Effects of an intervention to increase bed alarm use to prevent falls in hospitalized patients: a cluster randomized trial.

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.