bedrails

[nancydrew6]

We have instituted a "no bedrails" policy. While I understand the concept, in reality, it is a nightmare. On my shift (1900-0700), I am routinely dealing with residents ( usually the same ones) who are falling out of bed - I average 1-2 falls per shift. We have all the usual things in place, safety mats, alarms etc. But that doesn't take away from the HIR we must follow as per home policy, or the amount of paper work that follows. The PSW's are nervous wrecks on the night shift as there is only 1 for 30 residents. I have been on the floor when 5 or 6 alarms are sounding and we know that some will be on the floor. It is impossible for me to complete the proper HIR as sometimes I am running between areas every 15 min. to do follow up VS.

I would like to know how others are coping. Maybe there is something else our home can try.

Increasing staffing will not be an option.

[Nascar nurse, ASN, RN]

Well this will be unpopular BUT, first of all get rid of most if not all of those alarms!!!

- They are loud. They are waking the whole hall up for one problem person. They are very likely agitating several residents. (Think - are you giving sleepers/antianxiety meds at the same time you have alarms blaring in their ear?)

- They are scary if you are a confused resident. What do you do when you hear an alarm of any kind in society - you move quickly and try to get out of the way. Do we really want our residents moving quickly and trying to get out of the way?

- They do NOTHING to physically stop a fall. By the time you respond to an alarm in most instances, they are already on the floor

- Staff gets alarm fatigue and stop responding quickly, if at all, anyways.

Alternatives: Low beds, Floor mats, Body pillows, bolstered edge mattresses, a large stuffed animal for the resident to "hold" in the bed, stop waking people up as often during the night so they don't get agitated and actually sleep.

My facility started alarm reduction Jan 1 and last alarm removed end of March. I'm the DON - the staff insisted it couldn't be done at first but even they began to quickly see great results. I've done the fall stats from 2016 compared to 2017. WE HAD A 52% REDUCTION IN FALLS since we've discontinued alarms! I have to say, even I'm totally amazed it was that much but we all have come to the conclusion that the constant noise of alarms was driving both staff and resident nuts. The more agitated the residents were, the more they tried to get up. Interestingly our antianxiety and antipsychotic usage has also gone down, although not to the same drastic extent.

Give it some thought

[ChryssyD]

Sorry, but I have to disagree. Bed alarms may be your only indication that patients are trying to get out of bed. They may be upsetting and disorienting, but if they help prevent falls, that's OK.

There really isn't any foolproof way to keep anxious, antsy patients in bed. I wish there were. Talk to the doctor about sedation, increase the frequency of checks on the patient, and don't be afraid to institute 1:1 monitoring if you feel it's necessary. Falls, and their consequences (broken bones, mainly), are a major cause of litigation. Do whatever you have to do to prevent falls. And, if you find yourself in an impossible (poorly staffed) situation, tell your supervisor about it and make note of it. This is your only protection when staffing is woefully inadequate.

Good luck, and hang in there. Better opportunities are out there, but I know that I cannot abandon my patients just because staffing isn't ideal. But if you must, move on--not all facilities are chronically short of staff. Do what you have to do for you.

[Tenebrae, BSN, RN]

Those patient ratios sound hideous.

Re bed rails, the problem with using bed rails if that you have Mrs A who is highly agitated, highly active at night, if you stick bed rails on, its likely Mrs A will simply climb over the top of the bed rails which increases her risk for injury considerably. We only use bed rails when someone is a high falls risk and is unlikely to climb or move around much in bed

The alarms are loud and noisy and as someone has already said, bound to increase a confused patients anxiety all the more.

Sensor mats work well, however with someone who is a high falls risk, they require increased visual checking and with the understanding that if the patients mat activates that staff need to go ASAP. I had a scenario yesterday when a patients call bell activated and we went to find the patient on the floor

Its not easy IMO bed rails can cause more issues than they are worth if used indiscriminately

[mlolsonny]

Rails can help confused and agitated people be more mobile and help them get out of bed!!!

[heron, ASN, RN]

There really isn't any substitute for adequate staff to monitor residents and even then you won't prevent all falls. As fo bedrails ... have you ever seen someone strangle themselves by getting trapped between divided siderails? I have. Also the broken bones resulting from falling from the height of the rail instead of the height of the mattress.

There are simply no shortcuts.