Fulfilling the Promise Eliminating Restraints & Alarms Melissa Jackson CEO/Administrator.
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Transcript of Fulfilling the Promise Eliminating Restraints & Alarms Melissa Jackson CEO/Administrator.
Fulfilling the Promise
Eliminating Restraints & Alarms
Melissa Jackson CEO/Administrator
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Some Facts:• In 1991, 69% of residents in nursing
homes in the U.S. were restrained. (CMS)
• In 2011, the national average of residents in nursing homes who were restrained was 3%.
Restraints
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Restraints
Nationally, restraint usage has been recognized as significantly contributing to the deterioration of the residence physical and mental status. Potential negative outcomes of restraint usages include, but are not limited to:
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Continued• Decline in the resident’s physical functioning;
Ambulation, and muscle condition • Contractures• Increase in the risk of infection • Development of pressure ulcers, delirium,
agitation and • Incontinence
Restraints
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Alarms
• Alarms became a mainstay of the nursing home industry after the federal government cracked down on the use of physical restraints in the early 1990s
• The idea that by putting a restraint and alarm on a resident, I’m keeping them more safe. ….I’m preventing falls
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Alarms
• While most nursing homes still use alarms, in part to protect against state and federal penalties for inadequate fall-prevention measures
• We ask, what is the evidence to prove the use of alarms prevents falls and injuries? There really isn’t any
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Restraint Free 1st Nursing Home in Vermont 2005
Vermont Health Care Association
VVH Policy developed in 2004On Use/Non-use of Alarms &
Restraints
Audible Alarm free January 2014
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HOW DID WE
Well…..it wasn’t easy…
Full Facility buy-in Inter Disciplinary Team (IDT) approach One neighborhood at a time
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Education was/is key Full staff education prior to
launch Seminars Conferences Trade ShowsVeteran, member, and family
education during the process
Implementation
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Carmen Bowman, MHS Conference Calls Thinking outside the box
• “What if they never invented alarms, what would you do?”
Implementation
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Considered in process Room Care Plans Fall history Position Personal needs/toileting All else
Implementation
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LNA’s (CNA’s) from the Neighborhoods highly involved
Care plans updated at time of review
Finance- involved in new purchases
Consistent Staffing
Implementation
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Alarms – Mixed Messages Most tell us to get up & take action Can be associated with military
sounds No research supporting alarm use &
fall prevention – Reactionary devices
Implementation
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Change the mindset….. Proactive vs Reactive Anticipate needs vs Respond Documentation = Analysis
• Decision Tree• Assessment forms• Audits• IDT staff input forms
Implementation
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Things to think aboutRegulations – Why vs why not
Restraints• Alarms can be restraints• Convenience
o For staff, not Veteran safety• Accidents F323
o Alarms do not replace supervision• Homelike environment
o Do we use alarms on our children?
Implementation
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Early Nursing Policy
Implementation
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Engagement is the Key Know your Veterans
• Life story• Favorite activities/what brings joy• Institutional routine vs their routine
o Ask and forgotten
• Simple pleasures• Use Their abilities to benefit others
o Do not focus solely on disabilities
• Community calendar vs My day
Implementation
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Behaviors What are they trying to tell us Is it even fair to call them behaviors What would someone need to know
about you now, to take good care of you later
Implementation
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Our Accident & Investigation Process developed from this program Meeting with a “Huddle” Reviewing Incident/s Root Cause Analysis-Data Example-Grab bars initiated from this
data to enable self positioning Lower beds Landing strips
Implementation
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Sound reduction Overhead paging discontinued
• Noise level greatly decreased• Pagers issued to staff• Veterans with dementia reduced stress,
not searching for voices
“Whisper Hours” “Passive” call bells
Rehab brought in early Balance Program
Implementation
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Alternate therapy's derived from this study Music in Memory Namaste Room Activities
Prior- One central location Pushed to neighborhoods- Variety and Frequency expanded Evening activities
Implementation
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Restraints &
Alarms
Activities
Implementation
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ChallengesOld school
Full Facility buy-in Resistance
Families- understanding whyNo Alarms added w/o IDT meeting3rd shift
Difficult to educate/train
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ChallengesFull circle- “it’s their right to fall”Administrations-new leadership
desired a return to alarmsFamilies – fear of falling, they tried
everythingBuilding full of alarms
Noise Level Falls Behaviors “Vet to Vet”
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Conclusion
Pick a date &Stick with it!
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Questions…….
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