1 long Term care Highlights north dakota department of health Division of health Facilities April 2009. Yes, You Can Use Side Rails. But .. Joyce Johnson, RN. health Facilities Surveyor Many skilled nursing facilities have chosen to party regarding the risks versus benefits of side rail become restraint free, but continue to use side rails use. Attempts should be made to use the least for various reasons, such as allowing the resident to restrictive device necessary to meet the resident's maintain independence in bed mobility. Side rails needs. Immediately reassess the safety if an episode pose a significant risk for entrapment, and care must of entrapment or near entrapment occurs, with or be taken to ensure resident safety.
2 The potential for without injury. injury is greater when a fall occurs from a bed with elevated side rails when the resident attempts to In the past 21 years, the US Food and Drug climb over, around or between the rails, than from a Administration (FDA) received 691 entrapment bed without side rails. reports, 413 of which resulted in death. Entrapment is most likely to occur with a frail, elderly resident. Many factors need to be considered before making Residents may attempt to exit the bed due to confusion, pain, hunger, thirst and/or the need for the decision to use side rails. The process starts with repositioning or toileting. assessment. Use of side rails should be based on the resident's medical needs and be reassessed on a The FDA has identified zones that present a risk for regular basis and with any change in condition.
3 All entrapment. The FDA provides dimensional side rails, including those used to aid mobility, recommendations for zones 1 through 4 since 80. percent of entrapment cases have occurred in these transferring, and repositioning, should be addressed areas. on the resident's care plan. Documentation should (Continued on Page 2). include education of the resident or responsible INSIDE THIS ISSUE: You Can Use Side Rails Page 1, 2. Transfers-Moving Experience Page 3-5. Abuse/Neglect Allegation Page 5. RAI Update Page 6. CAN Update Page 6. 1. long Term care Highlights April 2009. (Continued from page 1). Zone 1: Within the rail any open space Creating a safe resident environment does not between the perimeters of the rail can present a necessarily rule out the use of side rails.
4 The risk for head entrapment. Recommended space: decision to use side rails should be based on less than 4 inches. assessment and identification of the resident's needs and include a risk versus benefit analysis. Zone 2: Under the rail, between rail supports, or Detailed information regarding entrapment, next to a single rail support the gap under the resident assessment, care planning, and assessing rail between the mattress and the bottom edge of facility beds may be found at: the rail may allow for head entrapment. beds/ Recommended space: less than 4 inches. Note: Side rails may also be considered a Zone 3: Between the rail and the mattress if restraint. In that case, follow your facility policy too large it can create a risk for head entrapment.
5 For restraint use. Recommended space: less than 4 inches. References: Zone 4: Under the rail at the ends of the bed a US Food and Drug Administration Website for Medical gap between the mattress and the lower portion Device Safety: of the rail poses a risk of neck entrapment. Direct Supply, Beds & Entrapment: What You Need to Recommended space: less than 2 3/8 inches. Know to Reduce Your Risk Zone 5: Between split rails when partial or split rails are used on the same side of the bed, the space between the rails may present a risk for neck or chest entrapment. Zone 6: Between the end of the rail and the side edge of the head or footboard a gap between the end of the rail and the side edge of the head or footboard can present the risk of resident entrapment.
6 Zone 7: Between the head or footboard and the end of the mattress when there is too large of a space between the inside surface of the head or foot board and the end of the mattress, risk of head entrapment increases. 2. long Term care Highlights April 2009. TRANSFERS, A MOVING. EXPERIENCE. Ken Gieser, health Facilities Surveyor During the calendar year 2008, the north dakota The goal of resident transfers in long term care department of health , Division of health facilities is generally to move the resident from Facilities, cited long term care facility one surface to another to accomplish a resident deficiencies at F323 on 32 occasions. Of those, care task in an efficient manner that is safe for the nine ( ) were related to improper transfers or resident and staff.
7 A variety of methods, improper use of portable total body sling lifts, techniques and equipment may be used. sit-to-stand lifts, or transfer and gait belts, which Mechanical assistive devices for transfer may resulted in actual harm or placed residents at risk include portable total body sling lifts, sit-to-stand of actual harm. lifts, and transfer or gait belts. This article will provide a brief overview of the The assistive devices and equipment can help use of these assistive devices and key points in residents move with increased independence, their use. Key points with any of these devices are transfer with greater comfort, and feel more RESIDENT ASSESSMENT for the most physically secure. Training of staff and residents appropriate use and STAFF EDUCATION in the on the proper use of assistive devices, equipment, equipment use.
8 And safe transfer techniques is important to prevent accidents and TOTAL BODY SLING LIFTS. A variety of manufacturers are The State Operations Manual, Appendix PP, at available. The sling is placed F323, states The facility must ensure that (1) the under the resident while in bed resident environment remains as free from or in a sitting position. The sling accident hazards as is possible; and (2) each is attached to the lift resident receives adequate supervision and apparatus. Key points include: assistance devices to prevent accidents. The Sling size appropriate to the intent of this requirement is to ensure the facility resident. provides an environment that is free from Resident properly accident hazards over which the facility has positioned in the sling.
9 Control and provides supervision and assistive Securely fastened sling attachments to the lift devices to each resident to prevent avoidable apparatus. accidents.. 1 Appropriate numbers of staff for the resident's needs. Avoid using the lift as a transport device. Documented preventive maintenance of the sling and lift according to manufacturer's recommendations. (Continued on page 4). 3. long Term care Highlights April 2009. (Continued from page 3). Securely fastened sling attachments to the lift SIT-TO-STAND LIFTS apparatus. A variety of manufacturers Appropriate numbers of staff for the are available. The resident resident's needs. must bear weight on at least Avoid using the lift as a transport device. one lower extremity.
10 If weight Documented preventive maintenance of the bearing is restricted on the sling and lift according to manufacturer's remaining extremity, an recommendations. approach must be developed, care planned, and FOLLOWED to accommodate GAIT OR TRANSFER BELTS. this restriction. The resident's feet are placed on a A variety of styles, foot plate or platform and the resident's knees manufacturers and suppliers placed against a padded knee board. The resident are available. The belts are grasps a set of handle bars and a sling apparatus is generally of heavy web placed around the upper back and under the construction with a buckle or resident's arms and attached to the lift. The lift quick-releasing attachment. apparatus lifts the sling, bringing the resident to a The belts are used to assist partial standing position, and the resident is residents for standing transfers and during wheeled to a wheelchair, commode, toilet, bed or ambulation.