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Answering the Call

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The nurse call light is a vital patient communication link during hospital stays. It is one of the few means patients can exercise control over their care in the inpatient unit. When they push the call light button, patients expect a nursing staff member will answer or come to them. Conversely, call lights have been commonly perceived by nursing staff as noise and interruptions to nursing tasks instead of an important way for patients to request assistance.1, 2

Nursing staff often find difficulties in determining patient care priorities and have a different conception about the purpose of call lights. As a result, call lights might not be answered in a timely manner.3

Responsiveness & Patient Falls

The assumed dissonance between patient and nurse perceptions of call light usage may be at the crux of a patient safety problem, namely falls. Patients become impatient and attempt activities that threaten their safety. It is commonly assumed if a nurse responds to a call light faster, the patient may have less of a chance to fall.

It is estimated that serious injuries from falls add at least $20,000 to a patient's costs, from increased length of stay and surgical procedures.4-7 The cost of treating fall-related injuries is significant, as the Centers for Medicare & Medicaid Services no longer pays for preventable inpatient injuries (e.g., fractures). In addition, the issues related to nursing staff's responsiveness to call lights often affect nurse-patient communication, which is an essential part of patient satisfaction.8 Falls, with or without injuries, may also result in malpractice litigation.

Classifying Calls

We need to upgrade our antiquated nurse call light systems to help nursing staff determine patient care priorities. When a patient is lying on the bed, a modern nurse call light system should allow patients to indicate the urgency of their calls. However, the current call light systems and technology are lacking such simple logic and capability. We believe call light panels should have three options to indicate the urgency level of each patient- or family-initiated call:

1. urgent call - unexpected bleeding, shortness of breath, dizziness;

2. normal call - bathroom assistance, IV problems or pump alarm, pain medication and management; and

3. orderly assistance - repositioning, transfer or mobility assistance, personal assistance, obtaining information about medications and health status, demanding a nurse's companionship at bedside.

Once such a modern nurse call light is developed, manufactured and adopted in clinical settings, education to patients and family will be needed to promote the efficiency on call light classification. Nursing staff also need to "upgrade" their attitudes toward the reasons for call light usage and answer call lights in a timely manner according to the urgency level of each call.

The link of prompt response to patient- or family-initiated call lights as a patient safety or fall prevention issue is often overlooked and needs to be addressed in clinical practice and research. Technology may help in fall prevention only if we put patients' safety and needs first and design a patient-friendly nurse call light system from the eyes of our patients - the end users.

References

  1. Meade, C.M., et al. (2006). Effects of nursing rounds on patients' call light use, satisfaction, and safety. American Journal of Nursing, 106(9), 58-70.

  2. Roszell, S., et al. (2009). Call bell requests, call bell response time, and patient satisfaction. Journal of Nursing Care Quality, 24(1), 69-75.

  3. Tzeng, H.M., & Yin, C.Y. (2008). The extrinsic risk factors for inpatient falls in hospital patient rooms. Journal of Nursing Care Quality, 23(3), 234-242.

  4. Mathers, C., & Penm, R. (1999). Health system costs of injury, poisoning and musculoskeletal disorders in Australia 1993-1994. Canberra; Australian Institute of Health and Welfare, 1999. (AIHW Cat. No. HWE 12; Health and Welfare Expenditure Series No. 6).

  5. Boswell, D.J., et al. (2001). The cost-effectiveness of a patient-sitter program in an acute care hospital: A test of the impact of sitters on the incidence of falls and patient satisfaction. Quality Management in Health Care, 10(1), 10-16.

  6. Fonda, D., et al. (2006). Sustained reduction in serious fall-related injuries in older people in hospital. Medical Journal of Australia, 184(8), 379-82.

  7. U.S. Department of Labor Bureau of Labor Statistics. (2008). Consumer price indexes: Inflation calculator. Retrieved February 18, 2008 from the World Wide Web: http://www.bls.gov/cpi/#data.

  8. Deitrick, L., et al. (2006). Dance of the call bells: Using ethnography to evaluate patient satisfaction with quality of care. Journal of Nursing Care Quality, 12(4), 316-324.

Huey-Ming Tzeng is associate professor, The University of Michigan, School of Nursing, Division of Nursing Business and Health Systems, Ann Arbor, MI. Thomas E. Schneider is director, faculty & operational support services, also at The University of Michigan.


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