Avoiding Entrapment: A Four-Point Plan for Resident Safety in Long-Term Care
- Bilquis Ali
- Oct 24, 2024
- 3 min read
I received a message from one of my new Directors of Nursing, who recently started at a facility a few weeks ago.
When I opened it, I knew I had to stop everything and call her immediately.
I could sense the severity of the situation.
She needed to be aware, and more importantly, she needed to know that I’d be there to support her through it.
What happened?
One of her residents had become trapped between the bed and the side rail.
Thankfully, the resident was able to call out for help and get the assistance needed to stay safe.
How Did This Happen?
The bed was provided by hospice, meaning there were multiple sources involved, but rather than play the blame game, let’s focus on what we can do to prevent this from happening again.
First, let’s define some key terms.
What Are Bed Rails?
Per 483.25(n), bed rails are adjustable metal or rigid plastic bars that attach to the bed.
What Is Entrapment?
Entrapment is when a resident becomes caught, trapped, or entangled in the space around the bed rail. This is exactly what happened to the resident, and it could have been fatal.
Bed Rails: Bed rails should only be used as a last resort, after every possible alternative has been explored and deemed inappropriate. But it’s not enough to just say alternatives were tried—you must clearly document:
What those interventions were.
Why they weren’t effective or appropriate for the resident.
For example, you might consider alternatives like:
Lowering the bed.
Using positioning aids.
Providing increased supervision.
Implementing fall mats.
Each of these interventions should be documented in detail, along with why they were not suitable for the resident’s needs.
Only after exhausting all other options should bed rails be considered, and even then, all the necessary paperwork and consents must be in place.
After we unpacked everything, I encouraged the Director of Nursing to initiate a Four -Point Plan.
A four-point plan is a structured approach to solving a problem or addressing a deficiency.
It typically involves four key components that work together to identify, correct, and prevent issues from recurring.
This format is often used in healthcare and management settings when developing a Plan of Correction or addressing regulatory issues.
A Four-Point Plan to Prevent Entrapment Incidents (Example)
Identification of the Problem: In this case, the resident became trapped between the bed and side rail. This prompts a facility-wide investigation into the use of bed rails.
Immediate Corrective Action: The resident was quickly assisted and made safe. All bed rails in the facility were inspected to ensure they were properly installed and safe for use. Unsafe bed rails were removed or adjusted immediately.
Preventative Measures: Policies and procedures were updated to reflect that bed rails should only be used as a last resort. The facility also established a requirement for maintenance to perform monthly inspections of bed rails to ensure continued safety.
Staff Education: All staff were retrained on the proper use of bed rails, alternatives to bed rails, and the documentation required when considering their use. Education ensures that everyone understands the seriousness of entrapment and their role in preventing it.
Rounding: The Key to Prevention.
Yes, I know—here I go again about rounding. But high-risk residents are your VIPs, and you need to round on them daily. I challenge you to take a look at your facility:
Who has bed rails?
Should they have them?
Best Practices
Make it a habit to remove bed rails immediately after a resident is discharged.
Do not place a resident in a bed with rails until all documentation has been completed and the bed has been evaluated by maintenance.
Review at care plan meetings.
Review when noted when significant change in condition.
I highly encourage you to review F-700 if you haven't. It dives into a lot of information. Use this as encouragement to get started!
Here are links to assist you!
Want to learn more? Join my Thrivng Director of Nursing Community!!
コメント