Bed Safety Alternatives for Frail Elderly

1
Bed Safety Alternatives for Frail Elderly
BedSAFE
2
BedSAFE Team

• VISN 8 Patient Safety Center of Inquiry
• Stephanie Hoffman Leah Rathvon
• Gail Powell-Cope Stuart Wilkinson
• Nursing Home Management and Staff
• Myrna Alvear Bonnie Reele
• Sandra Flores Gladys Rosario
• Paula Lambright Paul Sink
• Sara Larry Maria Thomas
• Other Departments
• Kim Bero, Kinesiotherapy
• Mary Keffer, Occupational Therapy
• Steve Ritchie, Engineering
• Ann White, Social Work

3
Background

• 2.5 million hospital and nursing home beds in use
  in the U.S.
• Between 1985 and 1993, 371 incidents of patients
  caught, trapped, entangled or strangled in beds
  with rails were reported to the FDA. Of these
  incidents
• 228 people died, 87 had a nonfatal injury and 56
  were not injured because staff intervened
• Most patients were frail or elderly

4
Bed Rails as Restraints

• Restraints are any manual method or physical or
  mechanical device, material, or equipment
  attached or adjacent to the resident's body that
  the individual cannot remove easily, which
  restricts freedom of movement or access to his or
  her body.
• (OBRA-87)

5
Risks of Bed Rails

• Suffocation, strangulation, bodily injury
• Fall from higher level
• Skin bruising, lacerations
• Increased agitation
• Feelings of isolation or unnecessary restriction
• Preventing patients from performing routine
  activities

6
Entrapment Zones
7
Why Residents Want Bed Rails

• Habit
• Sense of security
• Family Pressure
• Turning or repositioning
• Serves as utility hanger

8
What are Alternatives?

• Height-adjustable bed that raises from floor
  level to high enough to provide nursing care
• Body pillows
• Bed alarms
• Placing bed next to wall
• Increased supervision
• Raised-edge mattresses
• Floor mat

9
BedSAFE Components

• 1. An interdisciplinary team that conducts
  walking rounds monthly
• Kinesiotherapy
• Education
• Nursing
• Social Work
• Engineering

10
BedSAFE Components (cont.)

• 2. Individual patient assessment of risk
• confusion, history of falls, weakness
• 3. Intervention
• recommendations for alternatives, bedside signs
• modeling decision-making process for staff
• positive feedback, constructive criticism
• 4. Audit and feedback
• observational checklist, team meetings

11
BedSAFE Components (cont.)

• 5. Family support and education
• regular family meetings, educational brochure
  (http//www.fda.gov/cdrh/beds/)
• 6. Equipment trials and testing
• 7. Equipment design
• urinal holder, bed control clip
• 8. Program evaluation
• review of falls variance reports

12
Overcoming Barriers

• Front line worker involvement
• Friendly competition
• Capitalizing on staff desire to do the right
  thing
• Working with nursing students
• Weaning process
• Reinforcing from direct care providers

• Staff
• Patients

13
Overcoming Resistance

• Families
• Administration

• Family involvement on BedSAFE team
• Enlisting family as program ambassadors
• Keeping lines of communication open

14
Prevalence of Bed Rail Use Pre/Post Program
Numbers reflect the fact that one or two rails
could be raised on each bed
15
Rates of Bed-related Falls by Quarter
16
Bed-Related Falls Resulting in Injury
17
Minor Injuries from Bed-related Falls
18
Hip Fractures from Bed-related Falls
19
Products of BedSAFE

• Patient/Family Educational Brochure
• Bed Safety Observational Checklist
• Product Evaluation (in progress)
• Algorithms to guide appropriate selection of
  alternatives (in progress)

20
What are the Challenges for Long Term Care
Settings?

• Patient, staff and family barriers
• Punitive culture of patient safety
• Communication across shifts, disciplines and
  departments
• Low staffing levels and staff turnover