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

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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