# Presentation: 559987

## Bed Safety Alternatives for Frail Elderly

- BedSAFE:

**Notes:**
BedSAFE:Bed Safety Alternatives for Frail Elderly

## 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

**Notes:**
BedSAFE Team
VISN 8 Patient Safety Center of Inquiry
Stephanie Hoffman
Gail Powell-Cope
Leah Rathvon
Stuart Wilkinson

Nursing Home Management and Staff
Myrna Alvear
Sandra Flores
Paula Lambright
Sara Larry
Bonnie Reele
Gladys Rosario
Paul Sink
Maria Thomas

Other Departments
Kim Bero, Kinesiotherapy
Mary Keffer, Occupational Therapy
Steve Ritchie, Engineering
Ann White, Social Work

## 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

**Notes:**
Background
2.5 million hospital and nursing home beds in use in the US.
Between 1`985 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 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)

**Notes:**
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)

## 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

**Notes:**
Risks of Bed Rails:
Suffocation, strangulation, bodily injury
Fall from higher level
Skin bruising, lacerations
Increased agitation
Feelings of isolation or unnecesary restriction
Preventing patients from performing routine activities

## Entrapment Zones

**Notes:**
The seven entrapment zones from left to right area: (1) Patient’s whole body entrapped between the side rail and the mattress; (2) Patient’s head entrapped at the headboard area of the bed under and between the headboard and the bedrail; (3) Patient’s head entrapped between the vertical rails of the side rail; (4) Patient’s whole body entrapped between the side rail and the mattress with the potential of entrapping the head between the headboard and the front of the side rail; (5) Patient’s body entrapped between split rails when they have tried to exit the bed between the split rails head first, and where hips do not allow patient to slide to floor and they are hanging from the bed; (6) Patient’s head entrapped under a split rail when they have tried to exit the bed feet first; (7) Area between the bottom of a full-length rail and mattress where a patient can become entrapped.

## Why Residents Want Bed Rails

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

**Notes:**
Why Residents Wand Bed Rails
Habit
Sense of security
Family pressure
Turning or repositioning
Serves as utility hanger

## 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

**Notes:**
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 Components

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

**Notes:**
BedSAFE Components
An interdisciplinary team that conducts walking rounds monthly:
Kinesiotherapy
Education
Nursing
Social Work
Engineering

## 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

**Notes:**
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.)

- 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 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

**Notes:**
Overcoming Barriers
Staff
Front line worker involvement
Friendly competition
Capitalizing on staff desire to “do the right thing”
Working with nursing students

Patients
Weaning process
Reinforcing from direct care providers

## Overcoming Resistance

*Families*
*Administration*

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

**Notes:**
Overcoming Resistance
Families (family involvement in BedSAFE team, enlisting family as program ambassadors)
Administration (keeping lines of communication open)

## Prevalence of Bed Rail Use Pre/Post Program

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

**Notes:**
Prevalence of Bed Rail Use Pre/Post Program (numbers reflect the fact that one or two rails could be raised on each bed)
Dementia Unit: 35 pre, 26 post, 25% reduction
Rehabilitation or Skilled Care: 62 pre, 51 post, 18% reduction
Hospice: 62 pre, 40 Post, 35% reduction
Overall: 159 pre, 117 post, 27% reduction

## Rates of Bed-related Falls by Quarter

**Notes:**
Rates of Bed-Related Falls by Quarter
This chart shows that pre program the rate of bed-related falls was 2.41, post program the rate was 2.1

## Bed-Related Falls Resulting in Injury

**Notes:**
In the years prior to BedSAFE the frequency of bed-related falls resulting in injury were 63 (42% of total falls)
After one year of the program the frequency dropped to 45, and 36% of total falls.

## Minor Injuries from Bed-related Falls

**Notes:**
Minor Injuries from Bed-Related Falls
Limb, back or hip pain injuries per program were 7, post-program were 7
Superficial hematoma pre-program accounted for 7 injuries, post-program, 3 injuries
Scrapes, bruises and lacerations accounted for 57 injuries pre-program and 43 post-program

## Hip Fractures from Bed-related Falls

**Notes:**
Hip Fractures from Bed-Related Falls
In the year before the program there was 1 unwitnessed injury that was possibly a fall from wheelchair to bed
During the year of BedSAFE there were 2 fractures, 1 unwitnessed that was possibly a fall from wheelchair to bed and one witnessed wheelchair to bed.

## Products of BedSAFE

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

**Notes:**
Products 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?

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

**Notes:**
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