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Common Sense, We Barely Knew You

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A few years ago I was introduced to a book called The Death of Common Sense, by Philip K. Howard.  In the book Mr. Howard provides a variety of examples of well intended regulations that have produced negative consequences.  One of my favorite examples from the book was a story of Mother Teresa’s nuns, the Missionaries of Charity, and their attempts to rehab some abandoned building in the South Bronx into homeless shelters.  Finding the buildings was pretty easy and the city was more than willing to sell them the properties for $1 apiece.  Unfortunately, after over a year of working through various municipal committees and regulatory bodies the nuns had to abandon their efforts because local regulations required that the rehab of any multi-level building must include an elevator.  Despite the nun’s appeals and all their logical arguments the rules would not be bent.  The nuns had to walk away from the project as they could not bring themselves to spend over $100,000 per elevator when such money could be much more effectively used in helping the poor.

You know, you can’t even read something like this without shaking your head!  What were they thinking?!  Yet, examples like this are rampant and increasing in number every day.  Maybe if everyone would just recognize that we’ve already killed common sense they wouldn’t keep trying to do it again and again… and again.

With all deference to Mr. Howard, I’d like to add a few examples of my own in the unending list of attempts to kill common sense, again.  Over the next few blogs I’ll try to share some of my favorite examples.

The Hospital Bed Safety Workgroup:

The Hospital Bed Safety Workgroup, HBSW, (let’s face it, any government body has to be tied to an acronym) was a group comprised of representatives from the Food and Drug Administration (FDA), the Veterans Administration (VA), the Centers for Medicare and Medicaid Services (CMS), Health Canada (God bless the Canadians, I don’t think they’ve got an acronym) and a variety of other interested groups.  The HBSW was formed to address an issue identified from statistics gathered from 1985 to 2006.  From this data it was identified that 413 deaths had occurred due to individuals being entangled, suffocated and / or strangled in hospital beds.  The HBSW’s mission was to identify the causes and provide recommendations and guidelines to reduce, or eliminate, such events from happening in the future.  Now this is a very laudable goal and I think everyone would agree that one death from entrapment is one too many.

Well, the HBSW went to work and published their recommendations and guidance in 2006.  In their guidance they identified several potential dangers in hospital beds including the size of the mattress in relationship to the bed frame, which could cause gaps at the head, foot or sides.  However, the strongest recommendations were saved for side rails.  Bottom line, there just didn’t seem to be anything “safe” about side rails.  The group identified that patients could be entrapped in the side rail, between the side rail and the mattress, between the side rail and the head of the bed, etc.  Holy buckets, what an obvious safety hazard!  Something must be done!  To add to the evil side rail threat, we’ve got our wonderfully litigious society and it’s insatiable desire to find the next lawsuit.  The solution was obvious for most health care facilities, “We’ve got to get rid of these side rails!”

Now, here we are several years in the future confident that we have thwarted the evil side rail monster.  Most, if not all facilities, are now bed rail free.  Yeah, but something’s nagging at me.  What the heck was that other name we used to describe side rails?  Oh, I remember, “safety rails”.  How can such an obvious danger ever be described using the word “safety”?!  Think Dave, think!  Oh yeah, I remember, some misguided folks actually thought that these rails might keep people from inadvertently falling out of bed, resulting in injury or death.  Oh, but we’ve got evidence to prove that side rails actually caused deaths by entrapment, 413 deaths in 21 years (although to be fair not all of the deaths could be directly tied to the side rails).  Now don’t get me wrong, no death is acceptable, but in the grand scheme of things how does approx. 20 deaths per year compare to the number of folks that were saved from falls.

At least one group involved did seem to recognize that there might be a conflict.  The American Society for Healthcare Engineering of the American Hospital Association (ASHE of the AHA… can’t let the government have all the fun) suggested in their comments on the HBSW’s draft guidance that facilities should perform a patient assessment first to determine the individual’s risk of entrapment in relationship to other patient specific risks and goals.  They stated that, “Without a clear discussion of the critical role of clinical assessment, the specific dimensional limitations may be viewed as a model code and be adopted by state or other agencies…”  Holy buckets!  Who needs Nostradamus when you’ve got the ASHE of the AHA?!  Maybe I should contact them to get a good stock tip or long-shot bet during March Madness?

All kidding aside, I really believe that ASHE’s comments have been proven out again and again.  As I mentioned, most healthcare facilities are now side rail free.  In addition to eliminating the risk of entrapment, here are the other things that this has spawned:

– A major increase in the number of patients falling out of bed.

– Healthcare facilities, equipment providers and equipment manufacturers striving to figure out ways that they can avoid any responsibility for such falls and place the blame on someone else.

– The reduction in the use of some support surfaces designed to address a patient’s skin integrity issues because they need to be used with side rails and / or they cause the patient to be higher off the floor.

– The introduction of new hospital beds that are much closer to the floor (sometimes called “low boy beds”).  Hey, at least you won’t fall as far…

–  An increase in the number of workman’s comp incidents of health care workers handling patients that are closer to the floor.

As my mom often told me, “the road to Hell is paved with good intentions”.  Stay tuned, this is just my first installment in a series, which doesn’t lack for good examples.

Also, feel free to share your own examples.  Sadly, I’ll bet we can all identify several.

– Dave

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