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.
Specializes in Gerontology, Med surg, Home Health.
We do not consider a fall onto the mat from a low bed a "fall" unless they roll off the mat. But yes, if a resident does not have freedom of movement anything can be a restraint. I believe side rails were considered a restraint after several residents strangled themselves by getting caught between the side rail and mattress. It is quite a challenge to think of some way to keep them safe.
I think you better check the MDS definition of a fall. A change from one plane to another is a fall. It is considered a fall if you catch the person before they hit the floor because if you weren't there, they would have hit the deck.
The MDS definition on "falls" and " level plain" certainly presents a challenge to the mind - once in desparation we tried using another mattress next to the low bed to allow for more unrestricted space to roll without actually rolling out of bed - did it work? - not - It still created a non level plain due to the frame of the bed. As far as an earlier reply about mats and people getting up for the bathroom - if a resident does try to independantly transfer / ambulate it's best not to use the mats for the sole reason of the increased risk of injury - keep the bed low and enlist the use of a bed alarm - in the time it takes them to get up from the low bed - if they can at all - the alarm should have sounded at first attempt giving added time for staff to respond. The roll or fall would still be less severe then if the bed had been in a higher position and with out the mat - But of course that is my opinion and you can choose to accept it or reject it - just offering some advice to a truly challenging issue. Take Care !!!!
The facility I work in is currently on a "the resident has the right to fall" kick. State surveyors were very restraint-focused this year, so we are implementing a new fall-risk program.
The staff as a whole is VERY resistant to it. However, I am pleasantly surprised to find that it is actually working out OK. I have only had one my residents fall, but better that she fell off the bed (trying to get up) as opposed to off the bed from another 12 inches up, going over the siderail. LOL
The hardest part is getting used to seeing my residents in bed with both siderails down and stopping myself from running frantically into the room and pulling rails up!
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!
Hi! I agree with your answer! I thought to myself, she knows what she's talking about...aha! You cited a facility? Must be you are a surveyor?
The parts of your answer that I most agree with and can't emphasize enough is know the definition of a restraint and learn to recognize when something is a restrain and when it is not. Assess, use less restrictive means, care plan and document!
e ....document, document, document and care plan, care plan, care plan....:) !
In theory I agree but in the real world with budget cuts and minimal staffing, this is close to impossible unless the nurse works on her own time - as I have often said- there is plenty of time to do everything if you work 24 hours each shift!!
I think surveyors are asking for champagne on beer budgets.
In theory I agree but in the real world with budget cuts and minimal staffing, this is close to impossible unless the nurse works on her own time - as I have often said- there is plenty of time to do everything if you work 24 hours each shift!!
I think surveyors are asking for champagne on beer budgets.
Specializes in Gerontology, Med surg, Home Health.
As with any restraint, you may use it IF you document need, medical diagnosis, consent, and all the other methods you have tried before you use a restraint. Side rails are only restraints if they prevent the resident from getting up...much like a recliner. If you put ME in a recliner, it won't be a restraint because I have the strength and the cognitive ability to put the foot rest part down and get out. On the other hand, if you take a confused, debilitated elder and put them in the same recliner, it could be a restraint.
We had survey 2 months ago. One of the surveyors looked at the seat belt on one of the residents. She asked why the resident had a restraint. I explained that she was a frequent faller with no safety awareness and severe dementia. She had fallen and broken a wrist and despite alarms and self releasing seat belts, she continued to get up and try to ambulate. The surveyor had no issue with it.
Take Care !!!!
CapeCodMermaid, RN
6,092 Posts
I think you better check the MDS definition of a fall. A change from one plane to another is a fall. It is considered a fall if you catch the person before they hit the floor because if you weren't there, they would have hit the deck.