Bed S afety A lternatives for F rail E lderly

1. BedSAFE: BedSafety Alternatives for Frail Elderly

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. 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 Barriers

13. Families Administration Family involvement on BedSAFE team Enlisting family as program ambassadors Keeping lines of communication open Overcoming Resistance

14. 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% 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