Frequent Faller

Specialties Geriatric

Published

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 indented and is very soft. I have talked until I'm blue in the face about safety and calling us to help her to the bath room or any other needs. Yet she continues to refuse to do so. When I ask her why she says "I don't know." I have sent this lady out to the E.R. several times due to falling and hitting her head. She is her own responsible party and refuses to wear any type of restraint, bed alarm, walker or cane. We had a treatment team meeting with her, her family and the facility Social Worker and D.O.N. We explained that there are special dangers to her falling due to her skull being caved in already (which by the way is from years earlier before she developed the Parkinson's symptoms). That if she hit that part of her head on the bedside table or somthing like that she would be severly injured and possibly coma or death. She states she understands all this and still refuses to wear any type of safety device. She can pass any and all Neuro or Psych exams you can throw her way, meaning we can't restrain her in any way unless she agrees to it or we will be violating her rights. I'm out of ideas!! I'm afraid if she does fall and end up in a coma or dead WE will be blamed!..I've asked them to get a signed statement releasing us from any liability, but they have yet to get that done. I'm the night supervisor and I instruct my staff to do a visual check every thirty minutes, and wake her for toileting every two hours to try to prevent her from getting up without assistance. But that is very time consuming and we have 98 other residents to care for too...Does ANYONE have any suggestions? I really think she will fall and kill herself. The last fall (happened at the beginning of my shift) she was sent to the E.R. to have sutures only 3 inches away from the area of the head that is caved in.

those are some ggod ideas...thanks

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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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Just a passing thought.......placing someone in a beanbag chair "because it is difficult to get out of" could be seen as restraint, too. Better to use one to "assist in preventive pressure area care."

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At the facilities I consult in we use low beds, bed and chair alarms,baby monitors, and motion sensors. If you choose a baby monitor- make sure that you do not call it that. The state may cite you for a dignity issue. We careplan them as "Adult Sound Monitors". Also- we buy the motion sensors from a local Radio Shack. They work as well as any of the more expensive ones you will find in your supply cataloges.

The motion sensor uses a light beam that alarms whenever the beam is interupted. Maintenance attaches one part of it to the wall at the head of the residents bed. Then we attach the other part to a portable base (maintenance made some similar to the standing "wet floor" signs used). When the resident goes to bed- staff position the "portable" piece of the alarm at the foot of the bed and turn it on. By having a portable base- it can be moved out of the way during the day (stood in the corner of the room) and that piece of the alarm doesn't get lost. Before we started using this base- pieces of the alarms kept disappearing (res picked up and carried out of the room, got knocked into the trash, etc.) The base will help to keep your expenses down. Also remember if you choose to use a beam alarm- put the bed against the wall so the resident has to get out of bed on the side the alarm is on.

Residents who have parkinsons and other disease processes that make their gate/balance a challenge are difficult to care for. We have come up with ideas for safety while in bed but a bigger challenge is how to keep them free of injury while they are ambulating.

Have you discussed an adult "merry- walker" with this resident? It is a piece of equipment that is made from PVC that serves as not only a balancing tool- but also has a seat for resting. They are available in therapy cataloges. Although it is an assistive device- this resident should be able to release it independantly. There are alot of mixed feelings about these walkers (dignity) but the safety of the resident needs to come first.

Unfortunately discharging this resident to another facility will be difficult because when they come in to assess him and read the chart- they will see the concerns and there is no miracle out there that one facility has that will solve the problem of an independant resident that falls. And in order to discharge- you have to have somewhere to send him...or you can't discharge.

Good luck- if we think of anything else-we will pass it on to you.

klare

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Specializes in Geriatric/ Home Care.

In one facility I worked for we used an alrm that would ring outside the residents room but not "in" her room so we could monitor her getting up but the alarm didnt bother her at all, she was aware it was there but as long as she couldnt hear it she didnt mind us monitoring her. Also I just wanted to add....I attended an MDS seminar a week ago and it was mentioned that the low beds were not appropriate for some ambulatory patients, and considered more of a danger, I hadnt heard this before so just an FYI....read the manuel to be sure!

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We have people cruising the streets using walkers. I don't consider them a dignity issue, they are a fantastic aide to independance. We aren't allowed to use alarms though, they aparently breach the reidents charter, bummer, they are a great aide.

