How do you protect a resident on the bed from falling?

According to the Centers for Disease Control and Prevention (CDC), falls are a leading cause of injury among older adults. For a resident with mobility issues, preventing falls from bed is a critical safety concern. This guide outlines comprehensive strategies to help protect a resident on the bed from falling, ensuring peace of mind for both caregivers and residents.

Quick Summary

To prevent a bedridden resident from falling, utilize safety measures like low beds, cushioned floor mats, bed alarms, and bed rails, while also implementing consistent care routines and environmental modifications.

Key Points

• Low Beds: Using adjustable or ultra-low beds can minimize the distance and severity of a fall should one occur.

• Fall Mats: Placing cushioned mats with beveled edges on the floor beside the bed provides a safe, soft landing surface.

• Bed Alarms: Pressure-sensitive alarms can notify caregivers immediately when a resident attempts to exit the bed unassisted.

• Environmental Control: Ensure the resident's room is free of clutter, well-lit, and that the bed height is appropriate for safe transfers.

• Consistent Routines: Implementing toileting schedules, performing regular check-ins, and encouraging slow position changes can reduce fall incidents.

• Assistive Devices: Simple assist rails, trapeze bars, or grab handles can provide stability and support during transfers.

Understanding the Risks of Bed Falls

Protecting a resident from falling starts with understanding the contributing factors. Falls from bed can be caused by a variety of issues, often a combination of factors related to the resident's physical condition, cognitive state, and environment.

Resident-Specific Risk Factors

• Mobility Impairment: Weak muscles, poor balance, or difficulty with transfers can increase the risk of an unsteady exit from bed.
• Medication Side Effects: Certain medications can cause dizziness, drowsiness, or affect balance. A medication review is often a key step in a fall prevention plan.
• Cognitive Decline: Residents with dementia or other cognitive impairments may become disoriented, especially at night, and attempt to get out of bed without assistance.
• Chronic Conditions: Health issues like Parkinson's disease, arthritis, or neurological disorders can affect a resident's movement and increase fall risk.
• Incontinence: The urgent need to use the bathroom, particularly at night, can cause a resident to rush and fall.

Environmental Hazards

• Poor Lighting: Dark rooms and hallways make it difficult for residents to see obstacles.
• Cluttered Pathways: Loose cords, misplaced furniture, or throw rugs can create tripping hazards.
• Improper Bed Height: A bed that is too high or too low can make transferring in and out unsafe for the resident.

Creating a Safe Sleep Environment

Modifying the bedroom environment is a proactive step in preventing bed falls.

• Strategic Bed Placement: Positioning the bed against a wall can eliminate one side as a fall risk. Ensure there is no gap between the bed and wall where a resident could get trapped.
• Clear Pathways: Remove any unnecessary furniture, clutter, or decorative throw rugs from the floor. Secure all electrical cords to the wall or use cord covers to prevent tripping.
• Optimal Lighting: Install motion-sensor nightlights along the path to the bathroom. A lamp with an easy-to-reach switch should be placed on the bedside table.

Bed Equipment and Assistive Devices

Leveraging the right equipment is crucial for protecting a resident on the bed from falling.

1. Low Beds: Consider a low or ultra-low hospital bed. These beds can be lowered to just a few inches from the floor for sleeping and raised to a safe height for transfers during the day. The reduced fall distance significantly lessens the risk of injury.
2. Fall Mats: Cushioned mats placed on the floor next to the bed can absorb the impact of a fall, providing a softer landing and minimizing injury. Ensure the mats have beveled edges to prevent tripping when walking on them.
3. Bed Exit Alarms: These devices utilize a pressure-sensitive pad on or next to the bed that triggers an alarm when a resident's weight is no longer detected, alerting caregivers immediately.
4. Assisted Transfer Devices: For residents who need help getting in and out of bed, devices like assist rails, trapeze bars, or stand assist poles can provide crucial support. Ensure they are correctly installed and don't pose an entrapment risk.
5. Cushioned Bed Edges: For residents who tend to roll toward the edge, placing pool noodles or special wedge pillows under the fitted sheet can create a soft barrier. This provides a tactile reminder of the bed's edge without being restrictive.

