inpatient falls in dementia pts

[martymoose, BSN, RN]

Hello- I am doing a a project for my RNBSN regarding in patient falls in dementia patients.

I am looking to get some input from other acute care nurses.

The biggest problem I see is that STAFFING is key. Currently where I work, there are fall protocols , restraint free plans, etc. But the one thing that stnds out is that these pts don't have the cognitive ability to use a call light, or use any judgement at all. Veryy impulsive,undirectable.

If we had the right staff, we could try to ambuate them regualry. Toilet them regualrly. Spend some time with them

On evenings , the nurses have 5-6 pt's a piece, with one tech for 14 pts. This is on an intermediate care/"step down" ( lol) unit, complete with some pts having art lines, some titrateable drips like cardizem and nitro, etc.Lots of IV Lasix, and even some lasix gtts.

Anyhow, the likelihood of us answering someone's light in a timely manner is terrible, as most of the population we get now takes 2 people just to toilet to a commode, and because of the fall protocol, someone must be within arm's reach of that pt. Some people are on the bsc/toilet, for 20 mins at a time. And if lasix is involved,try that every hour for 2 or 3 hours. Now times that by 14 pts.

No wonder we cant keep up, and are running like idiots, as the bed/chair alarms are going off, and we are still stuck with a previous pt.

My question is- what numbers would be ideal in this setting.

Thank you

[Pangea Reunited, ASN, RN]

An ideal (except financially) staffing ratio would be 1:1, but even patients with a dedicated sitter fall on occasion. When a patient's family is very involved and take turns staying with the patient, that seems to be the most helpful. Patients tend to be calmer and easier to direct when the direction comes from someone they're familiar with. Most families are unable or unwilling to take on the task, though.

I think you're not getting answers to your question because there are no good answers.

[K+MgSO4, BSN]

You need to look at more than ratios, in this financial climate that is not going to change. How did I reduce falls as a NUM? I changed culture. I started with my staff nurses and clerical staff. At the beginning of each shift the in charge of the previous shift would discuss the high falls risk pts. to all nurses and clerical staff. Each time and Nurse or clerk passed that room they had to look in and ask the pt was there anything they needed, actions depending on who you were. Then I got the clinical assistants in on the action and my ward assist volunteer group. Then my allied health and pharmacist. Then I went to my consultants I wanted all junior doctors in on the action so every 10 weeks when the interns rotated I spoke to the new group every 4 months when the residents rotated I spoke to them, twice a year I spoke to registrars and once a year to fellows. It took a long time to turn the ship but my God it turned.

[martymoose, BSN, RN]

Pangea- I think you are right- usually there is no family.

What makes me angry tho is that suddenly I am responsible over something I don't have much control over ( lack of staffing) yet if they fall and break something it's our fault. No win situation.

K+mgso4 you have a great idea. I dont thinkit will work where I am though, as there's a lot of " it's not my job" that goes around already. Too bad. The more eyes the better/safer.Once in a while I will get that housekeeper who will say " hey, is that guy supposed to be up" and lets one of us know( \actually we've got great housekeepers) , but forget anyone else- esp. residents. ughh. But great Idea.

Thanks so far.

[PTvisitor]

Boy- it does sound like increased staffing would really help in your situation

Some of the things that lowered falls at our facility were :

EVERYONE on staff asks "is there anything I can do for you before I leave". This could be anything from repositioning in the recliner, getting a glass of water, getting a patient's comb, finding a specific tv channel etc. This can free up time for the nursing staff by lessening the running around to answer call lights for little things. It also can alert the nursing staff to pain or need to toilet before the patient tries to get up on their own so we can be more proactive and less reactive (also improves patient satisfaction)

Our housekeepers check each room as they clean for turn-over and make sure there is a gait belt in the side table drawer. That has been a life saver for those times the patient is getting up out of bed and you know they're unsteady but you can't really leave the room to find a gait belt either.

[martymoose, BSN, RN]

Gosh,I wish we could use gait belts.but I guess they had some problems with skin tears or something in the heavier pts.

The patients we seem to get lately are beyond cognitive. They get up repeatedly.you can ask if they need anything before you leave.they will say no,and proceed to get up 30 seconds after you step out of the room.

If you ask them how you could help them or what they need, they either say I don't know,or I'm going home.

The only solution I see for that is more staff.

Ughh.

[Pangea Reunited, ASN, RN]

We have started putting many of our high-risk patients in enclosure beds. I've grown to love the things for certain patients, although they're not appropriate for everyone. But unfortunately, patients still fall on occasion because their beds are not secured properly at times ...usually by lab, radiology, etc.

I have a strong dislike for regular wrist or vest restraints, but the enclosure beds allow a patient more freedom to move, turn and make themselves comfortable.