Recliner Entrapment!

[AZ Ogre]

I'm a new grad working on a cardiac progressive care unit and have identified an issue with the way our recliners are being used. When assisting patients into a reclining position, nurses and aids often put the garbage can under the foot of the recliner to prevent it from falling back into the sitting position because they don't stay in the reclining position for some reason.

Our patients are older and our plan of care includes getting them out of bed and into the chair for breakfast lunch and dinner and walking four times a day among other things. We encourage them to only use the bed at night so reclining in the chair is a great way to make position changes and allow them to rest between meals, assessments, interventions, walks and physical therapy.

The problem is that I've walked into rooms to see confused patients or patients who can't reach their call light trying to get out of the recliner with their foot/feet stuck in the garbage can and/or one or more legs caught in the space between leg-rest and the seat. I'm afraid that someone will end up falling and sustaining an injury. It seems to me that if using all four bed rails can is considered entrapment, then the same would be true if a patient can't get out of a recliner without assistance moving the object from under the let-rest.

Does anyone else think that this situation seems dangerous or know of any facilities that have policies that prohibit the use of objects to hold up the leg-rest in a recliner chair?

Thanks in advance for reading my post and sharing your input.

[dishes, BSN, RN]

It is a both a legal and safety issue, defective equipment should be reported through the proper channels and repaired or replaced. What steps were taken when patients were found with their feet stuck in the garbage can or their legs caught between the legrest and seat? Were incident or near miss reports filed? Staff who witness entrapment incidents are responsible for reporting them.

[RNperdiem, RN]

The quality of recliners varies considerably. In my unit there are a few different types. The best has a nice big lever on the side. The feet go up and stay up without propping. The lever is easily reached by the patient if the patient wants the feet down.

I am surprised that a cardiac stepdown unit would keep the crappy kind. The bad recliners have weak breaks, the foot rest drops down easily and they are somehow uncomfortable.

This is a safety issue, and worthy of bringing it to the attention of your manager.

[nrsang97, BSN, RN]

This is a safety issue that needs to be brought to your manager's attention.

[MunoRN, RN]

I've worked with a couple of brands of patient recliners where the "two-can-method" is required; a small garbage can under the feet and a tall garbage can under the head of the recliner. Ideally garbage cans are not structural parts of any hospital equipment, but I have to strongly disagree that it's more dangerous to use them rather than letting patient get flung out of the front of the recliner or flipped over the back of the recliner which I've seen happen. I actually watched one patient as they pushed down on the footrest of the recliner the back of the chair came up very suddenly and pushed her forward causing her to faceplant into the corner of a metal nurse-server. Another patient was trying to push the back the chair back more and it basically collapsed backwards suddenly, he rolled backwards out of the chair ripping out his RIJ cordis in the process which required emergent vascular surgery. So from a safety standpoint, no, the garbage cans as supports are not generally more dangerous.

As a legal issue, it's not considered a restraint from a regulatory standpoint. Using four bedrails up is actually not considered a restraint if the primary purpose is not to keep the patient from intentionally getting out of bed. If the rails are up to facilitate treatment such as auto-rotation, or to just keep a turned patient from rolling or sliding out of bed then it is not considered a restraint. If the purpose of the garbage cans is to keep the chair from doing things it should only be doing under the control of staff then that is also not a restraint.

[NOADLS]

Typically this is a nice trap for dementia patients who wander or are at a greater risk for falling. Other applications of this may have been inadvertently discovered.

[suanna]

We used the same "trashcan" technique for most of our patients in recliners. The two most common dangers we had without the trashcan were, 1) Patients catapulting forward when they were making minor adjustments in thier position. A "face plant" was pretty likely, not to mention the loss of lines, drains, and a good chance of cracking thier chest open like an egg. 2) Fuzzy headed patients would stick thier leg down between the footrest and the chair seat when in a reclined position. As they tried to stand up the foot rest would trap thier leg and make a very good attempt at breaking it off just below the knee. With the trash can there they could still get thier foot down between the footrest and the seat, but the chair couldn't "unrecline" and guillotine off a leg.

[K+MgSO4, BSN]

O my goodness, so many issues. First question does your manager know about it. Report this as both a clinical and oh&s risk. Get it visible, get people annoyed about it, dump the damaged recliners.

[martymoose, BSN, RN]

i hate those recliners. the legs on ours stay up most of the time.its when when the pt wants out- the legs part is too difficult to push down, so Mr "I dont want to bother anyone" tries to get out of the chair with legs straddled and dumps the chair forward.i have seen it twice. ive seen electric powered recliners; these dont seem to have the same problems as pt just presses a button.

[dishes, BSN, RN]

For those using garbage cans to prop the recliners, does risk management know you are doing this? Altering the way the way the recliners are intended to be used, removes liability from the manufacturer and places it on the hospital.

[marvelmom]

It is considered a restraint in my state and punishable as abuse. Huge no no.

[MunoRN, RN]

For those using garbage cans to prop the recliners, does risk management know you are doing this? Altering the way the way the recliners are intended to be used, removes liability from the manufacturer and places it on the hospital.

These recliners aren't actually intended to be adjusted by the patient, the manufacturer intends them to remain in position unless changed by staff.