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

Falls in hospitalized persons are widespread and serious threats to patient safety (1, 2). Accidental falls are among the most common incidents reported in hospitals (3), complicating approximately 2% of hospital stays (3–5). About 25% of falls in hospitalized patients result in injury, and 2% result in fractures (4). Substantial costs are associated with falls, including costs of patient care associated with increased length of stay and liability (6). Beginning 1 October 2008, the Centers for Medicare & Medicaid Services eliminated payment to hospitals for costs incurred in treating injuries resulting from falls during hospitalization, further compounding the fall-related costs to hospitals (7–9). Most falls in hospitalized patients occur in patient rooms and are related to ambulating from a bed, chair, or toilet without adequate assistance (10, 11). Bed alarm systems (for example, bed or chair alarms) could therefore reduce falls by alerting personnel when at-risk patients attempt to leave a bed or chair without assistance. Another potential benefit is that bed alarm systems may reduce the need for physical restraints—a Centers for Medicare & Medicaid Services quality-of-care indicator (12). Although 1 uncontrolled study found that restraint use decreased by 37% after the introduction of alarms (13), the relationship among bed alarm monitoring, falls, and physical restraint use has not been well-studied (5, 14). To address the utility of bed alarm systems as an approach to falls prevention in hospitals, we conducted a cluster randomized trial aimed at increasing use of bed alarms by nurses to estimate their effectiveness.