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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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.

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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The Risk Factors Associated with Patient Falls

Patient falls are one of the most frequent and costly hospital acquired conditions in the United States. Beyond the fall itself, hospitals are concerned about adverse events and injuries caused by a patient falling out of bed. These risks and injuries can include bruising, fractures, dislocations, brain injuries, a decline in overall health, and in some instances, death.¹

Patient falls can be one of the most challenging hospital incidents for healthcare providers to approach because of the varying risk factors and circumstances that contribute to each fall.

Who is at Risk for a Fall?

The National Center for Patient Safety has identified a number of physiological and internal risk factors that contribute to a patient’s risk of hospital falls including:²

1. Age
2. Chronic Disease
3. Visual Impairment
4. A Previous Fall
5.  Medication
6. 
   

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