How to keep a patient from getting out of bed? A Comprehensive Guide

According to the CDC, over 36 million older adults fall each year, with falls from beds being a significant risk. For caregivers, understanding how to keep a patient from getting out of bed is a crucial aspect of patient safety and fall prevention.

Quick Summary

Preventing a patient from getting out of bed requires a multi-faceted approach, focusing on understanding the patient's needs, creating a safe environment with appropriate aids and technology, and addressing underlying reasons for mobility, rather than resorting to restrictive measures.

Key Points

• Address Underlying Causes: Identify and address the root cause of why the patient is trying to get out of bed, such as pain, confusion, or needing the toilet.

• Modify the Environment: Lower the bed, use cushioned floor mats, and install motion-activated nightlights to minimize fall risks and injury.

• Use Non-Invasive Technology: Implement bed alarms or pressure-sensitive pads to alert caregivers immediately when a patient attempts to leave the bed.

• Prioritize Ethical Care: Avoid physical restraints, which carry significant risks and ethical concerns. Focus on patient dignity and safety through less restrictive means.

• Proactively Manage Needs: Stick to a consistent daily routine, offer scheduled toileting, and keep necessities within easy reach to prevent urgent, unsafe attempts to get out of bed.

• Communicate and Engage: Involve the patient and family in safety discussions and provide daytime engagement to reduce nighttime restlessness and anxiety.

Understanding the Root Cause of Leaving the Bed

Before implementing any intervention, it is vital to understand why a patient is attempting to leave their bed. Identifying the root cause allows for a more targeted and compassionate care plan. Leaving the bed can be a sign of discomfort, confusion, or a basic human need. Common reasons include:

• Confusion or disorientation: Conditions like dementia or delirium can cause patients to forget where they are or what time it is, leading them to believe they need to be somewhere else.
• Sundowning: Patients with dementia may experience increased agitation and confusion in the late afternoon and evening, increasing the likelihood of attempting to get out of bed.
• Pain: Patients may attempt to move to a more comfortable position to alleviate pain, or believe standing will help.
• Basic needs: A full bladder or thirst can motivate a patient to seek a restroom or drink of water, even if they are disoriented or unsteady.
• Restlessness and anxiety: A lack of activity during the day can cause restlessness at night. Anxiety can also trigger a feeling of needing to escape or wander.
• Medication side effects: Some medications can increase confusion or dizziness, making attempts to get out of bed more dangerous.

Non-Restrictive Strategies and Environmental Modifications

Physical restraints should be avoided as they pose significant risks, including injury, agitation, and ethical concerns. Instead, focus on creating a safer, more comfortable environment and addressing the patient's needs proactively.

Creating a Safer Bed and Bedroom

• Lower the bed: Using a low-profile hospital bed or adjusting a standard bed to its lowest setting reduces the distance to the floor, minimizing injury risk if a fall occurs.
• Place fall mats: Cushioned, non-slip mats on the floor beside the bed provide a soft landing surface in case of an accidental fall.
• Improve lighting: Use motion-activated nightlights to illuminate the path from the bed to the bathroom. Adequate lighting helps reduce disorientation and prevents trips over obstacles.
• Clear pathways: Remove clutter, loose cords, and throw rugs from the bedroom to create a clear, safe path for movement.
• Ensure comfort: Check that the patient's bedding is comfortable and not too warm or cold. A supportive mattress can help with pain and restlessness.

Managing Needs Proactively

• Scheduled toileting: Offering regular, scheduled trips to the bathroom can help prevent the patient from trying to get up urgently on their own.
• Easy access to necessities: Keep a bell, water, tissues, and other essential items within easy reach on a bedside table to prevent the patient from stretching or reaching unsafely.
• Daily engagement: Engage the patient in activities during the day to help with sleep patterns. A consistent daily schedule can also reduce confusion.
• Calming interventions: For patients with sundowning or anxiety, try calming music, a warm drink, or gentle massage before bed.

Assistive Devices and Technology

Technology offers effective, non-invasive ways to monitor and protect patients at risk of falling.

