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.

[icuRNmaggie, BSN, RN]

I took care of an elderly woman after she was thrown from a recliner, the type with a high back and no hand control for the footrest.

She sustained a fx nose, sinuses and orbits. She might be alive now if someone had secured the footrest with a chair or trash can to ensure her safety.

[dishes, BSN, RN]

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

Do the recliners come with their own trash can and written instruction from the manufacturers on how to prop the recliners with the trash can? If the recliners are not staying in the reclining position and are causing injuries to patients, the solution is not to modify the recliners but report them as a patient safety hazard.

[MunoRN, RN]

Do the recliners come with their own trash can and written instruction from the manufacturers on how to prop the recliners with the trash can? If the recliners are causing injuries to patients, the solution is not to modify the recliners but report them as a patient safety hazard.

The problem is well known, the manufacturers position is that their chairs are not intended for the patient to be changing the position of the chair, which is included in their IFU. We used to use the cans as a fix for chair that patients had broken, although now we use them to prevent the patients from breaking them by trying to change the position of the chair. Ideally, the patient follows directions and only allows staff to change the chair position themselves, although we primarily use these for post-open-heart patients which aren't exactly the best at remembering directions.

So basically there are 3 options; 1) don't get these patients up into chairs, which is bad for them, 2) Put them in the chair knowing full well what could and has happened when there is nothing preventing a patient from overpowering the position lock and do nothing to prevent that, or 3) put them in a chair while adding a backup safety prevention, as ghetto as it may seem I don't think any patients prefer having their IJ ripped out of their neck compared to having a garbage can behind their chair.

[dishes, BSN, RN]

The fourth option is to get safe recliners.

[MunoRN, RN]

The fourth option is to get safe recliners.

We've purchased them from all the existing manufacturers.

[Graduatenurse14]

I voted incorrectly! I think that it is a safety issue if people are getting hurt. But I've used the trash can with various types of recliners in two hospitals- some were better than others. I've never had anyone get hurt- thank God! We now use the chair alarms on the patients that are or may become confused.

[dishes, BSN, RN]

For those who are propping the recliners with trash cans, do you have a written policy that supports this practice?

[icuRNmaggie, BSN, RN]

I have not seen the recliner that I was referring to in use in a hospital in many years. I found a picture of it but I would rather not post it here.

The ones in use now are low to the ground and designed to slowly lower the legs and raise the back. Using the side lever requires some physical strength and foot rest makes a distinctive noise when lowered.

It would be good if they came with a motion sensor that would alert the staff of changes in the chair position for patients at risk of falling.

If the recliners that slam closed and eject the patient out of the chair were in use in my unit, I would absolutely use something to prevent that from happenning.

[nurseprnRN, BSN, RN]

1) Don't just report to your manager. CC it -- in writing -- to the hospital risk management department. Somebody there will have a really, really good idea of what one accident will mean in terms of legal fees, bad publicity, and loss of public esteem (read: donations). If that doesn't work quickly, see 2).

2) After you do that, you can also call the local TV station's hotline and daily newspaper and make an anonymous report to their health reporters. Be sure to give them the name and contact info for the risk manager. Sit back. Count down from 10 to about 6,5,4,3... and your new chairs will be on the loading dock.

[MunoRN, RN]

For those who are propping the recliners with trash cans, do you have a written policy that supports this practice?

It's part of the unit policy, training check off, and care plans. Risk management is not only aware, but they are the ones that make sure everyone knows to use some form of support.

Are people actually saying they wouldn't use some sort of support despite the likelihood of injury without it just because it's unsightly?

[dishes, BSN, RN]

It's part of the unit policy, training check off, and care plans. Risk management is not only aware, but they are the ones that make sure everyone knows to use some form of support.

Are people actually saying they wouldn't use some sort of support despite the likelihood of injury without it just because it's unsightly?

Unsightly? It has nothing to do with how the trash can looks, it is the liability associated with modifying the recliners. Propping the recliners does not mean there is zero risk of injury.

[MunoRN, RN]

Unsightly? It has nothing to do with how the trash can looks, it is the liability associated with modifying the recliners. Propping the recliners does not mean there is zero risk of injury.

It's pretty clearly a reduced risk of injury, and there is no modification to the recliners being done. It also covers our requirement by the manufacturers instructions that the patient be prevented from altering the position themselves.