Restraint-free facility = FALLS GALORE

[TheCommuter, BSN, RN]

I work part-time at a local nursing home that implemented a restraint-free policy a few days ago. Management removed all of the side rails from the beds and, within four days, more than 20 residents have fallen.

Even though the fall-risk residents have low beds, they are still sustaining serious injuries. There are not enough fall mats to go around. Staffing is being reduced because this particular company is very much profit-driven. Families are frustrated and want the side rails back, but they're being told that the restraint-free policy arises from new federal regulations.

The increased incidence of falls disturbs me to the point where I am now fearful of coming to work because I'll probably have to deal with broken bones, bloodied noses, hematomas, and even worse.

[ChocoholicRN]

I have heard of restraint free facilities, but I would think that means just not using wrist, mitten or vest retraints. Siderails are not considered a restraint unless all four are up. It makes no sense for all of the siderails to be removed. You should be able to have them still on the bed, but only use three as that is not considered a restraint. I have patients who are not even confused or high falls risk ask me to put up 3 siderails (sometimes all four, which I explain I can't do) just because they move around a lot at night and it's not their own bed so they are afraid of falling. I would leave this place fast, sounds like a million law suits waiting to happen.

[Zookeeper3]

Now this is years ago, back in NY when that Joint Commission had this crazy idea .... that patients had the right to fall.... seriously.....we instituted this. I didn't work at a nursing home, but inpatient geriatric psyc.

Basically all the crazy screamers that drive you nuts would get a 30 day psyc inpatient to medicate them, diagnose the issue and return them back to the nursing home, where CHEMICAL restraints weren't allowed either:mad: It basically gave the patient a brief relief and the nursing home staff as well.

So like you, imagine now medicating this wandering screaming confused geriatric population with psychotropic drugs and not being allowed to restrain them from self harm?? CRAZY!

To implement this, we had a fall screening tool, as I'm sure you have. But our high risk ones had the bed removed and the mattress placed on the floor. Now this eliminated falling out of bed falls, not wandering falls. Guess what happened... BACK INJURIES of staff almost quadrupled due to the poor mechanics of caring for patients on such a low level, there was little improvement with an ergonomics class that was mandatory after that data was collected. So be very careful to suggest that without training and practice on turning and care with a patient that is not waist height and isn't close to your core.

My only pathetic suggestion, other than that great one above () is hand mitts for your pickers and pullers of foleys and pegs. Hand mitts that are NOT tied are not considered restraints per Joint.

Now on the somewhat helpful side, a wonderful nurse, not me, went to countless churches and senior gatherings to get a volunteer staff initiated. These older but healthy volunteer folks were great to walk with an unsteady patient, sit at the bedside and chat with a confused patient. Their sole purpose was only to redirect them and call for help. They in no way could do anything to "handle'" a patient... but those wonderful folks helped decrease our falls. We'd buy them lunch some days, they'd teach patients to do crafts and it really helped. Mind you... all that occurred because of a great nurse that spent a tremendous amount of non paid time recruiting them, after doing all the work of getting their roll approved. (had to have TB test and infection control class... which she did).

I know it's not a simple answer, and it didn't fix anything, but it made a difference and I learned to crochet too. Take it for what it's worth, it may help some:rolleyes:

[anonymurse]

Run away, run away!

[TakeOne]

Run away, run away!

Nonsense. The concept of "restraint-free" has been around for a couple of decades. Properly used, patients and residents ARE at reduced risk of serious injury from falls. The trick is to use it properly. Low beds and lots of floor mats are just the beginning.

The policy isn't called fall-free, remember. It's restraint-free. It's goal is to reduce the numbers of serious fall-related injuries. It does work.

[Altra, BSN, RN]

Twenty documented falls in 4 days? A call to your county health department will probably have them showing up immediately.

Family members of residents could call. They could even call, repeatedly.

[Flo., BSN, RN]

As others have said side rails are only considered restraint when all four rails are up. I would be shocked if admin took away our side rails. I would say 99% of my pts use them as assistive devices when getting into and out of bed. It sounds like admin needs some education.

[NurseKatie08, MSN]

Yikes! That place sounds like a lawsuit waiting to happen! We are restraint-free as well, however, as others have stated, we are allowed siderails (just not all four...though none of our beds have four on them, I don't think.) I would run far and run fast...

[morte, LPN, LVN]

If they can kill off some of the Medicaid clients, they can get a better payor mix.

[tyvin, BSN, RN]

As mentioned previously; a side rail can be a mobility device used by the patient to move in bed and or help them get in or out. I can't believe they took "all" side rails away; that would be insane due to the fact that having one up can be good for mobility.

Where I am, all you have to do is care plan and document that the side rail is used for mobility and it can stay up. Two/four are considered restraints and need boo coo documentation along with a docs order. It's hard for me to believe that the facility would implement no side rails at all considering the mobility factor.

Also; if there is such an increase in falls after dropping all the side rails; why weren't there more accidents prior? I only ask because if the resident is now so mobile/restless that they are falling out of bed because they have no side rails to keep them in why weren't they climbing over the side rails prior as their current behaviour would indicate that would be the case therefore resulting in just as many falls if not more? It has been my experience that if the resident wants to get out they will whether there are rails or not. That's when we would implement the on the floor bed situation and mats. Or could it be new residents supplying the data for the increase in falls. Either way it's interesting.

Another tidbit is if you stand by and watch unsafe practices and do not attempt to report or notify the proper people; you are just as (how should I say this) much a participant as the people implementing the policies. If a doc writes an order for 500mg MS IM stat; are you going to give it?

[netglow, ASN, RN]

Nice, how ridiculous.

I ran into one of these places (didn't work there). Funny how many new residents leave home/assisted living originally due to a fall, and are moved to a place where the family thinks they will receive a higher level of supervision. Nice to see blunt trauma/hospitalization as the determining factor for the move, and then he new place has a "philosophy" against using any type of restraint.

[tothepointeLVN, LVN]

Oh dear. I had the displeasure of looking after a hospice pt in a restrain free facility. Unfortunately the pt had an unreduced/unfixated hip fracture and there were no side rails and their suggestion was to put a mattress on the floor for if she fell. With a broken hip/arm already I think she had enough falling don't you think?

Of course just to make my day the smoke alarm when off and the staff insisted I evacuate her IMMEDIATELY. Of course they didn't have any tank oxygen available for me. Luckily the FD came quickly and determined that evacuation wasn't necessary. This was 5 minutes before the end of my shift too.

To be fair though this was a care center attached to one an assisted living facility and the patient shouldn't have been transfered their even though she had living upstairs previously as they weren't set up for that kind of care.