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BedSAFE:. Bed S afety A lternatives for F rail E lderly. BedSAFE Team. VISN 8 Patient Safety Center of Inquiry Stephanie Hoffman Leah Rathvon Gail Powell-CopeStuart Wilkinson Nursing Home Management and Staff Myrna AlvearBonnie Reele Sandra Flores Gladys Rosario - PowerPoint PPT Presentation
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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
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)