One of our hospice patients tonight fell twice in 30 minutes. I asked another nurse why his bed didn't have side rails and he told me they were considered a form of restraint. When did all this happen?
We ended up putting him on 15 min. checks and since he wanted to sleep in his recliner tonight we put a seat alarm on him too. He takes many narcotics for pain and insomnia. I feel that as his cancer progresses and he takes more and more morphine, that he should have side rails for his safety.
Low beds have controls and you can raise it into the air.
Not the ones in the LTC I worked at. I had one resident I had to change and dress at five am. For some odd reason, I could never find the CNA on the other hall to come help me. I'd search high and low, and she would not be anywhere to be found. So, I'd go back to the resident's room and change the resident and dress her myself. The bed was low, the controls to raise it didn't work, and the wheels would not lock completely and would slide on the slick tile floor, so when turning the resident to put the clean brief under her bottom, I had to manage it in such a way that I could lift her hip off the bed and quickly slide the brief under, while not making the bed slide across the floor. Now mind you, I'm 5'1" and about 110lb, and this resident was somewhere near 300lb. Just changing her brief was sustained aerobic activity for me. Once I got the brief changed and the resident (who was completely limp and unable or unwilling to help in any way) dressed and had retrieved the lift from the hallway to get the resident up into her wheelchair, the other CNA would miraculously show up to help.
Specializes in LTC, ER, ICU, Psych, Med-surg...etc....
Remember. it is only a restraint if it keeps the resident from doing something that they would normally do. If the person can get out of bed, and you put up rails and that stops them, then of course it is a restraint. It is much safer to put an alarm on them and mats in the floor with a low bed and let them go onto the mat than to put up the siderails and have them fall over the rails or become entraped...
Geri-chairs...if you put someone up in a geri-chair and recline it so that they cannot get out, then it is a restraint. If they wouldn't try to get out, then not a restraint. If you put a seatbelt on someone to keep them from standing up from a chair...restraint....if it is just to help posture because they do not try to stand up...not.
I don't mean to insult anyone's intelligence by my examples, but sometimes we forget what is a restraint. I have cited facilities for using geri chairs and siderails as restraints. It is OKAY to use a restraint if indicated AFTER you have tried other less restrictive means, but you must have consent, care plan, and documentation of attempts at restraint reduction, as well as documentation that you are releasing, and checking and all that stuff.
It is such a challenge sometimes, and it seems that every facility has the one houdini, or person that falls all the time and you get at a loss as to what to do with them. What you can do is make sure that you have interventions in place for safety and that you are documenting that those interventions are in place. After each incident, make sure that you document that the intervention were in place, and then what else you are trying to do...care plan! If the person were to fall and get injured, as long as you can show that you have tried everything and that you have documented everything, then you would be hard pressed to have any deficient practice there. If you have someone who removes their alarms, you need to make sure it is care planned that they do it and what you are trying to do to keep them from doing it....document, document, document and care plan, care plan, care plan....:) Sorry, I don't get on too much as I travel and am busy but leave me a message if I can help!
now most of our beds have two little hand bars up on the tops...they are called enablers.
as far as falling out of bed....low beds are the answer. depending on the mattress..they go all the way down to the floor. we use fall mats on both sides of the bed too.
very rarely do we see an injury from a fall....now they are kinds rolls to the mats.
we do the same and haven't seen an injury from a fall in many years. just last night a family member in perfect health slept on a couch (for good reason) and thud- fell out of it- the whole house shook. no injury (except to his ego).
you have to weigh the pros with the cons and try sleeping with full bed rails to see how humiliating it is!!!!
i once restrained all my cna's just 2 show them how it feels- boy did that hit home!!
and yes i agree- bedrails are a necessity in many circumstances- but bottom line- they are a restraint
Sure they can have the 'Right' but did they ever stop to think that residents may not 'Want' to fall out of bed onto a freezing cold, hard as a rock floor?
oooo....I forgot about the concave mattresses. They work great for those res who would give up after one try or those who need to feel like they won't just roll out of bed. The hard core climb out of bedders.......ha ha. They get out of them easy.
Bed rails can be very dangerous. The CMS (CDPH) data shows that there were 46 deaths last year related to people basically hanging themselves on their bed rails. Care planning is the key. If the resident uses the rail for mobility or requests that the top rails be left up you are good to go, as long as it's documented.
Its considered a restraint if all 4 rails are up according to OBRA and you need a doctors order to be able to use all 4 side rails . If you use just the 2 top rails via the head of bed its ok , I think putting the bed to absolute lowest position helps with falls because the distance is less to fall and put a foam pad on the floor by bed to break or facilitate the fall.
Side rails are case by case. Our environment is Acute!!! Hospice IPU with terminally restless, hepatic encephalopathy, psyche behavior pts that behavior health units have rejected, etc.
Low beds, mattresses on floor, etc are not an answer. They are inhumane, undignified, and put staff at a greater risk for injury.
We are left with inc. geri chair use, inc medication use, inc. use of staff.
Any suggestions on how to change this madness? (Besides ridding ourselves of the lawyers who have created this mess).:confused:
Specializes in Gerontology, Med surg, Home Health.
Its considered a restraint if all 4 rails are up according to OBRA and you need a doctors order to be able to use all 4 side rails . If you use just the 2 top rails via the head of bed its ok , I think putting the bed to absolute lowest position helps with falls because the distance is less to fall and put a foam pad on the floor by bed to break or facilitate the fall.
If ONE rail keeps the person from getting out of the bed, then it is a restraint. You could put me in a bed with all 4 rails up and I'd still be able to get out....much the same as a recliner. If the patient could get up from the chair in any position, it's not a restraint...if they couldn't get up in any position or out of a regular chair it's not a restraint...it's all how that particular device affects that particular resident.
:confused:
Virgo_RN, BSN, RN
3,543 Posts
Not the ones in the LTC I worked at. I had one resident I had to change and dress at five am. For some odd reason, I could never find the CNA on the other hall to come help me. I'd search high and low, and she would not be anywhere to be found. So, I'd go back to the resident's room and change the resident and dress her myself. The bed was low, the controls to raise it didn't work, and the wheels would not lock completely and would slide on the slick tile floor, so when turning the resident to put the clean brief under her bottom, I had to manage it in such a way that I could lift her hip off the bed and quickly slide the brief under, while not making the bed slide across the floor. Now mind you, I'm 5'1" and about 110lb, and this resident was somewhere near 300lb. Just changing her brief was sustained aerobic activity for me. Once I got the brief changed and the resident (who was completely limp and unable or unwilling to help in any way) dressed and had retrieved the lift from the hallway to get the resident up into her wheelchair, the other CNA would miraculously show up to help.
Ah, good times.