Frequent Faller - page 2

I'm at my witts end!!!..I work in LTC. I have a resident that falls frequently, I'm talking several times a DAY! She has Parkinson's and her gait is very jerky with shuffleing. Half of her skull in... Read More

  1. by   semstr
    Helmet, Hipsaver, documentation and a room in front of the nursescentre, plus a very low bed.
  2. by   tex
    I would also like info on the laser light alarm. Thanks Tex
  3. by   night owl
    I've got a story for you all...
    We had a resident about two years ago who was a paraniod schiz and had this phobia about lying down in bed. Had a Hx of a Fx hip already. He would do anything to NOT go to sleep lying down. He'd stand up watching TV by the side of his bed and fall asleep and fall, He'd sit in the side of his bed, fall asleep and almost fall foreward. He'd lie across his bed but propped up on his elbows and slept, but not for long. Then he'd use powder on his family jewels and get more powder on the floor than on him, slip on the powder and fall. He spent half his life on the floor. We gave him a low bed, he'd put the bed back up. Gave him a bed alarm, he'd disconnect it. No matter what we did, he undid it. We always said to him, "Mr. Smith, one day you're going to fall and break your neck!" An NA and I would take turns sitting outside his door where he could see you and did paper work etc, but being there seemed to keep him in bed...the second you walked away, he'd be OOB. We were the only two that were willing to sit by his door...everyone else complained. Documented every night about his behavior b/c we knew that he was a big accident waiting to happen. One morning I went to give him hids meds and he had his curtain drawn when I peeked around the curtain, he was naked, trying to get dressed. I dropped the med cup b/c I couldn't believe my eyes! His entire body (ie) elbows, hips back all had big bruises from falls he had that no one had witnessed. (supposedly) My HN at the time refused the 1:1 "It takes up too much staff." He also had sutures on his head from a witnessed fall. If his daughter ever saw his body we would have had a great big lawsuit. And that's when my NA and I really decided to take turns sitting outside his door. We always said top each other. When he does fall big time I just hope I'm not here when it happenes. Well we both had vacation at the same time ( don't even know how that happened) And then he fell big time. He was sitting on the side of the bed and he fell over, hit the wall with his head and broke his neck!!! and had a subdural hematoma and died later on. If my HN had put him on 1:1, that would never had happened, but she was ignorant to the fact, the Res suffered injury and died. Documentation is good, but it still didn't prevent the injury...just your a$$ form getting sued. What about the Resident??? It's all about him...
  4. by   nursedawn67
    Originally posted by LTC-LPN
    For a *frequent faller*, at the nursing home I work at, we use a low bed (about 3 inches from the floor) with a foam mat next to the bed. If the *frequent faller* rolls out of bed, he rolls onto the mat. The low bed is a bit difficult for the staff to provide transfering, but we understand about preventing injuries to the resident in the least restrictive way possible. We also use bed alarms and w/c alarms (as described by bandaidexpert). Falls are difficult to prevent 100% of the time, despite our best efforts.

    Good luck StormyCD,

    Jane Ann

    We use the low beds where I work too...they are a help.

    All I can tell you is document document document! Make sure to include her unsteady gait and the recomendations to wait for help and that the resident is noncompliant. (you probably are already doing this)...this way when state reads her chart it proves what you have done for her and how she handles things.

    Good luck!
  5. by   Catsrule16
    Wow, Night owl!

    Had they ever thought about getting a lazyboy type recliner to let him sleep in? Seemed like a logical option for this resident. I have seen a recliner used for someone who had obstructive sleep apnea and would only sleep on her back. She refused to use bi-pap because she felt like she was being smothered with something on her face. We did every other day skin checks for breakdown. We had the physician evaluate the continued need for sleeping in the recliner. Got the family involved by including them in the process. Had them sign a wavier with the understanding that if the resident's condition warranted the bed, the resident would have to go back to sleeping in a bed. With the psych diagnosis your resident had, getting the psychiatrist involved would have been most important. The resident would have gotten the illusion of sitting up while reclining and getting rest. Just curious, did they family sue the facility?
  6. by   Tookie
    We have a resident who has frequent falls - she wanders a lot in our dementia specfic unit - after family consultation she wears a helmet - like a bicyles riders helmet- helps when she walks into the walls etc - ( we do not have safety rails in the corridor of our home as we are very much an advocate of a homelike environment ) she is a lot less distressed as she can wander safely at will no more black eyes like she had on admission - familly are happy - she is content to wear it - everyone accepts this
    would this be of use?
  7. by   night owl
    Catsrule16,
    Family was aware of the frequent falls, but they never did sue.
    We did put him in a cardiac chair a couple of times, but he still tried to climb out of it! He needed the constant monitoring which he never received but could have had. Thanks to the wonderful HEAD nurse we had, she thought it would deplete her staff...can you imagine? and the resident died b/c of her stupidity...How sad is that???
    Psych should have been involved indeed, but they weren't...I guess the Paxil he was on was enough... {{{ahem!}}}
  8. by   panurse101
    i too would like info on the laser light thing. We too have a "frequent faller" that has parkinsons. I have noticed that when her falls become a daily or couple times a day however, she has a uti. Once treated, her falls seem to decline for a while, at least.
    Thanks, Tracy
  9. by   BadBird
    Wow, you all exhibit great ideas and patience. I am afraid I am not a patient person. I would notify the patient and family that if they were not willing to allow some type of restraint for safety then they would have to find other living arrangements. When the burdon is placed on the family I think they may see your point and allow a restraint. If the patient is AOx3 then tell them to find another facility. Liability is too risky.
  10. by   night owl
    BadBird,
    Didn't you know that more injuries and deaths have occured while using restraints than without??? a restraint is always the last resort...no matter what...
  11. by   adrienurse
    It's all well and fine to outlaw restraints. But the facility needs to have the foundation, support and skill to deal with the person while not restraining them into a chair. Setting rules and not providing guidance on alternatives is yet another form of abuse to nurses by administrations. It's one of those things that looks good on paper for the facility, but not in reality.

    Question: Are use of antipsychotics considered restraints where you work?

    At our facility, if things are to the point that the person's life is being threatened by falls so frequently we demand that the person has a sitter or any other type of 1:1. If the family cannot pay or the trustee will not pay, then the unit absorbs the cost.

    Recently I heard about a facility that places people in beanbag chairs if they are at risk for falls. They cannot fall from the chair and hurt themselves because it is difficult to get up and it's too low to hurt themselves. Also If everything else has been tried and nothing else works, remove all furniture from room and leave only mattress and a low chair in the room. Also Gym mats on the floor.
  12. by   StormyCD
    those are some ggod ideas...thanks
  13. by   Youda
    You folks are great! I now have some new ideas for my own frequent fallers! THANKS!

    Also be sure to care plan this so Division of Aging doesn't tag you for too many falls.

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