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Old 12-24-2010, 08:29 PM
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Default Safe In Bed?

March 10, 2010, 12:29 pm Safe in Bed?

By PAULA SPAN

Despite potential hazards, bed rails are still used in many nursing homes and assisted living facilities.

Early on Christmas morning in 2004, a staff member walked into Harry Griph Sr.’s room at the New Perspective assisted living facility in Brookfield, Wis., and found that Mr.Griph had died.

This was probably not a shocking development in itself. Mr. Griph, who was 75 and a retired phone company worker, was a hospice patient, given a diagnosis geriatricians call failure to thrive, a multifaceted decline that most commonly occurs toward the end of life. He had a do-not-resuscitate order.
But the way he died was unexpected. “He was found with his neck entrapped between the mattress or bed frame and the rail,” said Jeffrey Pitman, a lawyer in Milwaukee who represents Mr. Griph’s three children and his estate. “He was asphyxiated.”

The family’s lawsuit initially included the hospice organization, the manufacturer of the bed and the medical equipment vendor that supplied it; those three parties have settled with no admission of liability. The negligence suit against the facility continues, however, with a trial scheduled for August.

“New Perspective believes that it provided proper care to Mr. Griph,” said its lawyer, Marilyn Carroll, who said she was constrained from commenting further.

Mr. Pitman disagrees, of course. “Almost all health care providers as of 2004 were aware of the entrapment danger posed by bed rails, because an F.D.A. warning came out in 1995,” he said. “And the state of Wisconsin put out an alert about the dangers of bed rails in September 1999.”

True, Mr. Griph was already near death, he acknowledged. “But nobody at the end of life should have to die in this manner.”

Like a lot of people, I supposed that bed rails were a safety device, analogous to a seat belt in a car, meant to keep sick, drugged, confused or restless people from falling or climbing out of beds in hospitals and nursing homes. But as the geriatrician and bioethicist Steven Miles of the University of Minnesota has found — after years of reviewing cases of elderly people being injured or killed in bed rail accidents — the reality is different.
“Rails decrease your risk of falling by 10 to 15 percent, but they increase the risk of injury by about 20 percent because they change the geometry of the fall,” he explained in an interview. Confused or demented patients who try to climb over the rails, instead of falling from a lower level and landing on their knees or legs, are apt to fall farther and strike their heads.
But the greater danger is entrapment — patients getting stuck within the rails or between the rail and the mattress. By last year, the Food and Drug

Administration had tallied 480 deaths, 138 injuries and 185 close calls involving hospital beds over a 24-year period; Dr. Miles believes those statistics represent only a small fraction of the total accidents, which often go unreported.

In a typical case, Dr. Miles explained: “A person will roll into the slot next to the rail, and the mattress slides to the opposite side. That doubles the size of the gap. The patient drops into the gap, the mattress presses against his chest and he can’t breathe.” Asphyxiation can follow in minutes.
The F.D.A., bed manufacturers and hospital and nursing home administrators have known of such potential hazards for years, and in 2006 the F.D.A. issued guidelines to reduce them. In fact, bed rail use has dropped substantially, partly because of those guidelines but also because research has shown that they don’t benefit patients — and because of lawsuits by family members.

“Government sanctions cost a couple of thousand bucks,” Dr. Miles pointed out. “A lawsuit can cost $500,000 to a million; it gets much more attention.” (He’s scheduled to testify as an expert witness in the Griph case.)

At this point, based on Medicare surveys, he estimates that fewer than 10 percent of nursing home residents occupy beds with rails in use. But Ms. Carroll, the lawyer, said, “Bed rails are still used extensively today.” Either way, with roughly 1.4 million older people in nursing homes and rehabilitation centers, plus those in hospitals or using hospital-style beds at home, hundreds of thousands may still be at risk.

The ultimate solution would be to establish manufacturing standards so that no bed has a dangerous gap between mattress and rail, just as one can no longer buy a crib that could entrap an infant. “We value babies more than elderly nursing home patients,” Dr. Miles observed.

Meanwhile, here’s his straightforward counsel about how to distinguish a quality rehab facility or nursing home from an unsafe one: “Count off 10 beds. See how many have rails in use. If more than one or two in 10 beds have rails up, walk out of the facility.”

http://newoldage.blogs.nytimes.com/2...0/safe-in-bed/
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Old 12-24-2010, 11:18 PM
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I actually agree with this and EVERY TIME I see a patient with 4 rails up, I explain to the patient and the families that it is considered a restraint. What makes me even more mad is when the I have seen staff members do it. I take them down every time!
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Old 12-24-2010, 11:25 PM
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Then why are these old-fashioned beds being sold to home care pts???
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Old 12-24-2010, 11:39 PM
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I never knew that Tazzi....and to go with your thinking...why are the insurance companies paying for them?
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Old 12-24-2010, 11:51 PM
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Most are half-railed, but full rails can be requested.
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Old 12-25-2010, 12:09 AM
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Ours are half rails and are only put up at the top of the bed.

We never have all 4 rails up. We have mats on the floor also.
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Old 12-25-2010, 09:27 PM
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Quote:
Originally Posted by HhRNhhr View Post
Then why are these old-fashioned beds being sold to home care pts???

We order them only when families in the home ask for them. And at that we warn them about this. Our regular hospital beds come with or without partial rails ( half rails at the top ). Depends on the families needs/wishes. I am not a fan of side rails.

I saw one person break their leg tangled in those things a few years back. I'll never forget that scream.
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Old 12-25-2010, 11:53 PM
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All our local nursing homes around here do not have the rails up. They may have half rails up on occassion but due to the changes they should be left down.

For those patients that are prone to falling they will sometimes have the mattress on the floor! Although this is a killer for the staff to make.
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Old 12-26-2010, 06:49 PM
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you can definitely get MORE hurt going over the side rails.

I definitely like to see just the top rails used. We do have a fall risk bed available at our facility that has a gully in the center to make it harder to get out of bed.
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Old 12-26-2010, 08:21 PM
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A gully in the middle? That sounds like a great idea. If the distance between crib rails is now regulated, then the same should be true of any side rails that are used.
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