Mother in law being confined to hospital bed

[Mrsgg1984]

I was just looking for some advice regarding my mother in law who has middle to end stage Alzheimer's.

She recently had a fall at her previous care home ( that's a different story ) and ended up with a severe hip fracture , two operations later and 6 weeks on she is still in hospital. With physio she is able to walk 10 metres with one person assisting and a Zimmer frame but she is extremely frail due to not eating and drinking much and suffering from dehydration.
When my husband went in to visit last night a younger lady in the same bay as my mil called him over for a quiet word. She told him she had put on a formal complaint with regards to my mil and treatment she was recieving during the night by the nurses. To prevent her from getting out of bed and potentially falling they moved her bed from the back wall and placed it so one side was flush against the ward radiator then placed chairs and tables around the end of bed and other side in an attempt to keep her in the bed. She was literally barricaded in by a wall and furniture. I should also mention both bed rails were up too. The lady said they did this whilst my mil was fast asleep and when she woke up she was upset and confused knocking herself on the radiator.
When The lady spoke to the nurses about this they simply stated it was for her own safety so that she didn't fall. The lady pushed for more answers as felt that it was plain wrong and they eventually moved all the furniture, put the bed back in the original place and had a staff member come in to keep and eye on her instead.
The lady also took photographs of this which we now have in our procession.
My question is for anyone who works in hospitals with dementia patients, is this deemed acceptable to do this for prevention of falls? Surely they could of had someone sit with her in the first place rather than using that as a last resort because a fellow patient complained. I know when I worked in care homes with dementia patients we used bed rails and sensor pads to alert us but even then there was strict guidelines when using these. It's been a long time since my care days and I also know that the wards on hospitals are always short staffed but after the lady complained they somehow managed to find a staff member to keep an eye out.
I feel so upset seeing the photographs of my mil scrunched up in the bed confused why she's pushed up against the radiator and not able to get out. Although I understand that another fall could be very detrimental to her, this isn't the way I feel like it's taking away her dignity like this and causing her distress.
I am so thankful to the patient who reported this and spoke up for her as we would of never known as it only would happen through the night when it was quiet. It makes me think they wouldn't surely get away with doing something like this to someone of sound mind but knew my mil wasn't able to speak up about it 😥
Please tell me I'm not over reacting here .

Sorry to hear your MIL is experiencing this. If she is approaching end of life care, the hospital may suggest her moving home. Would this be an option for you and your DH to then manage her at home? Such a cruel disease.

When I was last a nurse some years ago now we only had two staff on the wards at night so sitting with someone is not an option as we were flying round all night.
I can't imagine it has changed since then.
Its hellishly difficult to stop a dementia patient from climbing out over the bars on a hospital ward at night.
What they did was certainly not ideal but maybe it was all they could do to stop her breaking bones.

She is actually being discharged to a new nursing home hopefully in next week or so as she is refusing medication so there's no point in her being in hospital anymore

Sunrise thankyou for your take on things

This would not be standard practice to stop someone falling - and may increase risk as they try to clamber over the obstacles.

Where I work it would be one side of bed against wall, bed lowered as far as possible, no bed rail and a mattress on the floor next to the bed, plus a sensor.

If she is really hard to manage they should be asking for an additional staff member to watch her.

I've never known anyone to do this where I've worked. I'd be concerned that it could make your MIL less safe, because she could still try to get out of bed, but have more obstacles to climb over, which could cause her to fall from a higher height. The usual solution would be to get a 'low profiling' bed and a sensor mat.
As pp has said, it's often a matter of simply not having enough staff to 'one to one' patients, sadly.
It's a crap situation. Hope your MIL does well in her new home💐

X post with @AnnaMagnani

This is completely unacceptable and unsafe, if I were you I’d be making an appointment with the ward manager to discuss this

OP i am a nurse.

This is classed as a form of restraint - i am raging on your behalf.

Please submit a formal complaint.

I’ve seen them his happen in our local hospital too. The flip side is someone has to sit with her constantly - meaning the other (20) patients are cared for by one nurse all night as they are so understaffed. My poor father was left unattended, sitting on a chair when he had bedsores, with the call bell out of reach for ten hours because the nurses were all tied up with trying to keep a dementia patient in bed.

Occupational Therapist here. This is not usual and it's unsafe. Please ask the new setting for Occupational Therapy input as we can help with safety and comfort at end of life as well as earlier stages. If I had seen this in a setting I worked in, I would be professionally duty bound to report it to CQC and the local authority (even if its a private one).

I'm so sorry for your MIL & family having to go through this. I know personally how heart-rending it all is

Not normal here, no. As pp said, we do move next to a wall but then try to make as safe an exit at the other side if there is a risk of them climbing or attempting to- so lowest bed and crash mats and a bed alarm.
Numbers are incredibly low for staff at night and fwiw i can see why staff thought barricading her in might keep her safe, but it wasn’t right. Even with an alarm, if someone gets up while you are attending to another patient and are alone- sadly that patient can fall and break a bone easily in the time you can get to them… so I’m not sure what is less “cruel” given the hand we are often dealt on nightshift…

If someone needs constant 1-to-1 supervision, there is funding for this that should be applied for following an OT/social worker assessment. Not doing so is at best ignorance and at worse laziness.

