Bed S afety A lternatives for F rail E lderly

Bed Safety Alternatives

for Frail Elderly

Bed Safety Alternatives

for Frail Elderly

BedSAFE: BedSAFE:

BedSAFE TeamBedSAFE Team

VISN 8 Patient Safety Center of InquiryStephanie Hoffman Leah RathvonGail Powell-Cope Stuart Wilkinson

Nursing Home Management and StaffMyrna Alvear Bonnie ReeleSandra Flores Gladys Rosario Paula Lambright Paul Sink Sara Larry Maria Thomas

Other DepartmentsKim Bero, KinesiotherapyMary Keffer, Occupational TherapySteve Ritchie, Engineering Ann White, Social Work

BackgroundBackground

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

Bed Rails as RestraintsBed 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)

Risks of Bed RailsRisks 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

Entrapment ZonesEntrapment Zones

Why Residents Want Bed RailsWhy Residents Want Bed Rails

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

What are Alternatives?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

BedSAFE ComponentsBedSAFE Components

1. An interdisciplinary team that conducts walking rounds monthlyKinesiotherapy

Education

Nursing

Social Work

Engineering

BedSAFE Components (cont.)BedSAFE Components (cont.)

2.2. 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

BedSAFE Components (cont.)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

Overcoming BarriersOvercoming Barriers

Staff

Patients

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

Overcoming ResistanceOvercoming Resistance

Families

Administration

Family involvement on BedSAFE team

Enlisting family as program ambassadors

Keeping lines of communication open

Prevalence of Bed Rail Use Pre/Post ProgramPrevalence of Bed Rail Use Pre/Post Program

Unit Type October 1999

October 2000

Percent Reduction

Dementia 35 26 25%

Rehabilitation or Skilled Care

62 51 18%

Hospice 62 40 35%

Overall 159 117 27%

*Numbers reflect the fact that one or two rails could be raised on each bed

Rates of Bed-related Falls by QuarterRates of Bed-related Falls by Quarter

Quarter FY Numberof falls

Patient Days(thousands)

Rate

Pre BedSAFEQ1 99 42 15.9 2.64Q2 99 41 15.4 2.66Q3 99 41 15.8 2.60Q4 99 26 15.0 1.74

Mean FY 99 2.41Post BedSAFE

Q1 00 20 15.3 1.31Q2 00 40 15.3 2.60Q3 00 35 14.6 2.39

Mean FY 00 2.10

Bed-Related Falls Resulting in InjuryBed-Related Falls Resulting in Injury

Frequency Percent ofTotal Falls

Year Prior toBedSAFE

63 42%

Year ofBedSAFE

45 36%

Type of Injury Year preBedSAFE

(n=63 of 150)

Year ofBedSAFE

(n=45 of 124)

Limb, back or hip pain 7 7

Superficial hematoma 7 3

Scrapes/bruises/lacerations

57 43

Minor Injuries from Bed-related Falls

Time Period Freq Explanation

Year pre BedSAFE(n=63 of 150)

1 Unwitnessed,possibly fall fromwheelchair to bed

Year of BedSAFE(n=45 of124)

2 Unwitnessed,possibly fall fromwheelchair to bed

Witnessed,wheelchair to bed

Hip Fractures from Bed-related Falls

Products of BedSAFEProducts of BedSAFE

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

alternatives (in progress)

What are the Challenges for Long Term Care Settings?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