MedicalNurseTraining.com

Author:  Wade M. Thomas

The FDA recently updated a document on their website that deals with Hospital Bed Safety on April 5, 2010.  I’ll give the link here at the beginning of the article for you to download and use at your hospital.

http://www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/HospitalBeds/ucm125857.pdf

There are about 2.5 million hospital and nursing home beds in use in the U.S.  From 1985 through 2008, it was reported to the FDA that 803 patients/residents were caught, trapped, entangled, or strangled in beds with rails.  480 people died, 138 had a nonfatal injury and 185 were not injured because the staff intervened.  MOST OF THE PATIENTS WERE FRAIL, ELDERLY OR CONFUSED.

A more detailed look at hospital bed safety can been seen on the FDA website below:

http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/HospitalBeds/default.htm

A lot of hospitals still don’t know about ( or else do know but have decided not to do anything about ) the bed safety issue with their old hospital beds.  There is a test kit available that the FDA suggests facilities use to test their beds with from National Safety Technologies.  You can find the test kit at this address:  http://www.nst-usa.com/Pages/B4000Main.html

Patient Safety

Patients who have problems with memory, sleeping, incontinence, pain, uncontrolled body movement, or who get out of bed and walk unsafely without assistance, must be carefully assessed for the best ways to keep them from harm, such as falling. Assessment by the patient’s health care team will help to determine how best to keep the patient safe. Historically, physical restraints (such as vests, ankle or wrist restraints) were used to try to keep patients safe in health care facilities. In recent years, the health care community has recognized that physically restraining patients can be dangerous. Although not indicated for this use, bed rails are sometimes used as restraints. Regulatory agencies, health care organizations, product manufacturers and advocacy groups encourage hospitals, nursing homes and home care providers to assess patients’ needs and to provide safe care without restraints.

The Benefits and Risks of Bed Rails

Potential benefits of bed rails include:

• Aiding in turning and repositioning within the bed.
• Providing a hand-hold for getting into or out of bed.
• Providing a feeling of comfort and security.
• Reducing the risk of patients falling out of bed when being transported.
• Providing easy access to bed controls and personal care items.

Potential risks of bed rails may include:

• Strangling, suffocating, bodily injury or death when patients or part of their body are caught between rails or between the bed rails and mattress.
• More serious injuries from falls when patients climb over rails.
• Skin bruising, cuts, and scrapes.
• Inducing agitated behavior when bed rails are used as a restraint.
• Feeling isolated or unnecessarily restricted.
• Preventing patients, who are able to get out of bed, from performing routine activities such as going to the bathroom or retrieving something from a closet.

Meeting Patients’ Needs for Safety

Most patients can be in bed safely without bed rails. Consider the following:

• Use beds that can be raised and lowered close to the floor to accommodate both patient and health care worker needs.
• Keep the bed in the lowest position with wheels locked.
• When the patient is at risk of falling out of bed, place mats next to the bed, as long as this does not create a greater risk of accident.
• Use transfer or mobility aids.
• Monitor patients frequently.
• Anticipate the reasons patients get out of bed such as hunger, thirst, going to the bathroom, restlessness and pain; meet these needs by offering food and fluids, scheduling ample toileting, and providing calming interventions and pain relief.

When bed rails are used, perform an on-going assessment of the patient’s physical and mental status; closely monitor high-risk patients. Consider the following:

• Lower one or more sections of the bed rail, such as the foot rail.
• Use a proper size mattress or mattress with raised foam edges to prevent patients from being trapped between the mattress and rail.
• Reduce the gaps between the mattress and side rails.

Which Ways of Reducing Risks are Best?

A process that requires ongoing patient evaluation and monitoring will result in optimizing bed safety. Many patients go through a period of adjustment to become comfortable with new options. Patients and their families should talk to their health care planning team to find out which options are best for them.

Patient or Family Concerns About Bed Rail Use

If patients or family ask about using bed rails, health care providers should:

• Encourage patients or family to talk to their health care planning team to determine whether or not bed rails are indicated.
• Reassure patients and their families that in many cases the patient can sleep safely without bed rails.
• Reassess the need for using bed rails on a frequent, regular basis.

