Incidience of falls .

[sweetnurse11]

The incidience of falls and the severity of complications in older people rises steadily with age and with increased physical disability and some times with aggressive patient and very restlessness required nursing interventions to restraint thoses patient by side rails or use of cot sides and use bandages as restraint .*My question is does the nurse should be consulting the doctors or telling the patient relatives the best thing to do is apply cot sides .Next there is any written guide lines relating to the assessment of patient s` potential to fall .

THANKS .

:chuckle :zzzzz

[DAISY MAE 1]

I worked as a resident care coordinator on a dementia unit where

falls were very prevalent. Falls went on to an incident report. I

got those first, and reviewed them, and listed each fall in a monthly log. I was the second line of defense after the initial fall was taken care of.

I reviewed:

[DAISY MAE 1]

oops I hit the wrong button ( I fell )

With all falls I reviewed: Drugs, last necessary drug level, any

new drugs, last falls and any correlation in times, current inter-

ventions being done, locations of falls, possibility of a UTI, or

other medical concerns with their history, vital signs and any

changes noted, whether restraints were involved. There are many factors to take into account, and it comes with knowing

your residents. Sometimes I found that a fall, is a fall, is a fall,

with no rhyme or reason initially. Rather than use restraints,

we used mobility alarms, floor mats, mattresses by beds, custom

made w/c's or equipment to fit specific needs, hi/lo beds that go

clear to the floor. Our third line of defense was to talk with staff,

RT, and other team members as to suggestions on how to prevent falls with certain residents. It's not easy.

[jennilyn]

Restraints are rarely safe, they have their own perils, they should only be used in rare instances. We use sensor alarms, low beds, and many time just keeping the resident in site of the nurse, close to the nursing station, in a day room, or in really troublesome cases, one on one, if we have a very agitated resident. Residents become more agitated when restrained and I've seen a resident hung with a waist restraint, not a pretty picture.

[eagleRN]

If and Only if the resident is highly agitated and nothing else helps, I stay within the legal realm, write a 24 hours order for a geri chair and put them in a place (not isolation) where there is less congestion. Then release and amb them q 2 hrs and at meals, or if they can't ambulate them let them sit in a recliner for a little rest. It takes times, but in the long run it's worth it, and it all within the legal realm. Good question about safety-restraints.

[RhondaRNConsult]

when they're highly agitated you're going to restrain them?????????????

[mtgirl63]

Sweetnurse....In our facility we often consult OT first as to what would be the best type of restraint for a resident --- each has individual needs, and what works for one may not work for another. Before we can put a restraint on we have to first get the ok from the doctor and then get a signed consent from whoever is the decision maker, DPOA, for that resident. We use alot of bed alarms, chair alarms, and only have a few residents that we use bed rails on (too many of them try to climb over them, making even higher risk for injury) and a few that we do have to use soft cloth restraints on when they're up in wheelchairs. Does any of this help you at all?

[adrienurse, LPN]

I realize that it is a whole different story if your in ICU and the restraints are in place to save a life, but I rarely advocate the use of restraints on agitated people. Though this is not always feasible due to time constraints, one needs to find out the cause of the agitation to get the behavior to stop. At least that's the way I've learned to handle things on our 30 bed Alzheimer's unit. If the person is crawling out it can be because of pain, hunger, constipation -- you name it. Sometimes just assigning someone to sit with the person will do wonders. At least you don't have to worry about strangulation. ALso- pay attention to your tone and approach and you may be able to de-escalate the situation. Siderails do not prevent falls. They cause the person to fall from a higher distance to the floor and cause a site of impact that is more likely to result in a hip fracture. Put the bed as close to the floor as you can. Use mats on the floor if they are available, and it you have to roll the bed out in the hall next to the nursing station, do it.

-Ad

[nurse kratchet]

our facility also uses alot of low beds,mats,sensor alarms,motion detectors geri hip pants etc... but my question is when a res. is in a low bed with a mat on the floor rolls oob with no injury. is that an incident report? where i previously worked it wasn't,but at my current job it is. we have a res. who does this quite often. she also has foam supports under the mattress to help prevent this,but they really don't help,it's just another intervention that looks good on the careplan.

[night owl]

That's a good question. I'm no expert, but at my facility we make an incident report out for whatever kind of fall even if no injuries occured. You never know a day or two later something may show up. Then it's documented in the nurses note, The Doc is notified, comes an examines the resident, then makes his assessment. It's better to be safe than sorry...always CYA no matter what.

[nurse51rn]

In my facility, we use almost all of what others have listed. But we also use concave mattresses (they have built in siderails, made of the same pressure relief material as the mattress itself). We use roll control bolsters. We also use recliner chairs, either regular or geri chairs (without the tray table). We try a lot of the usual remedies also: food, fluids, toileting, therapeutic touch, and validation therapy, along with diversional activities). Our rrestorative department evaluates the residents for the least restrictive device needed, then reevals, and then reevals...