P0200: Alarms

P0200: Alarms

Item Rationale

Health-related Quality of Life

• An alarm is any physical or electronic device that monitors resident movement and alerts the staff, by either audible or inaudible means, when movement is detected, and may include bed, chair and floor sensor pads, cords that clip to the resident’s clothing, motion sensors, door alarms, or elopement/wandering devices.

• While often used as an intervention in a resident’s fall prevention strategy, the efficacy of alarms to prevent falls has not been proven; therefore, alarm use must not be the primary or sole intervention in the plan.

• The use of an alarm as part of the resident’s plan of care does not eliminate the need for adequate supervision, nor does the alarm replace individualized, person-centered care planning.

• Adverse consequences of alarm use include, but are not limited to, fear, anxiety, or agitation related to the alarm sound; decreased mobility; sleep disturbances; and infringement on freedom of movement, dignity, and privacy.

Planning for Care

• Individualized, person-centered care planning surrounding the resident’s use of an alarm is important to the resident’s overall well-being.

• When the use of an alarm is considered as an intervention in the resident’s safety strategy, use must be based on the assessment of the resident and monitored for efficacy on an ongoing basis, including the assessment of unintended consequences of the alarm use and alternative interventions.

• There are times when the use of an alarm may meet the definition of a restraint, as the alarm may restrict the resident’s freedom of movement and may not be easily removed by the resident.

• When an alarm is used as an intervention in the resident’s safety strategy, the effect the alarm has on the resident must be evaluated individually for that resident.

Steps for Assessment

1. Review the resident’s medical record (e.g., physician orders, nurses’ notes, nursing assistant documentation) to determine if alarms were used during the 7-day look-back period.

2. Consult the nursing staff to determine the resident’s cognitive and physical status/limitations.

3. Evaluate whether the alarm affects the resident’s freedom of movement when the alarm/device is in place. For example, does the resident avoid standing up or repositioning themself due to fear of setting off the alarm?

Coding Instructions

Identify all alarms that were used at any time (day or night) during the 7-day look-back period. After determining whether or not an item listed in P0200 was used during the 7-day look-back period, code the frequency of use:

• Code 0, not used: if the device was not used during the 7-day look-back period.

• Code 1, used less than daily: if the device was used less than daily.

• Code 2, used daily: if the device was used on a daily basis during the look-backperiod.

Coding Tips

• Bed alarm includes devices such as a sensor pad placed on the bed or a device that clips to the resident’s clothing.

• Chair alarm includes devices such as a sensor pad placed on the chair or wheelchair or a device that clips to the resident’s clothing.

• Floor mat alarm includes devices such as a sensor pad placed on the floor beside the bed.

• Motion sensor alarm includes infrared beam motion detectors.

• Wander/elopement alarm includes devices such as bracelets, pins/buttons worn on the resident’s clothing, sensors in shoes, or building/unit exit sensors worn by/attached to the resident that activate an alarm and/or alert the staff when the resident nears or exits a specific area or the building. This includes devices that are attached to the resident’s assistive device (e.g., walker, wheelchair, cane) or other belongings.

• Other alarm includes devices such as alarms on the resident’s bathroom and/or bedroom door, toilet seat alarms, or seatbelt alarms.

• Code any type of alarm, audible or inaudible, used during the look-back period in this section.

• If an alarm meets the criteria as a restraint, code the alarm use in both P0100, Physical Restraints, and P0200, Alarms.

• Motion sensors and wrist sensors worn by the resident to track the resident’s sleep patterns should not be coded in this section.

• Wandering is random or repetitive locomotion. This movement may be goal-directed (e.g., the resident appears to be searching for something such as an exit) or may be nongoal directed or aimless. Non-goal directed wandering requires a response in a manner that addresses both safety issues and an evaluation to identify root causes to the degree possible.

• While wander, door, or building alarms can help monitor a resident’s activities, staff must be vigilant in order to respond to them in a timely manner. Alarms do not replace necessary supervision.

• Bracelets or devices worn by or attached to the resident and/or their belongings that signal a door to lock when the resident approaches should be coded in P0200E Wander/elopement alarm, whether or not the device activates a sound or alerts the staff.

• Do not code a universal building exit alarm applied to an exit door that is intended to alert staff when anyone (including visitors or staff members) exits the door.

• When determining whether the use of an alarm also meets the criteria of a restraint, refer to the section “Determination of the Use of Position Change Alarms as Restraints” of F604 in Appendix PP of the State Operations Manual available at https://www.cms.gov/RegulationsandGuidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf.