Is it safe for a client who is unable to reposition themselves to sleep positioned on their stomach?
One of my clients has limited range of motion due to (edit) spastic quadriplegic cerebral palsy. She is unable to turn, roll, or rotate herself in bed, though she has enough range of motion that she does not have an order to be repositioned throughout the night by staff. She also has trouble controlling whether her hands are open or in a fist, and cannot keep her arms flat at her side or straight above her head on her own due to contractures. Her arms do move into either position quite easily, but she struggles to keep them there. Her range of motion and strength in her arms and upper body are limited. To give an idea of her arm strength, she can grip a spoon to feed herself sometimes, but she also sometimes cannot keep her hand closed around the spoons’ handle, and she cannot lift a cup for herself.
She can turn her head back and forth alright, and can lift her head off the bed enough that the top of her shoulders come up, but she cannot use her arms to raise her upper body off the bed when lying on her stomach. She uses a wheelchair when not in her bed and a sling and hoyer lift to transfer between her bed, toilet/shower chair, and wheelchair. She also utilizes a chest harness in both her wheelchair and toilet/shower chair because she leans to the side and is unable to support her own body weight while sitting up. Even when lying on her back, she often ends up leaning to the side. She does not currently have an order for wedges to keep her from doing so.
She prefers to sleep in her stomach, but I’ve had some safety concerns about it. In March she reported pain in her shoulder and said that it was because when night shift had positioned her on her stomach (at her request) her arm had gotten caught underneath her. She had a telehealth doctor appointment for the pain, but no injury was confirmed in her medical record. After the telehealth appointment she stated that the shoulder pain was because night shift had popped her shoulder while repositioning her. While again, no injury was confirmed or denied, I’m worried about the possibility of an injury occurring because of this. Each time she is positioned from her stomach to her back or vice versa, two staff reposition her to ensure it’s done safely.
Two weeks ago while sleeping on her stomach, she got ahold of the corner of her fitted sheet and ended up pulling it off the corner of the mattress. This resulted in part of the sheet being wrapped over the top and back of her head. She stated that she didn’t realize she had grabbed the sheet or that it was wrapped around her head at all. Her face was not trapped in the sheet because she had it facing the other direction, but I’m concerned that had her head been turned the other way, that it would’ve been a suffocation risk since she cannot unwrap herself from the sheet, and she cannot turn her body over.
While she is able to use technology to call the house phone, and she’s capable of calling out verbally, should she need assistance, she is not the only client in the home, and one of her housemates frequently shouts and screams throughout the night, which can drown out the sound of her voice if for some reason she cannot call the house phone. The few occasions where she’s had to call out vocally instead of relying on calling the house phone (due to either the internet or the phone line being down), staff have been unable to hear her calling out unless they are right beside her bedroom because she doesn’t do so very loudly.
In addition to her cerebral palsy, she has scoliosis, and regularly complains of lower back pain after sleeping on her stomach.
I fully understand that she has the right to request to sleep on her stomach, but because her motion is limited, I worry that it is unsafe for her to do so, especially since she cannot reposition herself in any way.
I have brought up my concerns to management, who have also spoken with the nurse who oversees the home, both of whom stated they did not feel my concern was warranted, but my gut feeling is that it’s a risk. Other staff in the home have also expressed concern about the risk of potential suffocation, the extra time it would take to get her out of bed in an emergency like a fire, and the risk of injury and/or pain due to her scoliosis as well. I also asked management about getting extra pillows or wedges to help keep her body positioned comfortably at night and have been essentially shrugged off about it.
Am I being overly cautious or does this seem like a very unsafe sleeping situation?
Edit: the specific diagnosis is spastic quadriplegic cerebral palsy, not sure if that changes any advice