Consistent Caregiving Routines and Monitoring

Procedures and vigilance are equally important in preventing falls.

Daily and Nightly Protocols

• Encourage Slow Transitions: Remind residents to sit on the edge of the bed for a moment before standing. This allows their blood pressure to stabilize, reducing dizziness.
• Regular Checks: Conduct frequent, scheduled check-ins, especially at night. For residents with cognitive impairment, more frequent checks are recommended.
• Toileting Schedules: Establishing a regular toileting schedule can help reduce the urgency that leads to rushing and falls. A bedside commode can also be beneficial.
• Comfortable Footwear: Ensure the resident wears non-slip footwear, such as rubber-soled slippers, when out of bed.

Comparison of Bed Safety Devices

Feature	Low Bed	Fall Mat	Bed Exit Alarm
Primary Function	Reduces fall distance to minimize injury.	Cushions impact of a fall.	Alerts caregivers of an exit.
Pros	Reduces fall severity, can be adjusted for transfers, promotes independence.	Reduces injury risk on impact, can be used with any bed.	Immediate notification for prompt response, non-restraining.
Cons	Higher initial cost, can still require effort to get up from lowest setting.	Can be a trip hazard if not properly stored during the day.	Cannot prevent the fall itself, may be unsettling for some residents.
Best for	Residents with a high fall risk, particularly those who attempt to get up unassisted.	Residents who are likely to fall, providing a protective landing area.	Residents who may wander or attempt to get out of bed without help.

Engaging the Resident in Their Own Safety

Involving the resident in the fall prevention plan respects their autonomy and can improve compliance. Discuss the safety measures with them, explaining the purpose of each device. Ask for their feedback on what feels comfortable and dignified. Ensuring they are comfortable in their bed and with the safety measures can reduce anxiety and encourage cooperation.

For more detailed information and resources on maintaining health and safety as you age, including fall prevention, you can visit the Centers for Disease Control and Prevention's Healthy Aging site.

Conclusion

Protecting a resident on the bed from falling requires a multi-faceted approach that addresses both physical and environmental risks. By implementing a combination of safety equipment like low beds and fall mats, consistent caregiving routines, and thoughtful environmental modifications, caregivers can create a significantly safer living space. This proactive strategy not only minimizes the risk of falls and injury but also promotes a sense of security and well-being for the resident, allowing for a safer and more independent quality of life.

Frequently Asked Questions

Are bed rails a recommended fall prevention method?

Bed rails can be effective but carry a risk of entrapment and can be seen as a restraint. Modern best practices often favor alternatives like low beds, sensor alarms, or cushioned barriers, and any rail use should be carefully evaluated for risk.

What is the correct bed height for a resident?

The bed should be set at a height that allows the resident to sit on the edge with their feet flat on the floor and knees at a 90-degree angle. This ensures safer entry and exit.

How can I make the floor safer around the bed?

Remove all clutter, secure cords, and use cushioned fall mats with beveled edges. Avoid throw rugs or use non-slip backings, and ensure the path to the bathroom is clear.

Can medication affect a resident's fall risk?

Yes. Some medications can cause dizziness or drowsiness, increasing the risk of a fall. It's important to have regular medication reviews with a healthcare provider to assess for these side effects.

What is a bed exit alarm?

A bed exit alarm is a sensor placed on or near the bed that alerts a caregiver when a resident begins to get up. It can be a simple pressure pad or a more advanced motion sensor system.

How do I prevent a resident from rolling off the bed?

You can use soft, padded side bumpers or wedge pillows under the fitted sheet. Low-tech options include tucking pool noodles under the sheet to create a soft, gentle barrier.

Should I use a bedside commode to prevent night-time falls?

A bedside commode can be a highly effective strategy to reduce night-time falls. It shortens the distance a resident must travel, which is especially beneficial for those who are unsteady or cognitively impaired.