IDPH has cited and fined Lexington of Lombard nursing home after a resident there suffered a 20 cm bone-deep laceration from a side rail on her bed.
Many families are unaware of the risks that side rails on beds can pose to nursing home residents, and are often surprised to learn that their use is discouraged in the long-term care industry. They would prefer that a side rail be used to keep their mother or father from rolling out of bed or getting up unassisted. Using a side rail to keep someone from getting out of bed is actually using one as a restraint, and the use of restraints is limited by federal regulations.
Side rails are associated with nursing home falls where residents try to climb over the top of the railing. They are also associated with suffocation accidents where residents get trapped between the edge of the mattress and the side rail. The are also associated with strangulation injuries where residents slide off the edge of the bed and get caught with their head or neck under or between sections of side rails. For these reasons, their use is discouraged in the long-term care industry, and most well-run nursing homes have standard assessments regarding the need for their use and policies and procedures about how and when they can be used.
The resident at issue was a new admission to the nursing home. She had suffered a fractured kneecap and was apparently suffering from dementia. When residents are newly admitted to a nursing home, they undergo an assessment which is part of the care planning process. The resident was in bed while the nurse was performing the assessment and tried to get out of bed. This led the nurse to put the side rails up.
However, having the side rails up did not stop this resident from getting out of bed. She apparently tried to slide between the upper and lower sections of the side rails (the very thing which at time leads to strangulation accidents) and cut her leg on a sharp section of the side rail. The cut was 20 cm long and bone-deep in sections. She was taken to the emergency room where the cut was stitched together. However, one of the functions that intact skin serves is that it keeps infecting organisms out, and the length and depth of this cut puts her at increased risk for potentially severe infections like cellulitis and osteomyelitis. Unsurprisingly, her family decided to not return her to the facility.
What was fascinating about this investigation is what the investigation revealed about this facility’s practices regarding side rail usage:
- Assessments for side rail usage was not a part of the admission assessment process, not just for this resident, but generally;
- The nurses were simply permitted to use side rails in their discretion. When side rails serve as a restraint (as they did here), there should be a very specific process that ends with the consent of the family and a physician order, none of which was done here;
- There was no policy in place regarding the use of side rails.
In short, it is well-recognized in the industry that side rails pose some very real risks of harm and for this reason, their use is generally discouraged. However, here there were no policies regarding their use, no standard assessments to determine whether they were appropriate, and nurses were simply left to their own judgment whether to use them or not rather than follow industry norms about treating them as restraints when they were being used in the manner they were here. This resident suffered a bed laceration, but it is an injury that could have been much worse.
What happened here demonstrated a lack of training of the staff and a lack of investment in developing safety practices that are consistent with industry standards. This is something that is a feature, not a bug in the for-profit nursing home business model.
One of our core beliefs is that nursing homes are built to fail due to the business model they follow and that unnecessary accidental injuries and wrongful deaths of nursing home residents are the inevitable result. Order our FREE report, Built to Fail, to learn more about why. Our experienced Chicago nursing home lawyers are ready to help you understand what happened, why, and what your rights are. Contact us to get the help you need.
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