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.
One of the comments above reminded me about one Sat or Sun at work. When I got to work I found leg rests on a resident's wheelchair. He'd never had leg rests before, he was mobile in his wheelchair. Having leg rests on his chair was definitely a restraint...I removed them immediately. Wish I could have figured out which bright cooworker decided to restrain this guy.
Specializes in ICU, PICC Nurse, Nursing Supervisor.
not only that but lawsuits because the facility failed to protect the patient....this is just one of the many things i hate about ltc... most places claim to be restraint free but really cant be so; when we had a family that demanded restraints they had to sign a waiver. its sad when we can compromise patient safety to level up to what the state or federal calls better quality care care ;when the people that initiate these laws have never even stepped in a nursing home....i could go on for days
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.
So, some of you are still using side rails? I kinda thought we were the last one to get rid of them. We remodelled about 2 yrs ago and finally got rid of the hand crank beds. Thank goodness.
Yes, we did notice a few more falls, but not 20 in 4 days! Look at the falls..what was the resident trying to do? Did they roll out of bed or try to get up unassisted. If it was a roll...you can get concave mattresses that would prevent that or use pillows for positioning. Of course the bed will be at the lowest possible position.
If they are trying to get out of bed, bed alarms and fall mats and maybe even the concave mattress. We have enablers on the upper portion of the bed. They are like mini grab bars.
Honestly..I hated the idea of no side rails and was soooo against it at first. The reduction in your staff doesn't help either.
It will get better...Honest. I think it was kinda a learning curve for the resident too. BTW..the ones that fall out of bed now would fall out of bed overtop of the side rail. If they are wanting to get out of bed...they will.
Specializes in LTC, ER, ICU, Psych, Med-surg...etc....
As long as you document the behaviors, care plan the behaviors, do a restraint assessment, have the PT look at them as see if they can recommend something, get consent, have your doc evaluate them, begin with the least restrictive device and move upward if you have to, keep documenting and care planning it, then a restraint can be used. Restraints can be a good thing! As long as they are done the right way. I'd rather see a person in a broda or geri chair, or something, than be doing an investigation because someone fell and broke something or cracked their head open and got a subdural.....
Many people use the side rails as a mobility aid to turn them-self in bed, to sit up, stand, some hold on to them while they dress. Then there are others who have already broken a hip from a fall who cannot flex their hip past a certain angle. Not to mention the germs, vermin, etc. down on the floor. It still comes down to an IDT assessing each res. individually and of course finding out what the res. and family members preferences are.
I am a new grad that just started at a LTC that doesnt use side rails for most patients and we have to me what seems like a large number of falls over just the past 3 days (5). It was explained to me it is not so much a restraint issue, it is the risk of the resident getting caught up in the railing of the siderails and it posing a choking risk. My unit manager told me they made this choice after documented accounts of residents dying from side rail asphyxiation. The few patients that do have siderails use them for mobility issues and they are A/Ox3.
The rest have no siderails and it seems they get low beds and mats only after a fall. I am torn on this issue..I see the point of wanting to protect the resident from strangulation in a siderail, but I dont think any nurse (at least me) wants to deal with a fall..I hate the extra paperwork and calls...and the guilt I can't shake for the entire rest of the shift that I could have avoided the fall issue somehow.
Specializes in Gerontology, Med surg, Home Health.
Side rails have been proven time and time again to pose a huge risk to residents. They become entrapped in them or decide to climb up and over the side rail and suffer a worse injury than they would have had they not had side rails.
It's up to us to educate the families and explain why the side rails are not the best option. It no longer matters that the family member wants them. We all have to think about what is safest for the residents.
I am a new grad that just started at a LTC that doesnt use side rails for most patients and we have to me what seems like a large number of falls over just the past 3 days (5). It was explained to me it is not so much a restraint issue, it is the risk of the resident getting caught up in the railing of the siderails and it posing a choking risk. My unit manager told me they made this choice after documented accounts of residents dying from side rail asphyxiation. The few patients that do have siderails use them for mobility issues and they are A/Ox3.
The rest have no siderails and it seems they get low beds and mats only after a fall. I am torn on this issue..I see the point of wanting to protect the resident from strangulation in a siderail, but I dont think any nurse (at least me) wants to deal with a fall..I hate the extra paperwork and calls...and the guilt I can't shake for the entire rest of the shift that I could have avoided the fall issue somehow.
Yeah my unit manager says that's the reason they've taken away SR's. But there have been people who have fallen, broken a bone, and then died right after that. I would say that's more common. That's what happened to my grandma. Once the elderly break a bone it seems like it's all over.
Specializes in Gerontology, Med surg, Home Health.
I've had 98 year old women fall and break hips, come in for rehab and go home to live happy lives for several more years. A broken bone is no longer a death sentence.
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itsmejuli
2,188 Posts
One of the comments above reminded me about one Sat or Sun at work. When I got to work I found leg rests on a resident's wheelchair. He'd never had leg rests before, he was mobile in his wheelchair. Having leg rests on his chair was definitely a restraint...I removed them immediately. Wish I could have figured out which bright cooworker decided to restrain this guy.