Constant Faller

CoffeeRTC, BSN, RN · Jul 18, 2003

Well, Im going in to work tonite and this weekend. Thanks for all the imput. We have tried all the interventions listed. Psych was to see him last week. The proplem with his meds before was that it took a lot to hit him then he was snowed and even more dangerous. Merrywalker didn't work he was unsafe in it. Restorative and other staff are working with him for ambulation, but he is weak and won't participate in any real program. Our facility is soo small as it is that its hard to make a safe area for him, where the other folkes in the merry walkers aren't bumping in to him on the floor. The incident reports are stacking up on him too. I know I had 4 on one shift. Prevention of skin tears and other injuries is top priorty. What this man needs is a Alzheimer facility where he could get the attention he needs. Its very frustrating. The docs have been trying to rule out all medical issues even ran a test for syphilis.

Thanks again for all the imput

**canoehead, BSN, RN** · Jul 19, 2003

How about a rocking chair? |Lots of movement and less risk.

NursePatsy · Jul 20, 2003

Can a pattern of the falls be determined? Such as the times of each fall, where the falls happen etc.

My facility recently dealt with a similiar situation involving a frequent faller that is also a hospice patient - with 75% of the falls occuring between 4pm - 6pm (determined through tracking). We tried everything imaginable. As our last resort, Social Services arranged for family members to be present at the high risk time until hospice can find a volunteer. The family is very supportive. so far, so good.

I have also heard of other facilities using Adirondeck chairs. My facility considers this type of chair to be a restraint, so I'm not sure how other facilities get away with it?

Hope this helps:)

ktwlpn, LPN · Jul 20, 2003

Originally posted by NursePatsy
Can a pattern of the falls be determined? Such as the times of each fall, where the falls happen etc.
My facility recently dealt with a similiar situation involving a frequent faller that is also a hospice patient - with 75% of the falls occuring between 4pm - 6pm (determined through tracking). We tried everything imaginable. As our last resort, Social Services arranged for family members to be present at the high risk time until hospice can find a volunteer. The family is very supportive. so far, so good.

I have also heard of other facilities using Adirondeck chairs. My facility considers this type of chair to be a restraint, so I'm not sure how other facilities get away with it?

Hope this helps:)

The residents can get out of the adirondack type low chairs(theoretically ,at least-or the chairs slow them down long enough to enable staff to reach them before they fall over) so they are not considered a restraint here-any device that the resident can get out of or unfasten is not a restraint(lap buddies,low chairs) We were citied due to a resident with over a dozen falls in a day-the facility had to provide 1 to 1 care to keep her safe...According to the state dept of health when you admit a resident you are agreeing to give them the care they require-not having enough staff was no excuse for them....

CoffeeRTC, BSN, RN · Jul 21, 2003

ktwlpn

sounds like my guy. He's settled down a little bit. Right now he's in a wheel chair with a seat alarm and lap buddy. He's able to remove the lap buddy, but at least its slowing him down a little. I like the addirondeck chair idea.

boxermom · Aug 3, 2003

He sounds like he needs a restraint, after you do all your supporting documentation. He needs to walk and tire himself out, and be toileted, repositioned and fed and given fluids and everything else, like labs done before you do a restraint. He needs hip pads to decrease the risk of injuries if he falls. He needs either his family to be of assistance to staff when he's busy or he needs to be transferred to a different facility if you aren't able to keep him safe. You sound like a great nurse, your administations sounds like they aren't in the real world.

Monica RN,BSN · Aug 3, 2003

Reply to comment " make an incident report each and every time and state the reason as lack of proper staffing and management has been notified" I will agree to make an incident each and every time, but in our facility if a nurse would have written the cause of fall was due to lack of proper staffing the nurse would have to rewrite the report. That information would never be allowed in an incident report. I would suggest making a separate letter to administration stating the unsafe practice and liability involved, go above the administrator if you have too. And if all else fails make an annonymous phone call to the ombudsman or elder affairs people who handle nusing home complaints. This will prompt an investigation on the facility and then management will have to listen!!

blueeyes827 · Sep 5, 2003

Our facility works very hard on preventing falls and still have a few who just are very persistant so we must be creative. We have a fall form to fill out after each fall............the nurse on the floor immediately so we can see what was found when the resident fell such as: were the alarms attached and working, all safety equipment in place, ask the resident what they were trying to do ( it is amazing that some of our demented residents are consistant with their response), do they need toileting, when did the eat last, last meds given. The unit manager then does a chart review and requests med review by pharmacy. PT/OT screens for least restrictive measure and begins treatment for strenghtening.

Things we have tried:

merry walker............but they can be dangerous if the resident climbs out of them.

aggressive toileting programs,

snacks,

changing med times

reducing or changing meds

using bolsters on the bed

low beds

various alarms

activities

restorative program---a must

family input

We meet weekly with a fall committee with a respresentative from all departments to come up with creative solutions.

deadend · Sep 15, 2003

I am concerned about frequent falls also we have tried everything however it appears that the staff are desensitized to fall incidents (even the nurses) we do have a new QA person however she is just getting to know the facility, supervisors on each shift are to review the incidents reports including myself however one stubborn supervisior does not seem to get it right and wants to dump all the fall investigation on me ADON what are my liabilities in regards to fall investigations? does anyone out there know how I can protect myself some of the documentation on the falls incident report is horrifying please help

blueeyes827 · Sep 16, 2003

In our facility we had a lot of nurses who did not want to follow procedure post fall. We made up education forms. We spent a lot of time educationing them. I always keep a copy of the education form and the DON keeps the original. She logs them and then they go to the employee file. We also had inservices to educate CENA's and all other staff members. We taught them that no one can go by a room with an alarm ringing. We also taught them how to use all equipment. It sounds like you do not have a team approach and your survey team will see that on survey. We also super glued are alarms to the on position and the loudest sound. Education forms have helped the most, unfortunately there are some who need to be written up. This has to be consistant across the board. Good luck

Nursie30 · Sep 22, 2003

We have stated the falling leaf program, had all staff sign a protocol of at risk residents, any resident that scored higher than 10 on fall risk assmt was placed on this list, first one down, last one up, helmets, siderails down, low bed, mattress on floor, pressure mat on floor, safety alarms, velcro restraints, lap buddies, all evaluated for effectiveness through OT for positioning device and which is the least restrictive for that resident, staff education is very important, drilling it into their heads, but falls have decreased dramatically since implementing this program (no longer work there, can't say about since I left last week, but it was working)