I have had the pleasure of working with Becky on creating an alternative to physical restraints or Posey beds as a method of keeping at-risk patients safe. Becky was instrumental in developing the less restrictive approach of using mattresses on the floor and floor mats to allow patients more mobilization while decreasing the risk of falls.
The unit where Becky works as Associate Nurse Manager noticed an increase in admission of patients with autism and other developmental disabilities. Often, once medically stabilized, these patients will stay on the unit for months waiting for placement. Placement options often require that the patient is not restrained or using a Posey bed to be considered for admission.
One patient suffered from developmental disabilities along with a movement disorder. She was hospitalized for six months. This patient began to deteriorate when she required restraints and then a Posey bed in order to keep her from falling. The patient became highly anxious in the Posey bed which in turn appeared to increase her constant movements. She lost significant weight and became increasingly despondent. Becky worked to implement the use of floor mats with her.
As a result of this work, the patient was noted to be happier, gained weight, and independently began using wipes to clean her mats. She was subsequently placed in a host home. Becky was instrumental in developing this program for our most vulnerable patients. Becky worked with the Infection Disease department along with Environmental Services to create a protocol that facilitated the safe use of floor mats. Criteria for use, a cart with shoe booties, written instructions regarding the use of floor mats, and a schedule for routine cleaning of floor mats were established. What began as an experiment is now available to the entire hospital as an intervention.
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Becky worked closely with our Behavioral Health Nurse Specialist on creating an alternative safe environment for patients that may benefit from a non-traditional set up while in the hospital, and she added floor mats along with floor mattresses as an option for select patient populations. Traditionally, patients are placed in hospital beds within the inpatient environment, and it was found that by transitioning some patients that may have primary means of mobilization by crawling or are at risk for safety were considered and trialed within our department. Primarily, our department had seen an increase of patients with either developmental delays or disabilities and they were coming up to the unit in restraints. It was found that placing them in restraints to help provide care was challenging and often times could expose safety risks that could lead to more harmful outcomes, such as falls or aggressive measures toward staff. Working with patients and families, we found that many expressed that the patients were more anxious and could be more difficult to manage if placed in restraints, so she partnered with families and worked within an interdisciplinary team to create a safe environment. By placing some of the patients on floor mats and mattresses, we were able to make them free of restraints, and allow them the ability to be more comfortable within our hospital environment.
For example, we had a patient with a movement disorder that was hospitalized for several months and once she was trialed on the floor out of restraints, she was able to gain her weight back, was happier, and she was able to get placed with a host home that was able to accommodate her room to a floor mattress as well. Another patient who was autistic was able to move away from restraint use and be placed in the room that allowed for fewer stimuli, and this allowed for a safe space for the patient to sit on the floor, where his mother had expressed was more comforting for him.
The overall outcomes of this innovative approach to providing patient-centered care allows our team to make adjustments in a patient's environment, so that utilization of restraints are decreased, and generally may allow for patients to be discharged sooner within their hospital stay. Although this intervention is limited to a select group of patients, we have found after implementation, we are seeing better outcomes in relation to restraints, reductions of falls, and reducing the overall LOS of this specific patient population. Anecdotally, it is evident in the case studies that were completed within the department that patients, families, and staff have benefited from being able to provide a safer environment for this specific patient population. This new approach in providing care is unique and some may find it very different, but we need to start thinking differently and allow for creative approaches within a complex healthcare environment. I am thankful for Becky and her work with our behavioral health specialist to make this possible for our patients.