per 1, 000 patient • Falls prevention bundle implemented Ø Morse falls risk assessment tool Ø Hourly rounding on unit Ø Hand-off shift report Ø Yellow wrist band Ø Hill-Rom Versa care beds launched on the unit. 10/24/2021 5

PURPOSE The purpose of this project was to examine the effectiveness of an education intervention & skills demonstration based on recommendation of Hill-Rom bed exit system with audible alarm on falls rate on a medical surgical unit of an academic medical center. Independent Variables Education and skills validation on activating the Hill-Rom Dependent variable Fall rates 10/24/2021 6

PICOT QUESTION • The population (P) consisted of registered nurses and certified nursing assistants. • The Intervention (I) consisted of educating and skills demonstration on zeroing the bed and activating the Hill-Rom bed exit system with audible alarm. • The outcome (O) examined the falls rate on the unit post intervention. • Time (T) was measured during a one-year time frame 10/24/2021 7

Methodology Study design • A quantitative, descriptive correlational design was used. Setting Sample Size • A purposive sampling technique was utilized. • Male and female registered nurses and certified nursing assistants ( n=32) working on the medical-surgical unit at an academic medical center were recruited Ethical consideration Approval from participating study site was obtained prior to implementing the study. 10/24/2021 8

METHODOLOGY • A spot check of bed functionality on the unit was conducted • Pre-test 8 item questionnaire was administered to all participants of the study. • Participants were tested for the skill in zeroing of the bed and turning on the bed alarm. • An education intervention from Hill-Rom on utilization of Bed exit alarm and zeroing of bed was implemented. • A post test and post intervention skill checklist was conducted • Post intervention spot check of bed functionality was conducted. • Falls rate on the unit were tracked 10/24/2021 9

PARTICIPANTS EDUCATION 10/24/2021 10

Advanta 2 Bed-Quick Tips Bed Exit Alarm: Bed alarm will not engage if the bed scale is not zeroed properly To Activate: • Make sure the pt. is centered in the bed & aligned with the hip indicator. • Press the Green Enable Key • Press one of the 3 desired Bed Exit Modes. The system will beep one time • The green light will stay solid when system is armed • To Reset or Deactivate: • Press the Enable Key • Press any Bed Exit mode control until the green light indicator goes off. • Safe view Green light illuminated on floor indicates: • -Bed exit is set • -Bed is in lowest position • -2 sides rails up • -Bed is locked • -Patient in bed • Bed exit has to be set for light to be activated • If any other perimeter is out of place light will flash YELLOW 10/24/2021 11

Advanta 2 Bed-Quick Tips Zero the Bed • With the bed empty, add the following: • 1 Fitted Sheet 1 Top Sheet 1 Blanket 1 Pillowcase 1 Pillow • Hold Zero Button • When Orange “Hands Off” light starts blinking-Do not touch bed!! • Weigh the Patient • Make sure the patient is centered in bed • Remove all drainage bags hanging from the foot section of the frame; remove excess linen; remove excess items from side rails and footboard • Push Weigh Button 10/24/2021 12

SKILL DEMONSTRATION 10/24/2021 13

Demographic characteristics of Participants Variable N Category of participants Registered nurses 19 Certified nursing Assistants 13 Gender Female 31 Male 1 Age in Years 20 -30 9 31 - 40 12 41 -50 10 51 -60 1 Years of experience 0 -5 years 12 6 -10 years 9 11 -15 years 10 16 -20 years 1 Education Qualification of registered nurses Master’s in nursing 2 10/24/2021 Associate degree 6 % 59. 38 40. 62 96. 9 3. 13 28. 12 37. 50 31. 25 3. 13 37. 50 28. 12 31. 25 3. 13 6. 25 18. 75 14

Comparison of activation of bed alarm Pre-intervention and Post-intervention Variable Number of Alarm Percentag patients on e with Morse Score ≥ 46 Pre -Intervention 14 4 28. 5% Post-Intervention 9 9 100% Prior to the education intervention 14 patients had a Morse score ≥ 46, only 4 (25. 57%) bed alarms were activated. Post education intervention and skills demonstration found nine patients had a Morse score ≥ 46 and 100% of the bed alarm were activated 15

