3.3 Safety, Fall Prevention, and Restraints
Key Takeaways
- Fall prevention is built on basics: bed in the lowest locked position, call light within reach, non-skid footwear, clear uncluttered paths, prompt response to call lights, and spills cleaned up immediately
- Restraints are a last resort that require a physician's order, must be the LEAST restrictive option, and may never be used for staff convenience or punishment
- A restrained resident must be checked at least every 30 minutes and released, repositioned, toileted, and exercised at least every 2 hours
- If a resident starts to fall, do NOT try to catch them; ease them to the floor protecting the head, stay with them, and call the nurse, then complete an incident report
- Restraint complications include pressure injuries, loss of muscle and mobility, incontinence, strangulation, and loss of dignity - which is why alternatives are always tried first
Why Safety Is a Core Aide Duty
Residents in long-term care are at high risk of injury because of age-related changes - poor balance, weak muscles, slower reflexes, dimmer vision, and medications that cause dizziness or drowsiness. Keeping the environment safe and preventing falls is one of the nurse aide's most important everyday responsibilities and a recurring exam theme under Basic Nursing Skills.
Fall Risk Factors
Know who is most likely to fall so you can watch them closely:
- History of falls - the strongest single predictor.
- Muscle weakness, poor balance, or an unsteady gait.
- Vision or hearing impairment.
- Confusion, dementia, or delirium.
- Medications that cause dizziness, sedation, or low blood pressure (sedatives, diuretics, blood-pressure drugs).
- Urgency or frequency - rushing to the bathroom, especially at night.
- Improper footwear or new, unfamiliar surroundings.
- Postural (orthostatic) hypotension - dizziness on standing up quickly.
Fall Prevention Basics
Most falls are prevented by simple, consistent habits. Make these automatic:
- Keep the bed in its lowest position and the wheels locked.
- Place the call light (signaling device) within the resident's reach and answer it promptly.
- Keep frequently used items (water, glasses, tissues) close by.
- Provide non-skid footwear and properly fitting clothing.
- Keep walkways, floors, and the room free of clutter, cords, and obstacles.
- Clean up spills immediately and report wet floors.
- Ensure adequate lighting, especially a night light to the bathroom.
- Lock the wheels on beds and wheelchairs before any transfer.
- Use a gait belt when helping an unsteady resident stand or walk.
- Use bed/chair alarms and increased rounding for high-risk residents as the care plan directs.
If a resident begins to fall
Do not try to catch or hold the resident up - you will both be injured. Instead, bend your knees, widen your stance, and ease the resident slowly to the floor, protecting the head. Stay with them, call for the nurse, and do not move the resident until the nurse assesses for injury. Afterward, an incident report is completed.
Restraints: A Last Resort Only
A restraint is any device, garment, or drug (chemical restraint) that restricts a resident's freedom of movement or normal access to their own body - a vest, lap belt, mitt, side rails used to keep a person in bed, or a chair the resident cannot get out of. Federal OBRA '87 rules and Georgia regulations treat restraints as a last resort because of serious complications.
Restraint complications to know:
- Pressure injuries and skin breakdown from immobility.
- Loss of muscle tone, mobility, and the ability to walk.
- Incontinence, constipation, and loss of dignity/independence.
- Increased agitation, depression, and confusion.
- Strangulation, suffocation, or other serious injury if the device slips - restraints can be deadly.
Because of these dangers, you must always try alternatives first.
Restraint Alternatives
Try the least restrictive options before any restraint is even considered:
- More frequent checks and answering call lights quickly.
- Repositioning, toileting on a schedule, and meeting the underlying need (pain, hunger, thirst, boredom).
- Moving the resident closer to the nurses' station, providing activities or companionship.
- Bed/chair alarms, low beds, floor mats, and wedge cushions.
- Addressing the cause of the behavior rather than the behavior itself.
Rules for Safe Restraint Use
When the team decides a restraint is truly necessary, strict rules apply. These are heavily tested.
| Rule | Requirement |
|---|---|
| Order | Requires a physician's order - never the aide's or nurse's decision alone |
| Reason | Only to protect the resident or others; never for staff convenience or punishment |
| Type | The least restrictive device that works |
| Checks | Visually check the resident at least every 30 minutes |
| Release | Release, reposition, toilet, and exercise at least every 2 hours |
| Application | Apply correctly with a quick-release knot tied to the bed frame (not the side rail), snug but with room for two fingers |
| Consent | Resident/family informed; respect dignity and privacy |
Applying a restraint without an order or consent, or to manage short staffing, is false imprisonment - an illegal act that can lead to a substantiated finding on the Georgia Nurse Aide Registry.
Worked Example: A short-staffed unit has a resident who keeps standing and is unsteady. A coworker suggests buckling him into a wheelchair lap belt "just until things calm down," with no physician order. This is wrong on every count: no order, used for staff convenience, and not the least restrictive option - it is an improper restraint and false imprisonment. The correct response is to use alternatives: place the call light in reach, move him near the nurses' station, offer toileting and a snack, add a chair alarm, and tell the nurse. If a restraint is ever ordered, you would check him every 30 minutes and release him every 2 hours.
Incident Reporting and Environmental Safety
An incident report documents any unusual event - a fall, injury, medication error, burn, or found bruise. Report the event to the nurse immediately, then complete the report with objective, factual information: exactly what you saw, when, and what you did. Do not guess at causes, assign blame, or chart your opinion. General environmental safety also means knowing where exits and equipment are, keeping equipment in good repair, and following the facility's safety policies.
A physician orders a restraint for a resident. According to safe restraint use, how often must the nurse aide release the restraint to reposition and exercise the resident?
A resident becomes lightheaded and begins to slide out of the chair toward the floor. What is the safest action for the nurse aide?
A resident in a restraint must be visually checked at least every ___ minutes.
Type your answer below
Which of the following is an appropriate restraint ALTERNATIVE rather than a restraint?