Comments on GeriPal - Geriatrics and Palliative Care Blog: Bedrest as a danger of hospitalization

Very well stated Paula. It really isn't enough to...

2009-09-17T08:59:32.143-07:00

Very well stated Paula. It really isn't enough to have a physician order if there is not enough support to back up that order. Out-of-bed TID also becomes a useless order if, as Chrissy stated, we tie patients down with IVs, foleys, and tele monitors. A comprehensive approach (like an ACE unit) is what is really needed, as well as taking into account nurse/patient ratios.

How can we prevent elder patients being bedbound? ...

2009-09-17T04:15:01.936-07:00

How can we prevent elder patients being bedbound? Hire more nursing assistants. The current level of nursing staff has barely enough time to admit and discharge patients and complete medical and hygiene care. And yes, our focus on patient falls definitely decreases a patient's mobility. If one has any risk of falling based on various criteria, the bed alarm goes on or a unit on the chair to let nursing staff know when the patient is moving...pretty soon most of them learn to stay put so they won't set off the ear-splitting alarm. Our hospital physicians already order activity levels. Even when they order "ambulate TID" though, it unfortunately doesn't rise to the top of my priority list as a nurse, trying to get all of the other medical orders completed. Does it need to change...definitely!

Other noteworthy alternatives to hospitalization a...

2009-09-16T13:23:15.441-07:00

Other noteworthy alternatives to hospitalization also need to be considered such as Hospital at Home models in communities and hospital regions with existing networks of physician housecall practices and home health agencies. There are many established models of care which are better than standard hospital care for older adults. We need to advocate for these (ACE, Hospital at Home, HELP, etc.) as a community. Another option I keep thinking about as my parents and friends age and retire (and find themselves needing a new purpose or volunteer activity) would be to recruit seniors to volunteer in hospitals as trained activity leaders, walking partners, etc.

In discussion with Ron Walent, he mentioned that p...

2009-09-16T12:11:37.145-07:00

In discussion with Ron Walent, he mentioned that physicians' orders used to require an "activity" level, to which I responded that they still do. However it occurred to me that the standard "ad lib" is in fact not very "lib", that patients aren't at their liberty to just get up and walk around. For one, they're tied down to their IVs or catheters (which have been in place since the ER) or the staff is worried b/c they can't find the pt who might now be AWOL. But wouldn't it be lovely to see a pack (or whatever the collective term for a roaming hoarde of hospital patients is) of patients doing laps around the nursing stations?

Great summary! On our ACE Unit one of our biggest...

2009-09-16T11:15:01.130-07:00

Great summary! On our ACE Unit one of our biggest initiatives is to get the primary team to cancel all the strict bedrest orders, which are rather common! It would be interesting to study whether the ordering of "strict bed rest" has actually increased since the CMS announced its never-events relating to hospital acquired falls. I agree with the others that we treat such orders as rarely necessary, and should be ordered like any medical treatment, with justification of continued use taking place each and every day.

Hmm... Good idea, NPBH. I think the standard shou...

2009-09-16T08:10:13.967-07:00

Hmm... Good idea, NPBH. I think the standard should be out of bed TID or more, and that you should have to particularly write if you want them to stay in bed.

And of course, go ACE units! Let's not forget, Margarita Sotelo is now staffing the "Ace of Hearts" unit at SFGH, also. It's for the cardiac floor older adults.

As a Physical Med/Rehab doc, I have often said tha...

2009-09-16T04:40:25.152-07:00

As a Physical Med/Rehab doc, I have often said that we need to order bedrest like a medication rather than assuming it is the standard for what patients will be doing while hospitalized.