Recliner Entrapment!

Nurses General Nursing

Published

  1. What do you feel is the nature of this issue?

    • There is no issue. Make sure your patients have their call light close and keep confused patients in the bed.
    • This is a legal issue. The patient is effectively restrained without a doctors order.
    • This is a safety issue and management should replace the recliners that don't stay in position without placing an object under the leg-rest.
    • This is both a legal and a safety issue.
    • I need more information / None of these answers are relevant.

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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.

Specializes in Critical Care.
I understand what you are saying muno, but I have read many malpractice inurance settlements and that influences how I see the risks associated with using faulty hospital equipment. If the manufacturer does not provide trash cans and written instructions on how to prop the recliner, then you are modifying the manufacturer's intended use of the recliners. In the event of an injury sustained from a propped recliner, the litigation will be against the nurse for malpractice, not against the manufacturer for product liability.

You do not have any written evidence to support propping the recliners and it is possible to find alternatives to the recliners, there are occupational therapists and ergonmists who have specialized training and they can recommend safer seating options for your patients.

There are actually no alternatives, we have recliners from all current and even now-defunct manufacturers in use, if you're aware of an alternative recliner please feel free to share. We've found that all currently available chairs do require that patients be prevented from damaging the chairs, which is actually true of a large number of equipment and devices regularly used in acute care, most which of which do not include specifics on how to manage patient behavior, just the general recommendation that patient be in some way preventing from causing damage to the product. Just because a product is breakable with sufficient efforts doesn't mean it's "faulty", if we're using that definition then everything we use is "faulty", and again, no alterations are being made to the recliner.

A malpractice claim wouldn't get very far since that depends on showing that the nurse did something that almost no other nurse would do, and it's not hard to find examples where this same 'technique' is used. Being aware of the risks and not taking some sort of action to reduce the risk is far closer to the negligence definition.

The best way to avoid a lawsuit is to avoid an injury in the first place, but what you'll be asked in court is whether you took any steps to avoid an injury (were you aware that a patient unable to follow directions could unsafely alter the position of the chair and did you do anything about it?)

Specializes in Critical Care.
I'm not talking about some "odd interpretation" of my own, I'm telling you what I was told in official CMS surveyor training. Sitting in a recliner is not, by itself, a restraint. However, if the recliner is positioned in such a way that the person cannot freely get up and walk away if s/he wants to, that is a restraint per CMS' definition.

If it is positioned for the purpose of acting as a restraint then it is a restraint, but just because a person is physically unable to get up out of a recliner that is a 'normal' position that is being used for therapeutic purposes (sitting position with/without feet up, fully upright/normally reclined) then it is not a restraint. By your interpretation every patient who unable to get out of bed without assistance is "restrained", which is a definition I've never come across or even heard suggested by surveyors.

Specializes in Critical Care.
The issue isn't whether a hypothetical "healthy person with full mobility and range of motion" could get out of the chair at will; the issue is whether that real-life individual who is actually in the chair is able to. If your clients are being put in recliners that they can't get out of on their own when they want to, that is a restraint per CMS' definition.

So you would consider any person unable to get out bed without assistance to be restrained? Or are you only applying this to chairs?

Specializes in SICU, trauma, neuro.

I don't see the issue of trashcan use as either make the chair safe or restrain the patient. The issue is that in the OP, the trash can is the safety issue. The chairs should be able to hold the position they were placed in without the nurse having to MacGyver their stabilization.

Specializes in Critical Care.
I don't see the issue of trashcan use as either make the chair safe or restrain the patient. The issue is that in the OP, the trash can is the safety issue. The chairs should be able to hold the position they were placed in without the nurse having to MacGyver their stabilization.

They actually are able to hold their position so long as the patient is able to remember and follow directions, and in a perfect world all patients would be able to that, which would mean intubated patients would not need to be restrained, stabilization devices would not be necessary, etc. It sounds nice, but I've never worked in "a perfect world", wherever that is.

@muno, if it was my workplace I would not assume there are no other alternatives to the four variations of recliners, I would consult with an occupational therapist and ergonomist with specialized training in seating. They have the knowledge, skills and ability to determine why the current recliners are unsafe, the applicable manufacturer and liabilty laws and can recommend approipriate seating alternatives. In the event of a law suit, I would have documentation that showed I had addressed the recliner safety issue with experts and followed their recommendations.

Specializes in Post Anesthesia.
The fourth option is to get safe recliners.

How would we go about doing this? I've seen about a dozen different recliners in my practice, all have similar safety issues (thus the use of trashcans). I guess I could hire a team of engineers and a product testing company to try to design a safe recliner. After many millions we may be able to come up with something the companies that are already designing patient furniture haven't thought of. After that I just have to manufacture and distribute this hypothetical recliner to the units needing them and provide any training necessary for staff to use them safely. Any chance AN wants to offer a grant for this proposal? If not, I'll accept personal, high limit MasterCards from anyone who would like to provide one. I'm not trying to be too snarky, but finding solutions to patient care needs with the equipment available is a big part of my job as a bedside caregiver. Some of the posts in this thread make it sound like we are using dirty coat hangers to guide wire central lines because we want to save a few bucks. I guess we could just leave patients in bed for days at a time, but hospital acquired pneumonia and bedsores aren't covered by Medicare anymore. (Plus patients didn't like these options). Most of the time, I explained to my patients, "these chairs can shift back to sitting position when reclined, so I'm going to put the wastepaper basket under the footrest just like you'd put a brick behind a car tire before jacking it up" It doesn't mean the car, the jack, or the tire was faulty. No car I've ever owned came with a brick for use with the jack, but I can't imagine junking the car if you get a flat or need to change the oil, -it's safer but not very practical.

I think AZogre may be on the right track with proposing chairs and footstools as a solution, it's what hospitals used before recliners became popular.

If I can't get a recliner to stay reclined, I don't use a trash can to prop it, mainly because I already don't have enough trash cans, and because "Ew, gross!"

I don't like other furniture to touch the top of the trash cans because I know most of them are not maintained cleanly.

What I do is take the visitor chair and place it in front of the chair, like a foot stool. If a patient needs to recline backwards, they get put back in the bed, in a modified chair position. I have seen too many people screw up a recliner to trust either the patient or the chair.

I don't really get the whole "need" for the recliner. I like the smaller visitor chair, myself, because the bigger recliner swallows most of my patients, puts them in awkward positions, and are hard to get the patient in and out of. The only recliner I actually like is the hip chair, because it usually works. I only use the other recliners if PT puts my patient in them.

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

Wow! That's great to hear. I definitely think this issue deserves some attention. A law on the books in my state would quickly bring to everyone's attention that it's not a safe practice.

Would you be willing to help me find the law/statute in your state that defines it as a restraint? I would like to read how the law is written and find out who pushed for that change and how they passed that law. Thanks for bringing that to my attention and thanks in advance for your help.

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