No, it's not acceptable to do it, it's 'old school' along with bucket seats and the like. And if someone is determined to be up then chairs blocking them in may just create a hazard as they try to climb over them to get out - same with bed rails.

I've worked in dementia units and we have had sensor pads, beds that go to the floor, crash mats and bed rails - although as mentioned they're not always appropriate.

But, we didn't ever have enough staff to be there the second someone was up and starting to wander as well as meeting the needs of the other residents, and the equipment would often be broken and not fit for purpose despite reporting and so you'd find someone in the corridor who's sensor mat didn't go off, or it would get wet and stop working, or there simply weren't enough of them for everyone who needed one. And all those things are depravation of liberty, and the right paperwork needs to be completed and a dols sought. That's great until it takes a week and they're at risk 24/7 from falling because dementia doesn't wait for the paperwork to be signed off.

Unfortunately it may well be that the person sitting with your MIL was then unable to be dealing with other patients and their needs - quite often the safest option is 1:1 but that's expensive and rarely done, even though it's the safest option.

It's a terrible disease, and although we do know how to treat someone with dementia to try and keep them calm and settled as much as possible, the resources just aren't there to achieve that all the time and situations like this happen, especially in hospital.

I'm sorry you're dealing with the reality of this, it's so incredibly hard.

I don't know what the rules are regarding patient restraint. But it does sound like she would be better in a residential home which specialises in the care of patients with dementia. I dont think a hospital ward could spare a staff member to sit with her all night.

Which from experience takes weeks and is often denied - conversely because they haven't fallen in that time because of things that aren't supposed to be done that are (like above) or because one staff member is assigned and the rest get less care, or a family member sits with them.

Definitely unacceptable and if anything even more unsafe.

I'm a nurse in Scotland, and we dont use bedrails for dementia patients or any patient who is at risk from a fall, as they are likely to try and climb over them and do more damage than from just getting out of bed. If someone repeatedly gets out of bed during the night and is at risk of falling, we use either sensor mats, although these are usually in short supply, or someone sits near them all the time. This can be difficult to facilitate as most wards are short staffed, but patient safety is priority. Well done to that woman for speaking up about it and taking photographic evidence. I would definitely be putting in a complaint about that.

It's difficult in most places but if we have confused patients that needed 1:1 supervision, this was always prioritised.

Not acceptable, I'm a nurse. You can't restrain patients like this. Get on to the ward manager and PALS. There might not be enough staff to 'special' her. We have staff at the door to each bay overnight on some wards to keep an eye on all patients.

Only possible if that shift fills.

A low bed and crash mat/mattress would be the safest option if she is prone to climbing out of bed and cannot walk safely unaided, at least any fall would be more of a roll onto a soft surface, so reduce the risk of further injury.
A few times we had to resort to simply putting the mattress on the floor in a side room for people with extreme confusion or agitation, as it was the only way to keep them from harming themselves. If they presented a risk to other patients we might occasionally get a 1-1, but usually only if they had assaulted and injured another patient.
Spent many years on the wards and cannot ever think of a time when we 'barricaded' anyone in like this. I think making a formal complaint would be appropriate, they obviously need better staffing, equipment and training.

Wow thankyou all for taking time out of your days to reply to me. I'm overwhelmed by all the responses so many thanks to you all.

It is such a difficult situation as I know funding is terrible and it's not the nurses fault as they are so short staffed but it hits hard when it effects a family member.

I was contemplating putting in a complaint for the sole reason to bring awareness to the situation so it isn't continually used as common practise in this ward. My mother in law is being discharged to a lovely nursing home this week as we know ideally a hospital setting is right for her especially now she is refusing medication and pulling out her cannulas all the time there isn't much point in her being there.

We only visited the nursing home on Saturday and already the manager has come off his annual leave, visiting my mil in hospital spoken to nurses and ordered a high low bed , crash mats and sensor pads for when she arrives. I know from my care background how difficult it is to prevent falls but at least knowing they are providing these measures makes myself and hubby feel much better.

I feel my heart I should complain and be the voice for my mil but I also know the struggles of staff and don't want to get them in trouble. It's so so difficult but I can't help feel angry with her being upset and distressed when she woke to find she couldn't get out either side of her bed.

You should complain, not about the staff personally but about the system that allows such low staffing levels that mean they use unsafe practices.

Also just to mention we are already having dealings with safe guarding. Social workers got involved because of her previous care home. She was found with a call bell round her neck in her bedroom but although staff have told safeguarding they are aware of the incident they did not document any of it and the call bell was not removed from her room. She had three falls in 24 hours whilst at that care home but after the first fall nothing was put in place to prevent any further falls and she ended up breaking her hip. So although safe guarding are involved in that side they seem more interested in the fact the incidents weren't documented rather than anything else so have lost a bit confidence with the whole process of complaining

Otheruser yes if I word it correctly then I hope the staff involved won't be affected by it. I just don't want it to happen to someone elses family member and god forbid they injure themselves by it