Low beds, falls and incident reports...

Bird2 · Sep 9, 2005

Hey Suebird3,
ALL found on blue mats are a fall...We also have low beds /c blue mats on the floor. On the A&I classified as "found on blue mat". On the MDS fall in the past 30 days.
We do also put lip mattresses on these people. But as far as the MDS goes, fall......
Does anybody else do this???

Are the lip mattresses pressure reducing? Do you find them helpful in decreasing the roll outs onto the mat?

MDSlady · Sep 9, 2005

Are the lip mattresses pressure reducing? Do you find them helpful in decreasing the roll outs onto the mat?

ABSOLUTELY....Lip mattresses are a great invention. It actually takes alot of effort to get out of them. Included with a bed alarm.... you probably will catch them before they actually "fall OOB".

suebird3 · Sep 10, 2005

Hi, MDS. One of the two residents who has a "low bed" actually "scoots" herself out of the bed. Has dementia, yada, yada. I don't think we count these as falls-at least I have never done this. To be honest, I would be forever doing paperwork. I will have to ask my boss...or at least leave a note asking about this.

When she gets aggitated, the bed is a pain, cuz she has a GT for meds.....

MDSlady · Sep 10, 2005

Hi, MDS. One of the two residents who has a "low bed" actually "scoots" herself out of the bed. Has dementia, yada, yada. I don't think we count these as falls-at least I have never done this. To be honest, I would be forever doing paperwork. I will have to ask my boss...or at least leave a note asking about this.
When she gets aggitated, the bed is a pain, cuz she has a GT for meds.....

Hi Suebird3

On this person who already has a low bed /c blue mats and scoots out...how about if you put pediatric siderails on the lower half of her bed.

Granted, now you have a restraint issue, but sometimes the families like this idea. Also, does she have a bed alarm??

We did have one lady that always rolled OOB and the family wanted her left on the blue mat with a pillow and blanket. She had bi-polar and would roll out before we got out of the room. The family had pushed for this so much, that finally we just care planned it as non-compliant behavior, had the doc write a note and the state was fine with that.

But I would try pedi rails as a last intervention....Do you have anyone who has these??

Todd SPN · Sep 10, 2005

Our facility is restraint free, so we are unable to use any kind of rails. I have had res ask for a rail for their own protection and some like them to have something to grab on to when trying to get in or OOB. No matter what the reason, no rails.

dian57 · Sep 10, 2005

With all the pressure-relieving pads that add height to our beds, 1/2 rails only come barely above the surface. There isn't enough room for anyone to get their fingers around the top bar to use them as enablers. They couldn't keep someone from rolling out of bed, they'd go right over them.

We're a restraint-free facility also, but do have full siderail beds available for residents who have requested and can demonstrate use as enablers for bed mobility. Each quarter I have to ask them to show me they're still using them to turn. If they've deteriorated cognitively or physically, the rails are dropped and the bed is changed to a low one. Sometimes the family just howls with indignation, but that's where education comes in handy.

I have a few chronic roller outers, too and have adjusted their careplans: Problem: Resident has been identified as a chronic faller, frequently rolls out of bed onto bedside mat/mattress.

Goal: Risk of injury from falls will be reduced

Interventions:

1. do not place resident in bed until visibly tired

2. toilet resident before assisting to bed.

3. visual checks q 15 mins x first hour after PM care

4. bed alarm to alert staff to unsafe body movements, change battery q2m and prn. Check for proper function and placement q shift

5. provide Geo-mat pressure-relieving pad with wings on bed to discourage rolling off bed.

6. keep bed at lowest possible position, call bell in reach.

7. provide bedside mat/mattress

8. Q2H T&P/bed checks for safety.

We complete incident reports for roll-out, too.

MDSlady · Sep 11, 2005

Our facility is restraint free, so we are unable to use any kind of rails. I have had res ask for a rail for their own protection and some like them to have something to grab on to when trying to get in or OOB. No matter what the reason, no rails.