Comparing Bed Safety Solutions

Solution	Pros	Cons	Best For
Bed Alarms	Alerts caregivers immediately; can be pressure-sensitive or motion-activated; many are wireless.	Can be startling for some patients; requires consistent caregiver response.	Patients at moderate risk who need non-invasive monitoring.
Pressure-Sensitive Mats	Placed on the floor; activates an alarm when a patient's weight is detected; discreet.	May not detect movement before the patient is fully standing; can be a tripping hazard if not secured.	High-risk patients who might wander and need early warning.
Bed Wedges and Bumpers	Create a physical barrier to prevent accidental rolling out of bed; soft and non-threatening.	Does not prevent determined patients from climbing over; limited use for those who actively try to leave.	Patients who are only at risk of rolling out of bed while asleep.
Adjustable Hospital Beds	Allows for low height settings; can raise head/foot sections for comfort and ease of movement.	Can be expensive; requires specialized training to operate correctly.	Patients with complex mobility needs or those requiring frequent repositioning.

Leveraging Monitoring Systems

Bed alarms and pressure sensor pads are excellent tools for proactive monitoring. The alarm system alerts caregivers when a patient attempts to sit up or get out of bed. For patients with hearing impairments, visual alarms can be used. When choosing a system, consider wireless options that can transmit an alert to a pager or mobile device, allowing caregivers more flexibility while ensuring prompt response. Regular testing of these devices is crucial to ensure they are functioning correctly.

Ethical Considerations and Communication

The use of physical restraints to keep a patient in bed is highly discouraged by healthcare professionals and regulatory bodies. The FDA provides clear guidance on bed safety, emphasizing patient autonomy and dignity over restraint. Physical restraints can lead to agitation, injury, and a decline in a patient's mental and physical well-being. Always prioritize less restrictive, non-physical alternatives.

• Involve the patient: If possible, include the patient in discussions about their care. Acknowledge their concerns and fears about falling, and explain the safety measures being put in place.
• Communicate with family: Ensure family members are aware of the care plan and the risks of using restraints. Educate them on the benefits of non-restrictive alternatives.
• Document everything: Keep a detailed record of the patient's behavior, what interventions were tried, and the outcomes. This documentation is essential for care planning and legal protection. For more information, the U.S. Food and Drug Administration provides a guide on bed safety that is a valuable resource for caregivers and families, found here: FDA Guide to Bed Safety.

Conclusion

Ensuring a patient's safety in bed requires patience, observation, and a comprehensive approach. By understanding the reasons for leaving the bed, implementing environmental modifications, leveraging appropriate technology, and prioritizing ethical, non-restrictive care, caregivers can significantly reduce the risk of falls and promote a patient's well-being. Regular communication and reassessment of the patient's needs are key to providing the safest, most compassionate care possible.

Frequently Asked Questions

What are common reasons a patient tries to get out of bed?

Patients often try to get out of bed due to pain, confusion (especially in cases of dementia or delirium), anxiety, restlessness, or basic needs like needing to use the restroom. Understanding the motivation is key to finding the right solution.

Are bed rails a safe option to prevent a patient from getting out of bed?

Bed rails can be hazardous, particularly for confused or agitated patients, who may attempt to climb over them and fall from a greater height, or become entrapped. Safer alternatives like low beds with fall mats and bed alarms are often recommended.

How can I use bed alarms effectively?

To use bed alarms effectively, place the pressure-sensitive pad correctly under the patient and test it regularly. A well-placed bed alarm alerts caregivers immediately when movement is detected, allowing for a quick, proactive response before a fall can occur.

How can environmental changes help with patient bed safety?

Environmental changes can significantly improve bed safety. Lowering the bed height, using soft floor mats, ensuring a clear path to the bathroom, and using motion-activated nightlights can all help prevent falls and reduce the risk of injury if a fall does happen.

What is 'sundowning' and how does it relate to getting out of bed?

Sundowning is a phenomenon where individuals with dementia experience increased confusion, anxiety, and agitation in the late afternoon and evening. This can lead to restlessness and a greater desire to get out of bed during the night.

What should I do if a patient with dementia is trying to get out of bed at night?

For a patient with dementia, focus on calming techniques. Try redirection by offering a warm drink, playing soothing music, or simply providing gentle reassurance. Maintaining a consistent routine during the day can also help improve nighttime sleep and reduce wandering.

What are some ethical considerations regarding keeping a patient in bed?

Ethical considerations revolve around patient autonomy and safety. The use of physical restraints is highly controversial and often harmful. Caregivers should always prioritize less restrictive measures that maintain the patient's dignity and well-being, only considering restraints under strict medical guidance.