Comparison of test scores Pre-intervention and Post-intervention N Mean Std deviation Std Error mean Pre-test score 32 4. 94 . 716 . 127 Post-test score 32 7. 56 1. 722 . 304 The mean educational score of the pre-test was 4. 94, and the mean score on the posttest was 7. 56 (0 -8). This resulted in a 42% increase in test scores post educational intervention. The eight item questionnaire included responses of how to zero a bed, when to activate the bed alarm, who to call if the bed is not functioning for replacement, hospital policy on Morse scores to activate the bed alarm. 10/24/2021 16

Relationship between Pre and Post test scores Variables Mean Pre-test. Post test scores 2. 625 Std. Deviation 1. 845 t 8. 049 df Sig (2 -tailed 31 . 000* A sample t-test was used to examine the effectiveness of education on pre-test and post -test scores. The post-test mean was 2. 65 greater, t= 8. 048, p=. 000. The results were highly significant with gain of knowledge and skills post education intervention. 10/24/2021 17

Zeroing of Bed and Activation of Bed alarms Frequency Pre- Intervention Yes No Post- Intervention Yes No Percent 17 15 53. 1 46. 9 32 100 All participants were tested for zeroing and activation of the bed alarm. Preintervention, 17 (53. 1%) of participants were able to zero the beds and activate the bed alarm. Post-intervention all participants 32 (100%) were able to zero the bed and activate the bed alarm, indicating that participants 15 (46. 9%) were further educated through a skills demonstration of zeroing and activation of bed alarms 10/24/2021 18

Fall On Medical-Surgical Unit per 1000 Patient days January 2016 -December 2017 FALLS PER 1, 000 PATIENT DAYS 7 2016 2017 Linear(2016) Linear(2017) June 2 0 August September October November December 1 3 4 2 2 1 2 0 0 0 6 5 4 3 2 1 0 January 2016 3 2017 2 10/24/2021 February 1 2 March 5 1 April 2 1 May 6 0 July 1 0 19

CLUSION • Falls decreased 55% from 5. 8 to 3. 2 per 1, 000 patient days from 20162017 • Zeroing of beds and activation of bed alarms among patients with Morse score above 46 increased from 28. 5% to 100%. • Nurses and certified nursing assistants require consistent education, and spot checks to ensure that Hill-Rom bed system with audible alarms are utilized to benefit patients in reducing falls that could be fatal and nonfatal Future Research Multicenter randomized trials are needed to confirm the effectiveness of The Hill-Rom's bed exit system with audible alarm, used in conjunction with falls protocol. A larger sample including different floors in the hospital should be considered. 10/24/2021 20

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References Centers for disease control and prevention (CDC). National center for health statistics. (2020). Fall facts. Retrieved from https//www. cdc. gov//fall/adultfalls. html. Burns, E. , & Kakara, R. (2018). Deaths from falls among persons Aged ≥ 65 Years. United States, 2007– 2016. Morbidity and Mortality Weekly Report 67(18), 509– 514. doi: http: //dx. doi. org/10. 15585. Florence, C. S. , Bergen, G. , Atherly, A. , Burns, E. , Stevens, J. and Drake, C. (2018), Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc, 66: 693 -698. doi: 10. 1111/jgs. Haddad, Y. K. , Bergen, G. , Florence, C. S. (2019). Estimating the economic burden related to older adult falls by state. J Public Health Manage Pract. 25(2): E 17–E 24. doi: 10. 1097/PHH. 0000000816. Dibardino, D. , Cohen, E. R. , Didwania, A. (2012). A meta-analysis: Multidisciplinary fall prevention strategies in the acute care inpatient population. J Hosp Med, 7 (6): 497– 503, doi: 10. 1002/jhm. 1917. Dykes, P. C. , Carroll, D. L. , Hurley, A. C. , Benoita, A. Middleton, B. (2009). Why do patients in acute care hospitals fall? Can falls be prevented? J Nurs Adm, 39: 299– 304. 10/24/2021

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