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. 

By Wade Thomas

When helping administrators and managers decide what the best products are at Preventing Hospital Falls, I always like to look at both the products and non-product alternatives to preventing hospital falls.  So many times a patient just needs to go to the bathroom, that constant rounding by the CNAs ( PCTs or PCAs ) and RNs are all that are needed to show a decrease in fall rates.

But products such as the Posey Bed Alarms are also great fall prevention products to help assist the nurses in keeping their patient safe and preventing hospital preventable falls!!  The best part about it is that the nurses do NOT need a doctor’s order to use a bed alarm on a patient.  It is based on nursing judgment whether they need to use one or not, or better yet, when it is written into the hospital’s policies and fall prevention protocols, the nurses don’t even have to think about it - they just do it !!!

It’s also important to have awareness of nursing practices.  I was recently in a hospital where the falls rates were really high, and the CNO and managers were asking me to find out more information as to why their rates were so high.  Upon exploring this with their nurses and CNAs, I discovered a two really important reasons why they were having issues.

First, the nurses where spread out among 3 to 4 wings on a floor.  They would have 2 patients on Wing A, 2 or 3 on Wing B, and 1 on Wing C and in one case, one patient on Wing D.  Most of the nurses were spread among 3 wings on the floor.  The CNAs were also spread thin covering not the normal 10 to 12 patients, but they were covering 12 to 14 patients, especially when the hospital would pull a CNA to be a Sitter to watch a patient, because the doctors are use to ordering sitters.

By using the Posey Sitter II Bed Alarm, then CNAs were effectively able to manage that number of patients across the 3 to 4 wings that they were covering.  They hooked the alarms to the nurse call system, and whenever the alarm would start talking to the patient ( yes, I did say TALKING BED ALARMS ), it would call the nurse call system.  For those confused patients, they would set the alarms to TONE ONLY, and it would ring the tone AND call the nurse call system.

The second big problem was that the nurses, nor CNAs, did NOT have the time to ask and take each patient to the bathroom.  And when they would take them, they would leave them in the bathroom and help the patient in another room and come back and check on the patient in the bathroom.  THUS, the explanation for the BIG INCREASE IN BATHROOM Related Hospital Falls.

Now, there are solutions available to help solve that problem also.  But it really comes back to the nursing practice of AWARENESS !!!  Being aware of the patient’s needs will help predict future behavior or activities and can help in preventing hospital falls!!!

Other ways that can help hospitals in preventing hospital falls includes:

1. From the website Patient Safety & Quality Healthcare, hospitals are teaming up with each other, regardless of their competitive natures and locations to help solve this problem:

Hospitals Collaborate to Prevent Falls

By Kathryn Pelczarski and Cynthia Wallace

Philadelphia-area hospitals have charted a unique strategy in patient safety: Facilities that are normally competing for patients are collectively identifying effective measures to prevent patient falls. Harnessing their strength as a regional collaborative, the hospitals have shared stories of how to implement effective interventions for falls prevention and have participated in brainstorming workshops to identify a long list of additional strategies. The facilities can then choose from the list those interventions that zero in on their unique challenges.

http://www.psqh.com/novemberdecember-2008/91-november-december-2008/277-hospitals-collaborate-to-prevent-falls.html

2. Creating signs in the NATIVE LANGUAGES of your patients to help them AND their family members understand the things that can be done to reduce falls.  The Ohio State University Medical Center has an example of this for public use without copyright concerns, where they had the instructions in both English and Hindi.

http://www.healthinfotranslations.com/pdfDocs/PreventingfallsinthehospitalHdiFinal.pdf

3. Keeping current with Great Hospital Purchasing GPOs, such as Premier, and all of the resources that a GPO keeps on their website to help educate their hospitals.

http://www.premierinc.com/safety/topics/falls/

4. Staying Current by attending leading, cutting edge falls and patient safety conferences, such as the one that is sponsored by USF & the VA VISN 8 in Tampa, Florida each year in Clearwater Beach, Florida.  This will be their 11th Annual Conference on May 4-6, 2010.  I definitely attend as many as these as I can, and I’ve watched this one grow from 9 years ago to what it has become today.

Here’s a couple of links about it:

http://www1.va.gov/VISN8/PatientSafetyCenter/safePtHandling/default.asp

http://www.cme.hsc.usf.edu/falls/

5.  Posey Company Fall Prevention Education & Information - The Posey Company provides valuable information and resources for hospitals to use.  By just calling them on the telephone or even emailing the author of this article, they will have a well trained & knowledgeable representative contact you about the education information and fall prevention product solutions that can help your hospital.  By having representatives in hospitals daily, Posey learns what is working and not working, and offers educational webinars, online CEU training programs and product solutions.  Visit http://www.Posey.com/ for more information.

In wrapping up this guest blog post for Medical Nurse Training’s website,  by aligning yourself with leaders in the industry that are doing the research, staying on top of the research and creating new solutions for preventing hospital falls, your falls rates and hospital falls rates with injuries will significantly decrease!!  It does not happen over night, and you always have to remember, that it’s not a race, but it’s a marathon to find the right solutions and answers to help you and your hospital in preventing hospital falls!!
Wade Thomas is a Hospital Falls Consultant to hospitals primarily 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 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.