I have been an LPN for 11years. Some of that time was spent in med/surg, but most of it spent in geriatrics. Falls are almost a daily occurence. We are told now that "patients have the right to fall"; how insane is that? Do what you can to keep them safe, but you can't predict or prevent every fall. Make sure the call light is always within reach. Bed rails up when ordered. One trick I've learned over the years is if you have a patient sitting up in a wheelchair who likes to try to get up by herself, put a a bedside table in front of her. Now here is where it gets tricky, because if you put an empty table in front of her, it's considered a restraint. But if you put something on that table to keep her busy, its just a table, not a restraint.
Older, confused ladies like to fold washclothes, so I put a pile of washclothes on the table and they start folding. Just check on her every few minutes to make sure they are not all folded or she will get bored again. Some patients like to color. I make copies of my kids' coloring books and keep them in my locker for this reason, plus some crayons. Or you can giver her a snack on that table. Once a patient does fall, my staff knows not to move her until I assess her. Obviously you are looking for bruising and stuff like that, but an easy way to assess for a broken hip is to extend both legs while the patient is lying on her back. This accomplishes two things: first, look at the ankles and if one leg is rotated in or out, there is a problem; second, if one leg is shorter than the other there is a problem. This is not the be all end all of the assessment, but it's a quick way to check for the displaced hip. In your charting, chart where she was found, how she was found, who found her, what time she was found, what time she was last seen before the fall and her condition at that time, what she says about the fall when you ask her what happened (even if her answer makes no sense), any witnesses, any changes in condition after the fall or possible injuries, and most important - covering your butt. This entails charting that the last time you checked her her call light was in reach and and bed rails were up (if this is the case). Then begin with the calls; the doctor should not be surprised, this is a constant problem. And the family will just have to get over it. There's only so much you can do. I've had families who ask why I can't just sit with her for my entire shift and my answer is that I have other patients, but it would be okay with me if they want to come in and sit with her all day. And sometimes they do. Hopefullly at your facility you use the fall risk forms that will help you to keep track of possible causes for the fall such as psychotropic meds or things like that to look at. Good luck to you, I'm sure you will get used to this sad, everyday, sometimes unpreventable occurence.