Help How to keep pts IN Bed

One thing that can lead confused/unsteady patients to get out of bed is needing to go to the bathroom. We did a little evidence based practice thingy on a unit I used to work on and we found that frequent toileting of the confused/unsteady patient lead to less falls and more sleep.

the use of pillows are a great way to keep someone in bed without crossing the lines of restraints. we use three or four pillows or body pillows. Also I can not remember the name of the item so i will try to describe it. It is like two pads (intermaterial is foam) it is straped to the bed with velcro which the straps wrap around (under and above) the bed so that it is stablized. I am sorry i cant remember the name of the device, i hope someone knows the name. yes i do believe that the bed against the wall is a restraint however, there are several bed in my facility that are against the wall, and we dont do restraint forms, so i am not really sure about that . but i do believe that it is. it really helps though because there is only one side to fall out of. Yes tolieting schedules and individual plans do decrease the fall rate. We do a post fall assessment for of nurses, last time checked on resident, what were the doing then, the time of the fall, and the CNA also does a post op fall assessment, last time you checked on the pt, last time tolieted, (if over 2 hrs, write up is possible if the pt fall d/t incontinence or trying to go to the bathroom). hope this helps

When State Board of Health sets such strict guidlines on safty issues, how do LTC facilities keep the resident safe? I work for a hospice and have pts in a LTC facility, I have three pts for various reasons get out of bed. OK, fall out of bed. They are in a hi/lo bed, 1/2 side rails, mat on the floor beside the bed. In some cases, the bed is up against the wall. (Which I am told is considered a restraint by STATE). And still the pt rolls out of bed, or falls. The LTC DON is asking hospice to DO SOMETHING!!!! What more can be done??? Help please. I have PT/OT evaluation set up but not scheduled. Of course, medicating with Ativan (example) is also not an option. I need ideas....

The facility I worked in last had Scoop mattresses for this problem. It had a raised angled edge that was just enough to define the edge of the mattress. If that didn't work, maintenance made nice frames for the mattress on the floor with a mat beside the bed in case they rolled out. We were considered a " restraint free " facility.

I'm glad I wasn't the one to have to get them up for toileting! It was hard on backs!

One thing that can lead confused/unsteady patients to get out of bed is needing to go to the bathroom. We did a little evidence based practice thingy on a unit I used to work on and we found that frequent toileting of the confused/unsteady patient lead to less falls and more sleep.

I think you are on to something there. Usually there is a reason these patients are getting up--and most of the time it has to do with using the bathroom.

Besides a bed alarm, the only thing I can suggest is more frequent rounding--but I know that isn't always possible.

When they start to try to crawl out of bed, we get them up, toilet them, and give them something to eat. Sometimes they are scared or lonely or just cant sleep. Getting them up helps alot and we have had very few falls since trying that.

Our powers-that-be are working on a new restraint policy.The DOH in this area now considers low chairs ,low beds and beds against the wall all restraints.We have a few residents that we have tried everything with-now they are 24 hours a day 1 to 1-and we don't even charge extra for the service.They are also moved to rooms closest to the nurse's station.If we don't have cna's available for the 1 to 1 then we nurses take care of it.I mentioned this on another thread-try passing meds while dragging a screamer on your rounds.

We are still going to use the low beds and chairs but we'll be doing more frequent assessments.The DOH will accept NO excuses for frequent falls.We had an LOL a few months ago that really was a trainwreck and nothing worked.She'd stay up for 36 hours or longer and was very hyper-active.One afternoon after we were all ready to just freak out and were exhausted and frustrated we laid her on her bed on her side and I knelt over the side of the bed and held her in my arms-that worked for about an half an hour-she took a little power nap and then beat the crap out of me.

A restraint is only a restraint if it prevents the person freedom of movement or access to their body. If I am in the bed and you put up 2 side rails, it is NOT a restraint because I can get out. So far in this state 1/2 rails are not considered restraint...beds against the wall are. We use canoe (scoop) mattresses at times and other times we use bolsters to 'define the space'. We use low bed with matts...we have tried everything.

One thing that works sometimes is pain medication. Pain is one of the most under treated issues especially on a dementia unit.

And when all else fails, we get 'em out of bed, maybe in a recliner or at the station.

I once did a flow chart for this,will try to reproduce it here as best I can.

UNSETTLED-------check-------Toilet/or pad change

still unsettled----------signs of pain----change position/give analgesia

still unsettled-------temperature regulation-----too hot/cold---cover/uncover

still unsettled------hunger/thirst.

still unsettled------allow to 'safe' wander if able-----will become tired after period of exercise!

If not safe to mobilise regular checks/call mat/bed monitor/one to one until settled.

Of course knowing your resident helps.Some of ours you just hand them a sandwich straight away when they get up.Works like a charm!

I'm talking nights here ,of course.

We also have temporary care plans for the use of bed rails when all else fails.These are justified for protection and safety...not restraint!

They are signed off daily by nurse in charge and all residents are checked hourly/half hourly when they are in use.

Documentation, that is the key. The DQA does allow the use of half rails in WI, if properly documented as to the reason for the rails. The easiest way to cover that is have therapy document that they are needed for bed mobility. Raised edge mattresses also work if they are used to "define the parameters of the bed".

Four months ago we began q 2 hour rounds for the 3 P's - Pain, Potty and Position. Both our fall rate and restraint use have decreased significantly. We are also have very few issues with skin integrity.