One of the new MDS sections, P0200: Alarms, is now required on all OBRA assessments with assessment reference dates (ARD) of October 1, 2017 and later. The rationale for adding this section is closely tied to the new Requirements of Participation interpretative guidelines for resident-centered care (RAI Manual, Page P-8):

  • 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.
  1. 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. The RAI manual defines each category in P0200:
  • 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/attached to the resident that alert the staff when the resident nears or exits an area or 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.
    • Bracelets r devices worn or attached to the resident and/or his or her belongings that signal a door to lock when the resident approaches should be coded in P0200F Other alarm, whether or not the device activates a sound.
    • D not code a universal building exit alarm applied to an exit door that is intended to alert staff when anyne (including visitrs or staff members) exits the door.

One apparent issue with the new coding guidelines has to do with a wander guard worn by a resident that causes a door to lock and alarm when a resident moves into close proximity of the door. This would be coded as both a motion sensor alarm and as “other alarm.” If the door locks but does not alarm, it would only be coded as “other alarm.”

  1. an alarm meets the criteria as a restraint, code the alarm use in both P0100, Physical Restraints, and P0200, Alarms. In reviewing the Interpretative Guidelines for F604 Restraints, it appears the only type of alarm that may be considered a restraint is a position change alarm:
  • Examples of facility practices that meet the definition of a physical restraint include, but are not limited to:
    • Using a psition change alarm to monitor resident movement, and the resident is afraid to move to avoid setting off the alarm.
  • “Position change alarms” are alerting devices intended to monitor a resident’s movement. The devices emit an audible signal when the resident moves in a certain way. Types of position change alarms include chair and bed sensor pads, bedside alarmed mats, alarms clipped to a resident’s clothing, seatbelt alarms, and infrared beam motion detectors. Position change alarms do not include alarms intended to monitor for unsafe wandering such as door or elevator alarms.

Even if the type of alarm used does not meet the definition of a physical restraint, there are several places in the new interpretative guidelines that direct a surveyor to investigate use of the alarm. Examples are found in “F252 Respect and Dignity” and “F584 Homelike Environment.” In both sections, the following guidance is found:

Some good practices that serve to decrease the institutional character of the environment include the elimination of the widespread and long-term use of audible (to the resident) chair and bed alarms, instead of their limited use for selected residents for diagnostic purposes or according to their care planned needs. These devices can startle the resident and constrain the resident from normal repositioning movements, which can be problematic.