Monday, October 3, 2022

Nursing homes go to the mat after bedrail deaths

Between 1985 and 2013, the Food and Drug Administration received 901 reports of patients getting “caught, trapped, entangled, or strangled,” in bed. (Courtesy FabSafe Fall Mat)
Between 1985 and 2013, the Food and Drug Administration received 901 reports of patients getting “caught, trapped, entangled, or strangled,” in bed. (Courtesy FabSafe Fall Mat)

Sleeping may never be the same at Williamsburg retirement homes.

As federal regulations change substantially for the first time since 1991, Williamsburg long-term care facilities are changing longstanding practices in an effort to make patients safer.

One of the biggest changes occurring in elderly-living communities across Greater Williamsburg is the general removal of restraints, such as side-rails, on beds.

“Safety is the first priority that’s why it makes sense,” said Bernadette Varnes, director of clinical operations for Sentara Life Care.

The Center for Medicare and Medicaid Services (CMS) proposed the new regulations at the White House Conference on Aging in July 2015, according to a CMS news release in 2016.

Nationwide safety data collected by the CMS uncovered the dangers of side rails on beds in long-term care facilities, according to a Sentara news release.

Dangerous restraints

The data showed side rails were a greater risk to patients’ health from strangulation and entrapment than falling out of bed if the rails weren’t attached, the release said.

Between 1985 and 2013, the Food and Drug Administration received 901 reports of patients getting “caught, trapped, entangled, or strangled,” in bed, according to the FDA website.

Bed rails on a bed.(Courtesy Sentara)
Bed rails on a bed.(Courtesy Sentara)

“The reports included 531 deaths, 151 nonfatal injuries, and 220 cases where staff needed to intervene to prevent injuries,” the website states. “Most patients were frail, elderly or confused.”

The order to remove or render inoperable bed rails in long-term care facilities was put in place Nov. 28, 2016, but became effective one year later.

Both the federal government and Varnes consider bed rails a type of restraint against patient mobility.

“If a person can’t get it lowered it can confine them,” Varnes said of bed rails.

The new standards call for bed rails to be removed or rendered inoperable, unless every other preventive measure has been used, and a patient signs a consent form.

“Restraining patients has been a topic for years, we do not use restraints unless there’s a medical necessity,” said Peter Glagola, a spokesman for Riverside Health System.

Safer alternatives

While bedrails have been mostly phased out from long-term care facilities, staff training and simple devices are helping keep patients safe.

At Sentara, padded floor mats have been put down near some beds to reduce the impact of a fall, according to Dale Gauding, a spokesman for the company. Wedge shaped pillows can also be given to patients afraid of falling out of bed.

At Riverside facilities such as Patriot’s Colony and Warwick Forest, bed rails haven’t been removed, according to Glagola.

Instead, the bed rails have been made inoperable in case a doctor finds the devices are medically necessary, Glagola said.

A bed without rails. (Courtesy Sentara)
A bed without rails.
(Courtesy Sentara)

“We have a device that secures the bedrail down and unusable, but we’re not removing our bed rails,” Glagola said.

Other safety alternatives are lower a patient’s bed close to the floor or installing “weight-based alarms that sound when a patient gets up,” according to the Sentara release.

As regulations have changed, training for staff has changed as well.

“It’s a huge culture change, most of the staff in this industry have been here a long time,” Varnes said.

When a patient arrives at Sentara long-term care facilities, bed rails aren’t on the beds, according to Varnes.

The process to have bed rails installed for a patient is based on an assessment of the patient’s risk for injury. Then the patient needs to sign a consent form, have an updated physician order saying the rails are medically necessary, and have bed rails in their plan of care, Varnes said.

In the end though, the new federal regulations have been put in place to keep patients safer, according to Varnes.

“We want to make sure we do the right thing for our patients’ safety,” she said.

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