Wade Thomas is a Hospital Falls Consultant to hospitals primarily in the State of Florida and a Nursing Home Falls Consultant for Nursing Homes in the State of Florida.  He works to provide education, training, and fall prevention products that will help any hospital to decrease their fall rates and more importantly, their falls with injuries rates.  He attends the annual USF/VA VISN8 Patient Safety Conference in Clearwater Beach, Florida and also attends the State of Florida annual Florida Health Care Association show for nursing home directors and administrators.  To contact Mr. Thomas for more information on how he or one of his associates can work with your hospital, please email WadeThomas at AOL.com

Copyright 2010 - Wade M. Thomas & MedicalNurseTraining.com - Please feel free to share this article with your friends and colleagues.  Please leave the entire article and author’s biography box intact.  Thank You.

New inexpensive technologies by Safer Falls.com significantly reduce the risk of falls and protect against the effect of falls particularly in the population now approaching 60 and above. New personal use technologies that are relatively unknown to some in the medical field, and more often the public can easily eliminate these preventable injuries and deaths.  The National Center for Patient Safety recently recommended the use of these new approaches to be used in treating patients whom are at high risk.

Patrick Devaney, Founder of Medical Nurse Training, Inc; discusses the necessity of such products when dealing with an elderly person who is at risk for falls in Long Term Care Facilities or in-home.  “Many people who try to convalesce at home from hip fractures and head injuries don’t fully recover.  There are some new affordable devices that can prevent these injuries from ever occurring.” Mr. Devaney goes on about how each device can be necessary for care and each individual’s unique situation in the accompanying video.

Medical Nurse Training, Inc.  provides the latest on-line training to Doctors and Nurses on fall prevention and protection. This includes in-house education on devices that will reduce injury from falls and related deaths and on-line education for those concerned about falls at home.

Hip Protectors – High Impact – absorbing pads that help protect hip bones against injury from falls. About 320,000 people suffer a hip fracture every year.  These pads are built into briefs, panties, sweat pants and sweat shorts. They can easily be laundered and re-used numerous times to help protect from falls. The use of these devices has been clinically proven to reduce injury. Many individuals that experience a fall are afraid to continue normal activities like walking. These devices help these people resume a normal life. Hip Fracture is one of the number one causes of death in older individuals. Our experience shows that hip protectors are generally not known by the general public

Fall Alarms – Inexpensive bed and chair exit electronic monitors otherwise known as Fall Alarms, assist with the observation of patients and family members to help reduce falls and the potential for elopement from home or a facility. A variety of sensor accessories may be used including toileting sensors, bed/chair sensors, infrared sensors and self releasing sensors may be attached to the monitor to reduce risk. These alarms include a gentle voice reminder not to get up without assistance.

Floor Cushions and Bath Mats – Certain areas of the home are very high risk for injury from falls like the bathroom. Special floor cushions and bath mats are designed to help reduce the impact from a fall and are frequently talked about in the clinical literature. These floor cushions are tri-fold in design, making them convenient to carry to areas requiring the most immediate protection. Bathrooms are also very high risk zones. The sure step bath mat can be used to significantly reduce the impact of a fall.

A complete list of Fall Prevention Products and availability and Clinical Resources are available at www.SaferFalls.com.  Fall Prevention and Protection Training Programs are available at www.MedicalNurseTraining.com. 

SaferFalls.com has partnered with the leading manufacturers of fall prevention products for seniors and older adults to provide these life saving devices at wholesale prices. These are state of the art fall protection devices from the leading providers. This division of Medical Nurse Training Inc. was created to help educate and reduce injury and deaths associated with falls.

Many doctors and nurses have requested during our training programs, “where can we obtain this valuable fall protection equipment for friends, family members and patients at a reasonable price.” Finally that has been accomplished to reduce slip and fall injuries at home and in assisted living environments. Additonally, SaferFalls provides education to reduce the potential for these devastating falls.

The Center for Disease Control and Prevention indicates that over 60% of fatal falls occur in the home. Additionally the total cost of falls in 2010 is expected to be between 68 and 100 Billion Dollars. More than 25,000 older adults died due to falls last year. Katharine Graham, former Washington Post Chairman died as a result of a fall. Most of this cost and loss of life is completely preventable through new fall prevention, fall protection products and safer falls education. Many of these medically significant events include hip fracture, head injury, fear of falling again, broken vertebrae and broken wrist.

