Investigating the effectiveness of mobilisation alarms to prevent hospital falls using disinvestment: A randomised clinical trial.
Dai Pu, Kelly Stephen, Cassie McDonald and 19 others
PMID 41422595WHAT IT FOUND
Reducing mobilisation alarms on hospital wards did not increase falls beyond an agreed limit, but eliminating them did not meet that limit.
Patients in eliminated wards reported less sleep disturbance. Reduce carefully rather than remove.
Key findings
01Reducing mobilisation alarm use was non-inferior to current use for falls, but only just: the confidence limit for increased falls was just below 2 falls per 1000 OBDs.
02Eliminating mobilisation alarms was not shown to be non-inferior to current use because the confidence limit was an increase of 3.68 falls per 1000 OBDs.
03Patients in wards that eliminated alarms reported less sleep disturbance, while most other secondary outcomes did not differ.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The non-inferiority margin was 2 falls per 1000 OBDs, set by local stakeholders; a lower margin elsewhere could change the conclusion. The reduced condition only just met non-inferiority, so the result is marginal. Intervention fidelity was uneven: some wards did not exceed 3% alarm use during the current condition, and the reduced condition had 22 of 45 ward-months below 3% but not 0%. Other fall prevention measures changed: in eliminated wards, call bells, tables and phones were less often within reach, which could weaken fall prevention. 30-day readmission was not analysed because readmissions could not be linked to individual ward exposure. The trial occurred during the tail-end of the COVID-19 pandemic, with staff turnover and larger than expected variability in monthly fall rates.
The easy way to misread this
Do not conclude that mobilisation alarms can be safely eliminated on every ward. Elimination did not meet non-inferiority because the confidence limit was an increase of 3.68 falls per 1000 OBDs, and reduced use only just met the 2 falls per 1000 OBDs margin.