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Promoting Mobility, Reducing Falls and Alarms

Facilitator Instructions for Starter Exercise

WHAT: This exercise starts a conversation and simultaneously activates a process for change. It is a learn while doing exercise. The people who agree to wear alarms will have short personalized experience that they can then share with others. Everyone will begin to apply the new awareness about alarms and mobility to their own residents. By the end of the exercise you will have a place to start and a way forward.

WHY: Change is hard. Successful change requires discussion about why and how. This exercise starts that conversation by giving staff a personal understanding of the impact of alarms. As staff who wear the alarm reflect on their own experience, they better understand their residents' experiences and see how the changes will benefit residents. Then they can think through how to make it happen. Use this discussion to find out how the staff closest to the resident, who will implement a new approach, think it will work best. Have on-going discussions as the change evolves.

HOW: This guide includes discussion prompters to use after the personalized experience first to draw out staff's experience and reflections, and then to hear their ideas on how to do it. Allow time for each discussion. Hear from everyone. Ask for responses from quieter people. It may be tempting to brush off staff members who are openly skeptical, but putting into play major changes requires that concerns be welcomed as a contribution to the effort's success; get to the root of the concern, and note it as an area to keep an eye on.

RESOURCES: Toolkit Tip Sheet and Video Clip on Promoting Mobility, Reducing Falls and Alarms
Entire Toolkit and Webinar Series available at Pioneer Network store.

Preparation: Review tip sheet and video clip on Promoting Mobility, Reducing Falls and Alarms

Time: 20 - 30 minutes, depending on discussion time

Personal alarms
Paper and pen for a note-taker for each group

To give staff a personal understanding of the all the ways alarms contribute to social isolation and restrict movement.

Form groups of 4 - 6 people. Group people so co-workers are together. In each group, have a mix of CNAs, nurses, and other staff.

Ask for a volunteer in each group to wear an alarm. Ask the person sitting next to them to reset it if it goes off.

Ask for a volunteer note taken for each group.

Explain: In our field we continually learn new good practices and use new information to improve care. We now know that alarms can cause declines that otherwise wouldn't happen. CMS, in Quality of Life Survey Guidelines issued in 2009, said nursing homes should "strive to eliminate" use of alarms.

Homes that have removed alarms are helping residents be more safely mobile. As staff work with residents to build their strength, support their mobility, and anticipate their needs, fewer people are falling, less often, with fewer injuries.

Restricting mobility contributes to falls and falls with injury. Alarms, like restraints, restrict mobility. Alarms have negative impacts on strength and gait, sleep, skin, appetite and digestion, social engagement and mood.

Have a 10 minute discussion in small groups.

Ask each group to make a list of 5-10 residents with alarms.
Of these 5-10, put a star next to the names of any who regularly turn off their alarm, or have said they'd prefer not to have the alarm, or who could be considered for alarm removal.

For each of these people, discuss one at a time:
  • Why was the alarm decided on in the first place?
  • What is the need for the alarm now?
  • What more do we need to find out about the resident's risks and abilities to know how to help them be more safely mobile?
  • What are the next steps? Who will do what?

Explain: We understand best when we have a personal experience. Some of you have been wearing alarms.

One by one ask each person who wore an alarm to describe what they experienced.

People will have a range of experiences. Some will describe physical discomfort, while others will talk about how it affected their concentration, its isolating impact, and their concern about disrupting others. Probe their comments so they expand on their descriptions. Ask if they were surprised by how it felt.

Ask everyone to discuss what they've observed about how alarms do affect residents wearing them and sitting nearby.

Begin the discussion on how to make it happen.

Where would we start?

What would we need to make this work?

Download Facilitator Instructions for Promoting Mobility, Reducing Falls and Alarms (PDF)

Starter Toolkit Home          Step One          Step Two          Step Three          Self-Assessment
Prepared by B&F Consulting for Pioneer Network's National Learning Collaborative on Using the MDS as the Engine for High Quality Individualized Care. Funded by The Retirement Research Foundation.