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I think all the best advise has already been given~,,, As I have been in assited living for the last five years,,, little out of the loop as far as skilled units,,,,,

One thing comes to mind our insurance company risk monitor during one session,,,, Indicated we cannot say,,, write,,, think,,, we can "prevent" falls,,,, We can & do care plan all precautionary measures taken to protect the resident from falling,,,, protect them from injury,,,

Love the lazar light idea and think I will be doing more research and try to use it with a couple of my asssisted living residents,,,

I'm not sure if a signed letter releasing you from liability will hold any value when the incident occurs,,, The resident being A&Ox3,,, her stubborness,,, etc,,, will all be forgotten by the family at time of serious incident,,,,

Think it would be time in family care plans,,, to insist she wear at least protective head gear,,, comply to some of your requests for her protection,,, she is a danger to herself,,, Stress mental health consultation for the continued self destructive behavior,,, Insist if she doesn't try to comply,,, that another placement would be more appropriate,,,

I don't know what state you are in,, In florida,,,, since senate bill 1202 passed,,,, all adverse incidents have to be reported to the state within 24 hours,,,, with a follow up in 15 days,,,, that determines whether or not an investigation will follow,,,,

An adverse incident,,, amoung other things is defined as incident which happened you had control over,,, knowing what the facility does about your resident,,, If some measures are not taken and and at least attempted,,, It is your responsiblilty,,,,,

Last to repeat,,, DOCUMENT!!!

~~kitamoon

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Specializes in MS Home Health.

Will she wear a helmet?

renerian

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To renerian, nope she wouldn't wear a helmet either...I've tried that,,,,

To KlareRN..that is a wonderful idea about getting the alarm from radio shack!!!...i was just "elected" Chairperson of the Safety Committee at my facility and I will bring up all these wonderful Ideas at the next meeting!!....you are all GREAT!!

P.S. I finally got the family to agree to at least a belt restaint while in bed at night...how did I do it??...it was simple, really, we have to report all incidents to family members with the hour (if they can be reached)...since the night time was when most of the falls happened, I just started making sure the sister was call every time, no matter what time, also, she is private pay and all the EMS bills go to the sister, about a week of calling her at all hours and having to send her to the E.R. for evaluation and Xrays, she finally decided to bring it up herself!!!!...and the doctor JUMPED! at the idea..lol...Thanks again everyone!!...I'll let you know how the other ideas work out!!

StormyCD

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To renerian, nope she wouldn't wear a helmet either...I've tried that,,,,

To KlareRN..that is a wonderful idea about getting the alarm from radio shack!!!...i was just "elected" Chairperson of the Safety Committee at my facility and I will bring up all these wonderful Ideas at the next meeting!!....you are all GREAT!!

P.S. I finally got the family to agree to at least a soft waist belt restaint while in bed at night...how did I do it??...it was simple, really, we have to report all incidents to family members with in the hour (if they can be reached)...since the night time was when most of the falls happened, I just started making sure the sister was call every time, no matter what time, also, she is private pay and all the EMS bills go to the sister, about a week of calling her at all hours and having to send her to the E.R. for evaluation and Xrays, she finally decided to bring it up herself!!!!...and the doctor JUMPED! at the idea..lol...Thanks again everyone!!...I'll let you know how the other ideas work out!!

StormyCD

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I would think you would be covered well if you made a point to document that the pt refuses and is aware of the risks. Our facility used to have alot of restraints until the state said one year that the residents have the right to fall. We are now a restraint free facility (which sucks because most are too confused to know they are restrained in the first place) we use the alarms, both bed and chair, & low beds. The baby monitor is a great idea! I will have to remember that one, but it got me thinking about something else to, You know those motion detector fish that sing? Well I have seen frogs that ribbit, suns that sing "Good day Sunshine" (got one on the front porch:D )Dogs that bark etc. when you walk by them. Maybe your resident won't be to happy with one of those in her room, but maybe her roomate would like one? That way it would work for her and be in the roomates possesion. Also maybe the family would be willing to pay for a personal care giver to sit with her at times of days she has the most falls.

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Try the low bed( but if you put a mat there she might trip on it. ) She might go for a pressure sensative alarm but might figure out to turn it off !! Move her closer to nsg sta. We used to use Qhr obeservations which I dropped to Q15mins on my fav frequent faller (the CNa's will love ya !) Toileting schedule helps. Psych ? We had a program that ID'd these residents so that everyone passing will take a look. I'd get a urine bet she has a UTI........

My lady who fell constantly did it during state survey and broke her hip, talk about murphys law !! I had any and ALL documentation in chart the refusals/ family meetings ect. The next day "they" of course asked for her chart and I pulled out my folder full of observation sheets and they seemed pleased and didnt dig any further.

document document document

deb

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