[michelle126]

Okay this is a little of a vent here. We have a resident who loves to live on the floor. Falls and climbs on the floor more than he is in his chair. We've tried alot.. wheel chair alarms, bed alarm, self release seat belt, reclining chair, merrywalker, psych eval, lab work, diversional activity, redirection, even set up a mat on the floor (he kept crawling all over the place) . Thing is he needs one to one monitoring at all times and our staffing doesn't really allow for a private sitter. Administrator told day nurse.... "That's your job." (even tried to have him "work in the office" ) What have you done with res like this. any other interventions beside getting the whole IDT to help babysit him? (Weekends are the worst trying to watch him... family not interested in helping out either.

[renerian]

Wow you listed all the things I can think of off the top of my head.......cripe.

renerian

[NurseRN]

Michelle,
From the desk of a Director of Nursing (the position I currently hold), I would suggest you communicate to your staff that this resident must be layed down between meals if he/she is not in a organized activity. If this resident is one who attempts to rise from bed unassisted...try a low bed, with a fall mattress on both sides of the low bed.
When this resident is attempting to rise unassisted...Does he/she need to toilet? Have you gotten therapies involved (maybe he wants to attempt to ambulate). Does he have a Restorative program for the Restorative aides to ambulate XYZ feet X times per day?
Be sure to update your CNA flowsheet/careplan/assignment sheet (whatever tool you use to communicate this to your CNAs), and update your facility careplans with your interventions. Whenever this resident is up in his/her wheelchair he/she should be in some type of organized activity ot at meals. Get your activities dept involved in the resident's care when he is not in bed.

Hope this helps!
NurseRN

[Rapheal]

No advice, just my sympathy. This must be an extremely frustrating situation for the patient and the staff.

[michelle126]

NurseRN tried everything you listed, it would help if we had more of an activities involvement. Restorative works with him, he is weak and gait very unsteady... Another thing that would help is having more staff after 3-4 pm... All the therapy, activity, and other departments leave. After that we have 2 nurses and 4 aids for 50 res. (Ive been busy monitoring my dobuatamine drip res, see my other post. and watching all the other critical res)... The only thing that seems to work is one to one babysitting, the only thing with that is watching the others suffer...

[2bPhD]

Why don't you try helping your patient to exercise. When he is climbing out of bed or out of the chair... take him for a walk!!!!!!! Walking with strengthen his muscles, build his endurance and prevent future falls from occuring. TRUST ME IT WORKS!!!! It is called restorative nursing care. Don't restrict him and make him weaker, make him STRONGER!

[nightnurse49]

Any chance this person is in pain? I'm assuming you tried pain medication. Is he confused? What was his/her routine before admission to your facility? What hobbies did he/she have? What about soft music, or TV or maybe, if your facility is willing and able, a pet (canary in cage, for example.) Was the person like this when admitted, and is this why the family couldn't take care anymore? If so, what worked at home?

Could this person be on any meds making him restless?

Your administrator was out of line telling the day nurse that's her job and washing her hands of the situation. Safety is everyone's job. Part of administration's job is trying to make the nurses' job doable.

I sympathize. I work night shift. Most nights it's me, two excellent but overworked CNA's and 45 residents--many confused, in pain, with psych history. We are connected to an acute care hospital so unless they are ill enough for the ICU, we quite often keep them and treat them right there. It's more a geriatric med surg than anything else.

If this person actually LIKES being on the floor is there any harm in that if he is well protected? Be sure it's care planned. Good luck.

[BadBird]

From reading your post and the good advice given I summize the problem to be lack of staffing for safe patient outcomes, I would fill out a incident report each and every time he falls and document the reason for the fall is lack of staffing and that management was aware. Some facilities have statement of concern forms, I would fill those out too, if the patient falls and breaks a hip you can be sure the family will want to sue, at least your butt will be covered, let management explain to the judge and jury why they did not provide enough staff to ensure patient safety.

[BadBird]

By the way, I would keep a copy of the above for myself just incase I was called into court, I don't trust anyone and I think those forms could be conveniently lost or changed. Make sure you list all of your diversional therapies and what you tried to do to maintain safety for the patient.

[ktwlpn]

Originally posted by BadBird
By the way, I would keep a copy of the above for myself just incase I was called into court, I don't trust anyone and I think those forms could be conveniently lost or changed. Make sure you list all of your diversional therapies and what you tried to do to maintain safety for the patient.

I have a crawler,too.....We give her a safe area to do it in...Nothing else works...I have learned that with demented residents actually trying to CHANGE their behaviors is often harmful -the only thing that works is adjusting the environment to keep them safe....It requires a consistent approach from all staff and much education to family and visitors because some may feel it is a dignity issue to let someone crawl on the floor when in reality restraining them to prevent the behavior has far worse consequences.When a resident is repeatedly getting out of bed at night why put them BACK in bed 6 times? They want up for a reason-toilet,snack,pain med-maybe just company...What harm does it do to let them sit up for awhile?As long as the next shift knows that they were up all night..We do have low chairs-they look like adirondacks-we took regular chairs and had maintenance cut the legs down and angle them so the front is tilted up higher then the back...This can slow down some residents and prevent others from rising without assistance but is not considered a restraint because they COULD rise....I also have had 1 to 1 ordered by docs...an aide can pull a one hour shift-rotate staff from all over the building and then no-one is short for a whole shift....