Frequent Faller

  1. 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.
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  2. 36 Comments

  3. by   anitame
    Well, I don't know if this will help but when I worked long term care we had a few patients similar to this. One of our maintenence guys rigged up a laser light alarm. It's been a while so I can't remember what they're called but the nice thing is they're NOT restraints. We would set one up so the light beam was parallel to the bed. When the light beam was broken by patient (or staff!) walking through the light, an alarm would sound. Actually, it sounded like a doorbell. Much more pleasant than some of our other alarms. There was a choice of 2 tones and it could also be turned off while the patient was being assisted by staff. I don't know if you've tried something like this, but it really saved our butts when state came. It was one more intervention for the high risk for falls care plan and it really did work for some people. Also, it would free up your staff some at night! I hope this helps. Let me know if you want more info and I can contact the facility and see if I can get the name. Good Luck! I know it's frustrating!
    Anita
  4. by   anitame
    I just thought of something else that might help during the night. A baby monitor with the base in the patient's room. I can hear my 2 year old breathing, it would be very easy to hear if she was getting up. The receivers have the ability to be run by batteries. I've seen them with 2 receivers too, one could be at the nurses station for those RARE moments at night when anyone's there! And the other could be clipped onto a lucky! someone's belt.
    Again, good luck

    Anita
  5. by   bandaidexpert
    Stormy, I have worked in LTC for so long, these type of residents are so common. Have you tried a bed alarm? It's a strip that is placed under the sheet on the mattress. I have found this is very effective. The alarm goes off at the nurses station as well as the unit. There is also a chair alarm, if attached to the back of a resident's collar, it can be effective too. Good Luck. We just instituted a narrative with our admission packet that informs family and residents that falls, skin tears can happen. This facilitates calls from staff to family if a fall or skin tear etc. occurs. Non-compliant residents are very frustrating. I am sure you are doing what you can, while allowing independence.
  6. by   ucavalpn
    I don't think your pt. will go for it , but I once worked LTC and had a pt. who wore a helmet . He still fell but at least his head was protected.
  7. 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
  8. by   Catsrule16
    Have you thought about using a bicycle helmet to reduce the risk of head injuries? I realize the resident has the "right" to be free of restraint but the resident also has the "responsibility" to cooperate with the treatment plan. If you feel your facility has done everything possible to protect this resident and he/she continues to be uncooperative with the treatment plan AND you have the documentation to support this, you can discharge this resident. Make sure you read and follow the regulations regarding discharge. Can't think of the F tag for it but there is one. If you truly cannot provide the care this resident needs to remain safe, then the resident is inappropriately placed and it is the facility's responsibility to inform and assist the family with finding more suitable surroundings. Since the resident is able to pass all the neuro and psych testing, then he/she should also understand the consequences of his/her uncooperativeness with the treatment plan. Include your Medical Director and the resident's physician in the process.
  9. by   night owl
    Stormy,
    I know EXACTLY what you're going through b/c we just went through an exact situation with an 80 y/o parkinson's. He wanted to be independant, didn't want any alarms, belt, helmets you name it. After the last fall where he had to have sutures on his head, we finally had to put him on a 1:1 COS for fall precautions. He understood everything you told him, but he never would be compliant with anything. He hasn't had a fall since b/c we did it for his own good. (and ours too.) He still gets oob and all, but someone is ALWAYS with him when he does, and it takes alot of worrying off the staff. I find that you may be going in this direction especially if your resident refuses to be compliant...It'll prevent any further injuries and it will only insure her safety.
  10. by   jevans
    Unfortunately if your patient has capacity she can refuse any form of treatment. I'm sure you've documented that she refuses to comply but that is as far as you can take it. I completely agree with your request for written confirmation from the family though. How ever they do not have to provide it [ because if a patient has capacity they are the only person that can provide consent or refusal]but if you document that you have spoken to them about the risks with another member of your facility present, then you will be covered
    Must say I absolutely love Anita's suggestions and would apreciate more info please
    Good luck
    j
  11. by   StormyCD
    Thank you all for the support. Anita, yes I would like more information on that alarm. I'm sooooo glad I'm not the only that has to go through this....Thanks Again,

    StormyCD
  12. by   night owl
    Anita,
    That laser light alarm sounds like a great idea to me. Please if you can get any information about it I would certainly appreciate it, and so would my residents. Thanks a bunch.

    PS. By the way 1:1 COS for fall precautions is a medical decision and at least in my facility you don't need resident permission or family's permission. If the Resident is endangering himself in anyway, it is the physician's decision to place a resident on 1:1 for the prevention of self harm, for the protection, and for the safety of that resident when all other avenues have been explored especially if the resident is noncompliant. I work for the Federal Gov. so the laws may be different for State regulated facilities... I'm not sure.
    Last edit by night owl on Jun 16, '02
  13. by   shygirl
    Hi, Make sure you are charting every avenue that you have tried. Document document, document. Make sure it's charted that she is the responsible party and refuses any type of intervention from staff. Good luck ,Gilda
  14. by   Cubby
    DOCUMENTATION!!! It's the only way to save your ass!

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