European Geriatric Medicine - Supplement 1 - Volume 7

Each home used nurse call systems and body-worn and environmental

technologies to monitor resident and staff activity. Data collection

included 36 semi-structured interviews with staff, relatives and

residents, and 175 hours of non-participant observation; review of

care records and technology manufacturer literature; Media and

Technology Usage and Attitudes Scale and the System Usability Scale.

Analysis, informed by Normalization Process Theory, focused on

individual and organisational factors influential within successful

implementation.

Results:

In each home, staff training in use of monitoring technologies

appeared to be informal, ad hoc, and based upon assumptions that

staff would find the technologies familiar and simple to use. Staff

lacked full operational knowledge of the technologies, and at times

triggered false alarms. However, it was not clear that increasing

the quantity of formal operational training would have enhanced staff

knowledge and skill. Staff drew upon contextual knowledge of the

homes to work around their lack of operational knowledge of the

technologies. Staff placed a relatively low value upon the use of some

technologies compared to personal delivery of care.

Key conclusions:

Staff training in the use of monitoring technologies

needs to go beyond simple operational instruction to include a focus

on how the use of the technology aligns with the values of care within

the home.

Reference

[1] Yin RK.

Case study research: design and methods

. London: Sage,

2009.

P-727

Sound levels on a geriatric medicine ward

T.B. Jones, N. Carroll, C. Jerlehag, P.J. Lee.

Royal Liverpool and Broadgreen

University Hospital NHS Trust, Acoustic Research Unit School of

Architecture University of Liverpool

Introduction:

Sound levels within hospital wards may impact

negatively upon patients

’

recovery. High sound levels lead to poor

speech intelligibility, compromising communication with people with

hearing impairment [1]. High background noise levels are linked to

medication errors [2]. Increased sound levels also disturb sleep and

increase stress levels [2]. Actively reducing ward sound levels can

reduce the incidence and duration of delirium in ITU patients [3].

The World Health Organisation (WHO) have issued guidelines for

noise levels within hospitals, recommending internal ambient noise

levels, do not exceed LAeq 30 dB (average) and LAFmax 40 dB

(maximum) for wards [1]. We measured sound levels over 24 hours

on a geriatric medicine ward and assessed differences between single

occupancy and multiple occupancy rooms.

Method:

Acoustic measurements were undertaken on a geriatric

medicine ward in a university teaching hospital in the UK. Measure-

ments were undertaken in 2 single occupancy rooms, 2 four-bedded

occupancy rooms and 1 six-bedded occupancy room.

Results:

Sounds levels consistently exceeded the WHO recommenda-

tions, particularly at night. Therewas no significant difference in sound

levels between single occupancy and multiple occupancy rooms.

Sound levels never fell below 40dB. Noise levels often exceeded 70 dB

with 711 episodes in the single rooms and 726 episodes in the multiple

occupancy rooms.

Key conclusions:

High sound levels are present within our wards. The

lack of difference between single and multiple occupancy rooms is

pertinent in view of the recent trend towards new hospital buildings

with increased numbers of single occupancy rooms.

References

[1] Berglund B, Lindvall T, Schwela DH.

Guidelines for community

noise

. World Health Organization, Geneva,1999. Available online at

www.who.int

[2] MacKenzie DJ, Galbrun L. Noise levels and noise sources in acute

care hospital wards.

Building Services Engineering Research and

Technology

, 2007, 28: 117

–

[3] Patel J

et al.

The effect of a multipcomponent multidisciplinary

bundle of interventions on sleep and delirium in medical and

surgical intensive care patients.

Anaethesia

2014, 69(5): 540

–

P-728

Smart technology as an alternative for physical restraint

E. Lampo

, V. Carlassara

, N. Spruytte

, B. Degryse

Cretecs

–

Centre of

expertise of the University College VIVES, Bruges,

LUCAS KU Leuven,

Leuven, Belgium

Context:

Within healthcare, physical restraint is often used and

remains a controversial topic. Exact numbers of use in residential

care homes in Flanders aren

’

t available, but thanks to research in

2002 (Talloen, Milisen, & Evers, 2002) an estimation can be made. In

the past years many efforts have been made to reduce the use of

physical restraint, such as using less profound alternatives. However,

it can be seen that physical restraint remains to be the preferred

method by some care professionals. The use of physical restraint

can have a negative impact on the wellbeing of patients, so it is

advisable to find a more proper solution and change the current way

of working.

Methodology:

The STAFF-project investigates whether smart tech-

nology, more specific bed-exit alarm systems, can be an alternative for

physical restraint. A bed-exit alarm system sends out an alarm when

someone leaves his bed, attempts to leave his bed or hasn

’

t returned to

his bed on time. This project consists of 2 parts, (1) a survey that

examines the vision of care professionals on physical restraints

and smart technology as an alternative, and (2) an intervention

study were 8 different bed-exit alarm systems are implemented in 9

Flemish residential care homes. Every facility gets to test 2 different

technologies for a period of 6 months. After 3 month they had to move

the technology to another resident in the care facility.

The main goal of the intervention study is to examine if bed-exit alarm

systems have an impact on the resident, the care professional and care

flow. Quantitative and qualitative data is gathered through (1) focus

group interviews with care professionals (mainly nightshift) and in-

depth interviews with the resident (whenever possible), and (2)

normalized questionnaires. Through pretest-posttest design these

questionnaires monitor whether bed-exit alarm systems influence:

–

the quality of life (QUALIDEM), everyday activity (Katz-scale) and

unrest (CMAI) of the elderly.

–

the acceptancy of technology (TRI), the vision against physical

restraint (MAQ) and the use of smart technology as an alternative by

care professionals.

Results:

There are many preconditions that influence the successful

implementation and use of technology in residential care homes.

That

’

s why tips & trics are collected based on the experiences of 9

residential care homes with 8 different bed-exit alarm systems as an

alternative for physical restraint. First of all, it is very important to

involve the care professional in the choice of an alternative form,

because eventually they are the one who will be working with it and

will have to rely on its proper functioning. The success of technology

implementation depends also on the ease of connecting the

technology with the existing infrastructure of the care facility. Most

of the care facilities have an outmoded nurse call systemwhich cannot

connect with an extra standalone system, such as a bed-exit alarm

system. Furthermore, training is necessary to convince care givers to

work with the technology. Not only to get to know the technology but

also to build up enough self-confidence to work and relay on it. If they

do not support the choice for a bed-exit alarm system, the technology

will not be used in a proper way.

Conclusion:

Bed-exit alarm systems can be an alternative for physical

restraint. This is not so much due to the technology itself, but due to

the autonomy that is given back to the resident. Each form of restraint

is choosing between a certain degree of autonomy and safety of the

person. A personal approach is important to find the best solution that

meets those individual needs. Finally, involve the care professional in

the choice of an alternative form, because eventually they are the one

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