How to Manage the Risks of Patient Wandering

Patients living with dementia or Alzheimer’s can be prone to wandering. Unfamiliar environments like the hospital can increase the likelihood of wandering, which can create a challenge for hospitals to manage at-risk patients and ensure their safety at all times.

One of the biggest concerns for wandering patients in the hospital is falling, either when getting out of bed or when wandering. Exiting the hospital bed without nurse assistance can cause patients to trip or fall especially when experiencing altered perception at unfamiliar heights. Wandering through the hallways can lead to stumbling and tripping caused by weakness and disorientation. When patients fall, serious injury such as fractures, lacerations, or brain injuries can occur.

Most wandering prevention programs are put in place when a patient has been identified as a wandering risk. If a patient has not been diagnosed with dementia or Alzheimer’s, hospital staff may not realize immediately that the patient could be prone to wandering.

As a result, elderly patients should be screened for any signs of a memory problem or disorientation upon admission. This process can be similar to a fall risk assessment and should look for signs of memory loss or cognitive impairment. Since a patient’s condition can change throughout a patient’s stay, staff should continually observe patients for changes in functioning, mood, or awareness while simultaneously assessing fall risk.

If a patient’s mental condition changes, or if the patient has been assessed as a wandering risk upon admission, staff will need to ensure that there is regular supervision to minimize risk. Hospitals can use any combination of the following strategies to reduce wandering:

·         Sitters

·         Bed-exit alarms

·         Locating the patient’s room near the nurses’ station

·         Hourly nurse rounding

·         Watching for indications that the patient is trying to leave

Sitters can be a costly method to reduce patient wandering, but does employ constant supervision to eliminate wandering. A more cost-efficient solution would be to use a bed-exit alarm to monitor when a patient is exiting the hospital bed or showing signs of movement. When a patient is located close to the nurses’ station, staff can quickly respond and return the patient to bed or provide help if a patient requires toileting assistance.

Hourly nurse rounding can be used alongside a bed-exit alarm for regular supervision of wandering patients. Each hour, nurses can check in on patients and assess the patient’s condition and mental state. If a patient is confused and is asking about family members, this may indicate that a patient may be looking to leave the hospital bed to find his loved ones. When a patient is tying up shoes or putting on a coat, this is also an indication of wandering that should be addressed through intervention.

However, since patient wandering is not always entirely preventable by nurse intervention, staff should ensure that safety measures are put in place for when a patient wanders:

1.       Use a low hospital bed to reduce falls and injury when patients get out of bed unassisted

2.       Ensure patients are located far away from exits, stairs, and other hazards

3.       Outfit patients in appropriate footwear for safe wandering and slip/fall prevention

If a patient does leave the bed without nurse intervention, low hospital beds can provide a safe resting height that can minimize the risk of injury from trips and falls out of bed. Assuring that the patient is located far away from exits, stairs, and other dangerous areas can limit the adverse events that can occur when a patient wanders. Appropriate footwear should be worn by the patient at all times to minimize the risks of slips and falls.

Maintaining a safe environment for patients is the key to creating a wandering management and prevention program in your facility. Implementing the necessary steps to identify patients who are at-risk of wandering can prevent slips, trips, falls, or other adverse events that can occur when a patient wanders.

CHG Hospital Beds specializes in low hospital beds that are designed to prevent patient falls and related injuries within acute care environments. We are focused on patient and nurse safety and deliver innovative solutions to meet the needs of our customers.

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Noisy Hospitals = Patient and Staff Distress

Noisy Hospitals Cause Alarm Fatigue and Patient Distress

A recent study from the University of Chicago revealed that hospital noise is reaching 67 decibels in some environments, which is considerably higher than the World Health Organization’s (WHO) recommendation of 30 decibels in the patient room. Each year, the noise level in hospitals rises by an average of 0.35 decibels. An increasing number of devices are being hooked up to monitors every year, which is creating a sea of constant beeping and numerous patient safety concerns.