Over 44 million baby boomers live at home with an elderly sick parent according to The Caring Alliance. Another 25 million at risk elderly live alone and unprotected from devastating falls. The current economic conditions have exacerbated these numbers. Since life expectancy has continued to increase this situation is likely to become even more prevalent. The faller may need to move in with adult children and adult children often have to take time off work to care for at risk parents. The costs emotionally and physically to the person who falls and their families is enormous.

Much of this information is virtually unknown to the general public. Annually there are approximately 370,000 hip fractures. Head injuries from falls at home are another significant medical cost. Falls are the major cause of 40% of nursing home admissions and subsequent costs to families. Per year, of those admitted to a hospital only about
50 % will survive a serious fall. Falls are the leading cause of accidental death and more than 33% of adults 65 and older fall each year. Reductions in healthcare costs is a current concern of all in the government and the effect of falls are major cost factor.

Anyone who is above the age of 55 or has a relative, who is at risk for falls, is confused or agitated, has Alzheimer’s, or presents departure/elopement risk at home will be very interested in this new material. This information will be invaluable to seniors and their families. To see fall prevention training and fall protection devices for home, concerned individuals and families may go directly to www.SaferFalls.com for senior fall prevention.

Some of these devices include Hip Protectors, Fall and Exit Alarms, high impact Fall and Floor Cushions, Fall and Lift Furniture, Bed Safety Guards, Personal Pagers, high impact Bath Mats, Fall Management Socks and Shower Slippers.

Hip Protectors – High Impact – absorbing pads that help protect hip bones against injury from falls. About 320,000 people suffer a hip fracture every year. These pads are built into brief’s, panties, sweat pants and sweat shorts. They can easily be laundered and re-used numerous times to help protect from falls. The use of these devices has been clinically proven to reduce injury. Many individuals that experience a fall are afraid to continue normal activities like walking. These devices help these people resume a normal life. Hip Fracture is one of the number one causes of death in older individuals. Our experience shows that hip protectors are generally not known by the general public

Fall Alarms – Inexpensive bed and chair exit electronic monitors otherwise known as Fall Alarms, assist with the observation of patients and family members to help reduce falls and the potential for elopement from home or a facility. A variety of sensor accessories may be used including toileting sensors, bed/chair sensors, infrared sensors and self releasing sensors may be attached to the monitor to reduce risk. These alarms include a gentle voice reminder not to get up without assistance. Many of these devices are unknown to the general public. Pendants to call caregivers when help is needed are also very useful.

Floor Cushions and Bath Mats – Certain areas of the home are very high risk for injury from falls like the bathroom. Special floor cushions and bath mats are designed to help reduce the impact from a fall and are frequently talked about in the clinical literature. These floor cushions are tri-fold in design, making them convenient to carry to areas requiring the most immediate protection. Bathrooms are also very high risk zones. The sure step bath mat can be used to significantly reduce the impact of a fall. The mat is impervious to water and bacterial growth and can be custom cut to fit the contours of any bathroom or floor.

Please go to www.SaferFalls.com to receive more information and education on these important fall prevention and fall protection products.

Medical Nurse Training, Inc. announces two programs that will increase patient settlements, assist representation at trial, and bring Attorneys state of the art fall prevention and protection training.

Medical Nurse Training is the premier portal for training nurses and doctors utilizing a nationally known Geriatric Doctor, the Assistant Director of Nursing at Johns Hopkins and Patrick Devaney who has over 25 years experience lecturing on these topic to tens of thousands of nurses, doctors, lawyers, and healthcare facilities. The assistant director of Nursing at Johns Hopkins, an expert legal medical witness, demonstrates the current standards of care in fall prevention and bed safety.  Also discussed in detail, are the legal ramifications of not following these practices.

Root causes and specific solutions for patient falls, resident falls, and in home falls are also described in detail in this on line or DVD based program. There are two low cost accredited programs that include Acute Care and Long Term Care/Home Care.  Independent Falls Consultant, Jaime Cole stated, “The flow of the program is very impressive and easy to follow along with since it is predominately lecture video with side by side PowerPoint.”  Protocols and over 400 pages of other resources are also included that cover nearly every aspect of this topic.  

