One Success Leads to Another

Back in 2007, Caldwell Care Center in Caldwell, Idaho, had restraint rates of 14.3% for quarters one and two, and 9.5% for quarters three and four. In 2008 they decided to go restraint free. Going restraint free seemed like a challenging if not impossible task. Caldwell Care Center is a skilled nursing facility that specializes in mood and behavioral disturbances with anywhere between 63–65 residents. Residents in one wing have Alzheimer’s disease and dementia. Residents in the other wing have diseases such as Parkinson’s disease, Huntington’s chorea and other brain disorders. Behavior is often impulsive. It is a 100% secured facility. By 2009 they had brought the restraint rate down to 3.1% and then 0% by January 2010. The staff members were able to achieve success in going restraint-free while still keeping patients safe—a major staff concern with this population. Despite transitioning to a new Director of Nursing Services, Caldwell Care Center continues to maintain a zero restraint record.

Sustainable improvement in physical restraints enabled Caldwell Care Center to build on that success and reduce another type of restraint—alarms. A year and a half ago the Management Team led by John Schulkins, Executive Director at Caldwell Care Center, decided to implement an alarm reduction program that resulted in a startling 84%* reduction of residents on alarms. It all began when members of the Inter Disciplinary Team attended a seminar on alarms that was sponsored by the Idaho Health Care Association. Mike Taylor, RN, Director of Nursing Services, recalls an exercise at that seminar in which he was hooked up to an alarm while a speaker made a presentation. It was an eye-opener. He said he didn’t want to move for fear of setting off the alarm. He felt anxious and uncomfortable and realized then that alarms are a type of psychological restraint for residents.

Returning to his facility, the work began. Forty-five of the 60 residents were on alarms. Again, staff was reluctant to reduce alarms fearing for residents’ safety. Management had to create buy-in from the staff. Once staff accepted the idea, they did a full assessment of risk for each resident. Findings were interesting:

• One-half of residents could take off the alarm or turn it off
• Many residents were getting up and setting off alarms as a reaction to other alarms going off
• A small number of residents made up a high percentage of falls

The individual assessments of residents allowed the nursing staff to identify the unique habits and needs of each resident and to attend more fully to those needs, resulting in fewer residents needing alarms. They also placed the highest risk patients near nurses’ stations. Social worker Mary Brown, LMSW, says “Our CNAs are our greatest tool. Once the CNAs got excited, everything clicked.” And Mike Taylor shares that in addition to the reduction of alarms, “Our facility is now much quieter, more peaceful and calm.” But it gets better. Not only are fewer residents on alarms and fewer alarms going off, but falls decreased too. Since the reduction of alarms, falls have decreased by around 50%.* Mike says they continue with efforts to reduce the number of falls and is pleased that in March of 2011 they saw a further reduction in falls by approximately 71%* from when they started. Staff turnover has improved as well. Turnover was at nearly 100% when they began the journey of reducing alarms and is now at 25%.* Though Mary says, “Change can be hard and uncomfortable,” Caldwell Care Center has clearly accepted the challenge with exciting results.

*Data from internal mechanisms.