When the level of noise increases in the hospital because of high-pitched alarms, a patient’s sleep is more likely to be disturbed. The beeping of patient monitors has been found to be more disruptive to patients that the sounds of human voices or environmental noises like traffic.

Every hour of sleep that is lost can cause a patient’s blood pressure to rise by up to 6 points. Even if a patient’s sleep was not disturbed, high frequency noise can still cause a patient’s heart rate to rise. Hospital noise can also cause higher rates of heart disease, impaired immune function, and increased memory problems and depression in patients.

The effects of hospital noise can lead to other complications. Using sedatives to combat the effects of the sounds could create a higher risk of patient falls. If a patient experiences a fall, he could face an extended hospital stay, causing the patient to experience the noisy environment for even longer.

Nurses and Alarm Fatigue

Nurses experience the constant beeping and high-pitched noises of the hospital on an almost daily basis. The volume (both sound- and number-wise) of alarms has made it difficult for nurses to respond or assess which patients need immediate attention, if any at all. In fact, almost 95% of alarms are said to be alerting nurses to non-actionable events including false alarms.

Alarm fatigue is becoming a growing concern in the health care environment. Because so many devices are hooked up to alarms and the noise is so frequent, nurses are becoming desensitized to the sounds of monitoring alarms. Desensitization can lead to missed alerts or a delayed response in addressing the cause of the alarm, affecting a patient’s quality of care.

Reducing hospital noise is not just an issue of comfort, but an issue of safety for patients and staff. Considering only 5% of alarms are alerting nurses to actionable events, there is little evidence to suggest that alarms should be sounding off 24/7, except when triggering actionable alerts.

There are exceptions, however, as intensive care and cardiac care units require constant patient monitoring due to the delicate nature of the unit.

Patients at risk of falling or wandering also require the use of bed-exit alarms, and are in most instances, actionable. The best solution to minimizing alarm fatigue and the annoyance of bed-exit alarms is to implement an alarm that automatically resets when a patient repositions or gets back into bed.

By silencing and reinstating the alarm without nurse intervention, noise levels can be reduced and false alarms can be eliminated.

Curbing the noise level can help patients rest and recover in the hospital without fearing noise-related adverse effects like insomnia or heart complications. Nurses can benefit from a focused work environment without the distraction of unnecessary beeping and alarms. Reducing the noise level by limiting the number of alarms can help hospitals meet the 30 decibel range suggested by the WHO.

http://viewer.zmags.com/publication/cde0997d#/cde0997d/1

CHG Hospital Beds specializes in low hospital beds that are designed to prevent patient falls and related injuries within acute care environments. We are focused on patient and nurse safety and deliver innovative solutions to meet the needs of our customers.

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The 5 Major Causes of Patient Falls

The 5 Major Causes of Patient Falls

 

Patient falls don’t just happen because of intrinsic risk factors like chronic illness or previous fall history. Most often, patient falls are caused by a multitude of factors:

1.       Patients do not call for nurse assistance

Disoriented or confused patients may not realize they are in an unfamiliar environment and may not use the nurse call button when exiting the bed. Similarly, prideful patients may choose not to use nurse assistance and will try to get out of bed themselves, despite their abilities.

When patients overestimate their abilities and do not call for help, falls can occur. Weak or disoriented patients may not be able to get out of bed safely, or may stumble when walking. Nurse assistance can minimize the occurrence of falls by transferring the patient or offering other assistance when needed.

Bed-exit alarms should be used when patients refuse to call for nurse assistance.

2.       The bed-exit alarm is not set

Reinstating the bed-exit alarm on a hospital bed can be a forgotten task in a busy hospital unit. When a nurse or staff member does not initiate or reactivate an alarm once the patient has returned to bed or after receiving bedside care, patients can be exposed to risk.