Numerous current tools, statistics, pictures, and videos will be useful in any pretrial brief or trial proceedings.  Medical Nurse Training, Inc. provides continuous updates through their website that are sure to provide incredible insight to any Firm with valuable monthly blogs and newsletters. This program will bring added value to all personal injury cases with many statistical benchmarks, deferential analysis, and standards of care.

For more information about the programs available from Medical Nurse Training, Inc., please visit http://www.medicalnursetraining.com.

Author: Pat Devaney

Date: 5-18-2009

This is to announce a tremendous saving in lives and medical costs of over 200 billion dollars yearly. Most of these savings can be achieved by reducing the risk of falls and protecting against the effect of falls particularly in the population now approaching 60 and above. New personal use technologies that are relatively unknown to some in the medical field and more often the public can easily eliminate these useless injuries and death.. National Center for Patient Safety recently recommended the use of these new approaches. We are receiving numerous requests to offer this information to the general public and we are willing to perform this public service.

The President of Medical Nurse Training, Mr. Devaney is available to speak to these new technologies and education for your program. Medical Nurse Training is the premier portal for training nurses and doctors utilizing a nationally known Geriatric Doctor, the Assistant Director of Nursing at Johns Hopkins and Patrick Devaney who has over 25 years of experience lecturing on these topic to tens of thousands of nurses, doctors and healthcare facilities. Anyone who is above the age of 55 or has a relative, who is at risk for falls, is confused or agitated, has Alzheimer’s, or presents elopement risks at home will be very interested in this new material.

Mr. Devaney’s mother died as the result of an unnecessary hip fracture. This loss could have easily been prevented with one of these new devices or education techniques. Numerous lives have already been saved with these clinically proven devices.

We have partnered with the leading manufacturers of these low cost medical technologies to provide these devices predominately available only through hospitals and nursing homes to the general public at an institutional price.

By going to www.MedicalNurseTraining.com you can get a broad overview of the types of programs we offer to the medical community and review our blogs. We would welcome a discussion of how your program and listeners/viewers will greatly benefit from this information. This piece will be of interest to most if not all. These medically sound approaches will eventually get attention and will reduce government costs in the trillions of dollars over the next 10 years. You can also review clinical references on this site.

Medical Nurse Training provides the latest on-line training to Doctors and Nurses on fall prevention and protection. This includes in-house education on devices that will reduce injury from falls and related deaths.

Hip Protectors – High Impact – absorbing pads that help protect hip bones against injury from falls. About 320,000 people suffer a hip fracture every year.  These pads are built into briefs, panties, sweat pants and sweat shorts. They can easily be laundered and re-used numerous times to help protect from falls. The use of these devices has been clinically proven to reduce injury. Many individuals that experience a fall are afraid to continue normal activities like walking. These devices help these people resume a normal life. Hip Fracture is one of the number one causes of death in older individuals. Our experience shows that hip protectors are generally not known by the general public

Fall Alarms – Inexpensive bed and chair exit electronic monitors otherwise known as Fall Alarms, assist with the observation of patients and family members to help reduce falls and the potential for elopement from home or a facility. A variety of sensor accessories may be used including toileting sensors, bed/chair sensors, infrared sensors and self releasing sensors may be attached to the monitor to reduce risk. These alarms include a gentle voice reminder not to get up without assistance. Many of these devices are unknown to the general public.

Floor Cushions and Bath Mats – Certain areas of the home are very high risk for injury from falls like the bathroom. Special floor cushions and bath mats are designed to help reduce the impact from a fall and are frequently talked about in the clinical literature. These floor cushions are tri-fold in design, making them convenient to carry to areas requiring the most immediate protection. Bathrooms are also very high risk zones. The sure step bath mat can be used to significantly reduce the impact of a fall. The mat is impervious to water and bacterial growth and can be custom cut to fit the contours of any bathroom or floor.

Please go to www.MedicalNurseTraining.com for more information on these programs and devices. A consumer section with numerous new fall prevention and protection devices will appear on the site shortly. In the meantime you are welcome to email us with your immediate needs.

In recent months there have been side rail entrapments resulting in injury and death. Recent Joint Commission and CMS surveys have punctuated this high risk trend.