Rails on the MDS are NOT considered restraints when used for positioning and mobility. On all new admissions, we care plan rails as an alternative to restraint. Restraint definition is if the person cannot get OOB because of the rails. If the resident is using them to position and aide in mobility NOT A RESTRAINT.

Almost all of our people have rails...if we have a resident who cannot get OOB because of rails, ie. dementia, immobility, we care plan for fear of falling or poor trunk control.

I believe in our facility out of 150 beds we have 2 residents who don't have siderails. Otherwise, everyone else has them at least on their beds. Granted some don't use them, but we care plan "May have 2 siderails up to aide in mobility and positioning." Some residents have only 1 siderail up to remind them what side of the bed to exit. We did have someone from corporate come in and stated "well I bet all of these new admissions (re-hab residents) don't have siderails on their beds at home. The problem is that many feel safer with siderails up. Most don't have twin size beds at home.

If you can, find out the definition of siderails in your facility's RAI manual. It will clearly define restraints....

suebird3 · Sep 11, 2005

MDS, our facility is "restraint free", with side rails for ordered for positioning. As for the side rails on the low bed, this would NOT work, especially with her dxs. She would more than likely injure herself more than she already has.

Chel · Sep 11, 2005

OK, I've got a question. If a resident is found on the matt on the floor by his bed, assuming the bed is in the lowest position, do you all make out an incident report? We've been told two stories by two different people and that is as long as he/she is on the matt and the bed is in the lowest position that no report is necessary. Then we've been told that whenever a resident is found on the floor it is considered a fall, hence a report. Ok ladies and gents, which one is it? I'm thinking incident report anyway just to CYA.

Hi ya ~

Any change in elevation is considered an incident. I don't call the family or doctor though if it's late on something like that...unless there's an injury or skin tear. I just pass it on for dayshift to make the calls.

Chel

Chel · Sep 11, 2005

MDS....we have 2 patients who have VERY low beds, as in on the floor, d/t the patients attempting to crawl out of bed. We have a mat on either side. How would you rate this?
I think these are pretty decent beds.....basically PVC headboard/footboard, soft mattress....

I forgot to mention ~ our low beds are ON the floor. I think we currently have four right now.

Chel

Todd SPN · Oct 2, 2005

Rails on the MDS are NOT considered restraints when used for positioning and mobility. On all new admissions, we care plan rails as an alternative to restraint. Restraint definition is if the person cannot get OOB because of the rails. If the resident is using them to position and aide in mobility NOT A RESTRAINT.
Almost all of our people have rails...if we have a resident who cannot get OOB because of rails, ie. dementia, immobility, we care plan for fear of falling or poor trunk control.
I believe in our facility out of 150 beds we have 2 residents who don't have siderails. Otherwise, everyone else has them at least on their beds. Granted some don't use them, but we care plan "May have 2 siderails up to aide in mobility and positioning." Some residents have only 1 siderail up to remind them what side of the bed to exit. We did have someone from corporate come in and stated "well I bet all of these new admissions (re-hab residents) don't have siderails on their beds at home. The problem is that many feel safer with siderails up. Most don't have twin size beds at home.
If you can, find out the definition of siderails in your facility's RAI manual. It will clearly define restraints....

I printed out a few of the responses to this thread and gave them to the two MDS people. One, who has been at the facility for 15 years says it is company policy that rails be considered restraints, therefore in our restraint-free facility they are not allowed. Our DNS supports this. The other, who has worked at another of our facilities in the past agrees with your assessment and stated that the other facility she was at allowed them for positioning and mobility.

My dad used a siderail and a pole to get in and OOB, so I know they are of benefit. We have a resident who has a pole, but it alone is not effective in helping her get in or OOB. She just got an order for PT to show her how to effectively use just the pole, but she has a bad hip and is overweight so I'm sure it will be an exercise in futility. Funny, no one could show me the supposed "law" regarding siderails and restraints, so I guess I'll go to corporate myself to find out.

Thanks for the info.

PHutch824 · Feb 7, 2006

In our facility, if a resident frequently rolls out of bed and there is no injury, an incident report does not need to be filled it if it is care planned as a behavior.