Bed-exit alarms help alert staff to bed-exiting behaviour in fall-risk patients such as getting out of bed or moving positioning. Patients who are prone to wandering or who exit the bed for reasons like incontinence may choose to exit the bed without assistance, which can result in trips or falls out of the bed or when ambulatory. Bed-exit alarms also alert staff to rolling or unwanted movement towards the edge of the hospital bed, which can occur in limited mobility patients, and cause a patient to fall.

When a bed-exit alarm is not reset, a patient’s exit from bed or repositioning can go unnoticed and result in trips or falls. Preventative measures like bed-exit alarms can ensure that patients are assisted out of bed or are repositioned when they are too close to the edge of the hospital bed.

Bed-exit alarms that automatically restore settings should be used when monitoring patients.

3.       The patient is on high-risk medications

High-risk medications including sedatives and anti-depressants significantly increase a patient’s risk of falling. Dizziness, confusion, or impaired mobility can occur as a result of medication, and because of the numerous effects, patients on high-risk medications commonly experience falls.

Patients on high-risk medications should be assessed at the highest fall risk. Preventative measures include using adjustable low hospital beds, bed-exit alarms, and scheduled toileting can help reduce the occurrence of medicated patient falls.

4.       The patient assessment was inadequate

Sometimes a patient may not be assessed for fall risk on intake. In other instances, a patient may be assessed for a low fall risk, when in reality; a patient may be overestimating his ability or may be experiencing incontinence.

As a result, the patient may not be identified as a fall risk and does not benefit from the hospital’s preventative measures for patient falls. This increases the likelihood of falling, as the unidentified fall risk patient is not placed in a low hospital bed, not given non-slip footwear, nor is he moved closer to the nurses station for toileting assistance – common preventative measures for fall risk patients.

As a preventative measure, low hospital beds are recommended for use with all acute care patients to minimize falls and fall injury. Fall risk assessment should be routinely performed in order to address changes in a patient’s condition throughout the patient care.

5.       There was a delayed response to the nurse call bell

Incontinent or agitated patients may not be willing to wait for a nurse’s response to the call bell. Instead, these patients may attempt to leave the bed, wander, or use the bathroom unassisted. Much like the patients who refuse to use nurse call assistance, these impatient patients are at a greater risk of falls because they are unassisted when exiting the hospital bed.

Highly agitated or incontinent patients should be moved to closer to the nurses’ station in order to minimize the wait time for nurse assistance. Bed-exit alarms should also be used to alert nurses to patients exiting the bed.

http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2012/Jun;9(2)/Pages/37.aspx

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CHG Hospital Beds specializes in low hospital beds that are designed to prevent patient falls and related injuries within acute care environments. We are focused on patient and nurse safety and deliver innovative solutions to meet the needs of our customers.

The Evolution of the Low Hospital Bed

The Evolution of the Low Hospital Bed

Today’s low hospital beds offer patients comfort and peace of mind, while providing a safe working environment for nurses and staff. But it wasn’t always this way…

The low bed movement sprang up in response to the increase in the number of patient falls from bed in various health care environments. Patients who fall from bed often experience a decreased quality of life as a result of injury and trauma. Treatment for injuries from patient falls can be lengthy and costly, and are often at the facility’s expense.

Long-term care facilities, the pioneers of the low bed movement, saw that the height of the bed itself was an important variable in patient falls. Patients often did not feel secure when sleeping and could not easily get in and out of beds that were too high, which resulted in falls from the bed. The lowest position of regular hospital beds and long-term care beds ranged from 18-22” in height, which was much higher than what a patient was used to at home. Elderly, confused, and medicated patients were much more likely to fall and get seriously injured at these heights.

The first solution to patient falls from bed was to place the mattress on the floor. Though the mattress did effectively reduce falls and patient injuries, mattresses on the floor raised concerns for infection control, staff safety, and quality of life for patients.

Recognizing that using a mattress on the floor was not a sustainable solution for patient falls, nursing home equipment manufacturers set out to create the low bed, and so began the low bed movement.

Years later, after the success of low beds in long-term care facilities, CHG Hospital Beds launched the world’s first low hospital bed.