The Clinical Guidance for the Clinical Assessment and Implementation of Bed Rails from the Bed Safety workgroup and the FDA is the operating tool to reduce this risk. The use of this tool and other current resources for increasing patient and resident safety are included in the 3 credit hour program from www.MedicalNurseTraining.com . This program details the risk of side rails and offers everyday practical solutions to reduce the incidence of bed entrapment and fall related injury.

This program draws on Joint Commission recommendations included in the REDUCING THE RISK OF FALLS in your Health Care Organization by Joint Commission Resources. The program follows the evidence based protocols of such organizations as Johns Hopkins and relates these programs to practical solutions.

It also utilizes the recommendations of the National Center for Patient Safety and many other facility based solutions in a 400 page resource CD or downloadable on line program.

Delving deeper into the clear recommendations of Joint Commission include the use of numerous environmental changes as well as devices that protect patients and residents:

“Hip protectors are a good intervention for care recipients with dementia or other cognitive defects. They allow the care recipient to be active while helping to prevent hip fractures if they fall.”

“A safe room has devices such as nonskid floor mats and a commode placed at a 90-degree angle to the bed”

“Bed Exit Alarms, Chair Exit Alarms, Voice Alarms telling the patient not to get up because a nurse would come by shortly to help, Freedom Splints (sleeves that fit over the forearm and upper arm) to reduce the risk of the patient pulling out tubes, Torso supports to maintain the patients posture and positioning, Mitts to keep the patient from pulling out IVs and nasogastric tubes, Antiskid Floor Mats, and Antislip footwear”

All of the above recommendations appear in the REDUCING THE RISK OF FALLS in your Health Care Organization by Joint Commission Resources

I would suggest that a great way to review these types of devices would be to go to www.posey.com for a review from a premier manufacturer of patient safety devices. You will also find a complete selection of up to date side rail alternatives, seizure side rail pads and side rail protectors to help your facility become FDA compliant.

Written by Patrick Devaney, Medical Nurse Training, Inc. 

Falls Interventions for patients include – Safe Environment Individualized Interventions for High Fall Risk Patients Bed Safety and Fall Device Evaluation and Selection

Author: Pat Devaney, program contributor

Environmental design and setup very often create unique challenges  including how patient rooms are set up to avoid patient falls and the surrounding potential injury. The 3 hour train the trainer program from Medical Nurse Training demonstrates several safe room set ups for at risk patients.

This program indicates the use of fall devices like beveled floor mats for up to 92% reduction in injury from facility beds including low beds. Additionally the bed safety portion of the program indicates the use of bedside walkers and bedside commode to help enable the patient or resident.

Since four side rails are a restraint, the use of roll guards and perimeter mattress overlays is also recommended to reduce the incidence of restraint orders. One side rail can also be utilized to enable easy bed exit.

Bed alarms are becoming more prevalent to remind the patient to call for help and alert staff. Joint Commission has estimated up to a 85% reduction in injury from falls when bed alarms are utilized. Fortunately, reduced costs and improved alarm design have significantly helped to improve patient outcomes. Several evidence based studies that prove the efficacy of these devices are finally about to be published.

In recent years it has been very difficult to find evidence based programs for fall prevention and fall protection. I have a personal reason for my involvement in this matter since my mother passed away as a direct result of a hip fracture. This event was totally preventable utilizing the techniques implemented by some forward thinking facilities like Johns Hopkins.

Facilities have been struggling with the appropriate modalities to reduce the incidence of falls and reduce restraint use at the same time. In order to find the ultimate solution requires a mix of assessment tools and up to date devices to achieve the highest reduction in fall risk. Additionally bed safety and reductions in side rail entrapment have been serious concerns especially for older beds. I also believe, as does CMS, that one of the best answers is too provide a train the trainer approach to hospital and long term care on fall prevention, fall protection, bed safety and restraint reduction. Fall Prevention Programs work particularly well in this format since fall prevention in nursing often requires significant falls training and retraining.

I began our journey to reinvent an all inclusive, evidence based program for fall prevention including online video training with over 400 pages of resources including  DVD’s and manual. The best approach was to elicit the best speakers on these topics including the ADON at Johns Hopkins and a geriatric doctor at one of the top 100 hospitals, Dr. Deidre Carolan from Inova Health System. We teamed up and developed a train the trainer that is loaded with all the needed content. Finally,  programs that addressed on line and in house training for; Hospital Fall Prevention, Long Term Care Fall Prevention, Restraint Reduction, Fall Prevention Protocols, Falls and Restraint Assessment, Acute Care Fall Prevention and Bed Safety.  

