Why do patients fall from the bed and what can you do to address the problem?

When we think about patient falls from the bed, we tend to assume that this happens while they are asleep.  But when you think logically about it, all of us are trained from an early age to not roll out of the bed at night. This is reinforced every time we go to bed.  When was the last time that you rolled off the edge of the bed while you were asleep?

Unfortunately, most medical mattress manufacturers have tackled this problem incorrectly, because they have not fully understood why the patients are falling.

Sure, with altered perception, reduced ability to reposition, confusion and other complications, some patients may fall while sleeping, but most of the time, falls occur when a patient is awake and consciously trying to get out of the bed. This is exacerbated when they are confused, when they try to get out by themselves, when it is dark and disorienting, when they need to get to the bathroom quickly, or if assistance is not available and they try to get out by themselves. Sometimes, they are just plain uncomfortable, and want to get out of their bed! This is what makes them a fall risk.

Ask any OT or PT about gaining standing balance when exiting the bed, and they will all tell you that you first need to have your sitting balance…

According to CMS, the state operations manual will now classify bed and chair alarms or any position change alarms that make an audible sounds as a RESTRAINT. We feel it’s important to focus on ways to prevent residents from rolling-out and to safely exit a mattress or chair when care staff are not available to monitor or help them.

According to the Agency for Healthcare Research and Quality there are 1.6 million LTC resident-falls annually, with more than one third of those resulting in injury. The “transportable falls” that result in admission to the ER (or worse) are considered “never events” and are not funded by Medicare or Medicaid, so facilities have to foot the cost of these falls directly from their bottom line.

For several years now support surface manufacturers have tried to address fall prevention by building raised perimeters…whether with air or foam, but it stands to reason that if a patient is consciously trying to exit the bed normally, then raised perimeters may present a challenge for the patient to successfully negotiate in safety.

Ask any OT or PT about gaining standing balance when exiting the bed, and they will all tell you that you first need to have your sitting balance…whether you are using a walking frame or not, and whether you are being assisted or not. This may not possible when there are raised bolsters in the way, even when there is an egress area, as the patient may not align themselves with that space. Air bolsters may be too soft to allow for stable sitting balance.

At Immersus, we took this problem to the drawing board when we designed the Immersus mattress, and we incorporated transfer safety edges to the mattress design, which are a 3” wide firm rail, not raised, but special foam that is firm and stable enough for a patient to get their sitting balance on before they try to stand.

Then we established that the edges and overall mattress design would achieve our goal of preventing falls, by performing a 44-patient study with end-of-life patients, some of whom were noted to be frequent fallers, and were at high risk of repeat falls.

no falls occurred during the course of the study…

Patients and Caregivers ranked the pretrial and trial surface performance for overall immersion, support while sitting without bottoming out or hammocking, and heel offloading as evidenced by suspension or total immersion of the foot and ankle.

Eligible participants were mobility and/or activity impaired; had at least one comorbidity; received standardized skin hygiene, incontinence and repositioning protocols; and/or had previously documented negative outcomes (e.g. pain or discomfort when lying, falls, non-healing pressure injuries, and positioning problems such as leaning & slumping on their current support surface.

24 participants were male, and 20 were women with an average age of 79yrs (range 47-98). The average study time was 53 days (range 3–120 days). Compared to pre-study surfaces which included foam and air products, no falls occurred during the course of the study. 17 of 35 preexisting pressure injuries healed and no new pressure injuries occurred.

The full study is published in Wound Management & Prevention at the following link: Immersus Clinical Outcome Study Link

Now more than ever, you and your staff cannot always be on hand to help a patient get out of their bed, but by choosing an evidence-based solution such as the Immersus Mattress, you can support providing a safer way, with a stable sitting edge that is clinically proven to help prevent falls among high fall-risk patients.

For more information or to see the product yourself, please contact us at 855-994-4325




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