The Evolution of the Low Hospital Bed

Nursing Home Beds
Fixed Low Height Bed (Echo)	·         The answer to long-term care facilities’ low bed needs ·         Replaced the mattress on the floor ·         The fixed height was still much too low for nurses to safely transfer patients
Solo	·         North America’s first electric low bed, introduced in 1997 ·         Allowed fall-prone patients to rest at a safe height of 7.5” ·         Nurses and staff were able to raise the bed to a working height of up to 25” to reduce back strain ·         Only mobile at its lowest height, which still caused staff injuries
Arro	·         Replaced the Solo as North America’s lowest bed with a low height of 6.75” in 2000 ·         Rose to as high as 33” and was built with staff safety in mind ·         Now mobile in any position ·         Introduced hospital-like advanced features to low beds, including Trendelenberg and footboard staff control panels
Hospital Beds
Spirit	·         First low hospital bed, introduced in 2003 ·         Offered all the same features as traditional hospital beds, but with the added benefit of a low height of 8.75” from the floor ·         Featured a 15-function staff control panel and a central braking and steering pedals for nurse safety ·         Ideal for patients at risk of falls ·         Can be used as a traditional bed in regular acute care patient rooms
Spirit Plus	·         First med-surg low hospital bed, introduced in 2005 ·         Features the same low height as the Spirit, at 8.75” low ·         Exceeds the features of traditional hospital beds with embedded anti-bacterial properties, auto-contour and chair positioning and more ·         Passes all FDA entrapment guidelines
Spirit Select	·         The most advanced med-surg low hospital bed on the market, launched in 2008 ·         Height range from 10” to 35” ·         Offers the same features of the Spirit Plus and more ·         Features an integrated scale, Watchdog Monitoring System, and multi-zone bed-exit alarm ·         Central lock-and-steer system for safe patient handling

 

Low hospital beds have come a long way from the mattress on the floor. With a focus on patient and staff safety, low hospital beds will continue to innovate and evolve, forever changing the way health care facilities address falls

CHG Hospital Beds specializes in low hospital beds that are designed to prevent patient falls and related injuries within acute care environments. We are focused on patient and nurse safety and deliver innovative solutions to meet the needs of our customers.

5 More Reasons to Use a Low Hospital Bed

With patient safety concerns at an all-time high, it may be time to think about using low hospital beds in your facility. We’ve already shared 5 Reasons to Use a Low Hospital Bed, but here are 5 more: 

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5 Reasons to Use a Low Hospital Bed

When it's time to purchase new hospital beds for your facility, consider a low hospital bed. Specifically designed with patient safety and comfort in mind and recommended by leading health care groups, low hospital beds can be a valuable component of your hospital's fall prevention strategies.

Here are 5 reasons why your facility should use low hospital beds:

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Understanding Bed-Exit Alarms

Most hospital bed falls occur when a patient enters or exits the bed without staff assistance. Many fall risk patients forget to use the nurse call button and overestimate their physical abilities, which can lead to a fall or trip out of bed. Maintaining constant patient supervision to eliminate this unassisted movement can prove to be a costly effort for hospitals, as the cost of around the clock sitters adds up.

To combat the high cost of patient sitters, bed-exit alarms were introduced to detect bed activity and to minimize the number of bed exits without staff assistance. Instead of using a sitter to observe patient movement, the bed-exit alarm was designed to alert the nurses’ station to bed exit activity based on a change in patient positioning. A nurse’s response to the alarm would enable her to reposition, or assist the patient out of bed, which would minimize the possibility of a fall.

A nurse using a bed-exit alarm

The use of a bed-exit alarm is recommended for use with patients with stability issues, on medication, with cognitive impairment, or with any patient identified as a fall risk. Bed-exit alarms can help prevent falls by alerting nurses to bed exit behaviour that is attributed to patient falls, and is recommended as an integral component of a hospital’s patient fall prevention program.

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