The programs are recorded with a live audience to increase the learning and retention experience. Valuable technologies including Fall Alarms, Posey Beds, Hip Protectors, Fall Mats, Self-Releasing Devices and Restraint Alternatives are demonstrated and discussed. Reducing the impact of the new Medicare changes of October 2008 are reviewed in detail. These accredited on line training programs include all the patient/resident safety regulatory recommendations and device suggestions. Numerous tools including the new Johns Hopkins restraint, falls policies and protocols as required by the new CMS and 2009 Joint Commission recommendations. I have reviewed numerous programs and I am confident this is the most state of the art program available. Attendees report this is the best program they have ever attended for staff and nursing training.

Many regulatory guidelines are often overlooked due to lack of information from the regulating agencies.  I have had the opportunity to work with and train numerous surveyors. There has often been some inconsistency between surveyors on the guidelines. The training I have done with the surveyors has reduced some of these inconsistencies. We have included much of the lessons learned in the On Line and DVD programs in a train the trainer, video and PowerPoint format.  This will certainly help to minimize negative surveys in Long Term and Acute Care settings.

Testimonials and clips of the program can be viewed on www.MedicalNurseTraining.com/Testimonials.html/

Article is Copyrighted 2009 - Patrick Devaney

Patrick Devaney, BA Psychology

President and Founder, Medical Nurse Training, Inc.

Patrick has been a consultant / trainer to numerous Health Care facilities, Corporations and LTCDON Associations.  Most recently as Executive Director of a state Director Of Nurses Association Long Term Care.  He has trained thousands of LTC and Critical Care facilities as a speaker on fall prevention, bed safety and restraint alternatives in one and three hour accredited speaking engagements.  His programs have been nationally accredited by the ANA for over 12 years with excellent results.

FALL PREVENTION, BED SAFETY & RESTRAINT REDUCTION
NURSE TRAINING COURSE OUTLINE

In institutions, more than half of those with high risk factors fall every year. And one out of ten of these falls results in a serious injury. This program will help you identify risk factors for falls, both in the patient population and in the hospital environment, and it will help you take steps to prevent falls.  Falls among older patients and other-at-risk patients are very common.

OVERVIEWThis activity describes strategies and techniques for reducing / preventing falls. It is divided into the following parts.

a. Introduction

b. Nursing Home & Hospital Bed Entrapment and Hospital Bed Safety

c. Slide Program Review

d. Falls Management

PURPOSE/OVERALL GOALThe purpose of this activity is to provide nurses and others a review of strategies and techniques to minimize or prevent patient falls.

COURSE OBJECTIVES

After completing this course, the learner should be able to:

a. Define “restraints” according to Government Guidelines and Regulations.

b. Describe Fall Prevention/Protection, Protocols and New Alternatives to Restraint Products.

c. Describe indications and contraindications to various restraint and restraint free devices.

d. Describe selection strategy and authorized application techniques for restraints, postural supports, restraint alternatives, and New Bed Safety Devices as per CMS/FDA.

e. Describe in detail Hospital Bed Safety Work Group Bed requirements for safe bed environment.

f. Describe options to bed side rails as restraints.

g. Describe “Less Restrictive Alternatives” as required by JCAHO 2003, including QI Audit Documentation with special emphasis on the Joint Commission Patient Safety Goals, patient/resident family falls education and new less restrictive devices.

h. Describe and explain fall equipment, patient fall identifiers (as required by the Joint Commission) and criteria for utilization.

i. Identify root causes of patient falls and ways to prevent and protect patients.

j. Describe the training tools provided on the new CMS Restraint Regulations, including new interpretive guidelines released on 4-18-2008.

In our next post, we will talk about course options that are available for nurses to take online nurse training. We have Hospital Fall Prevention Protocols included in the package that you can take and use to modify your current protocols with. We are also one of the only few companies that offer fall prevention video training and have world class experts to teach the topics from institutions such as Johns Hopkins Hospital and Inova Health System.

To get started with our course, click here to visit Medical Nurse Training or type in www.MedicalNurseTraining.com