resident falls in a long term care facility - page 2

I am a DNS in a 90 bed long term care facility in Vermont. I am looking for unique ideas as to how to prevent falls. We have tried everything in the book I believe and still have too many falls in... Read More

  1. by   NH nurse
    I work in a 160 bed long term care facility. Our facility is in the process of going restaint free. We also use the merry-walkers, and the alarm previously described in the residents wheelchairs, beds, and a personal chair in their room if necessary. We have also started using lap buddies and velcro seat belts which most of the residents are able to release on command. We have had much success with these alternatives. We also bring our high rick fallers to the lobby where they can be better observed. We have had few incident since we started these programs. Most of our falls lately have been the mentally alert, who "forgot to lock their wheelchair", or "just lost their balance". I hope your programs will be successful. God Bless
  2. by   theleader
    Originally posted by little bit:
    I am a DNS in a 90 bed long term care facility in Vermont. I am looking for unique ideas as to how to prevent falls. We have tried everything in the book I believe and still have too many falls in my opinion. Some of the things we have tried are tab alarms, checking glasses of the residents who fall, checking their footwear, screening by PT , some residents are then put into a program for strenghtening, those are just a few. We also have a weekly falls team meeting to discuss falls that have happened during the week. Staff attending the meeting are myself, the nurse from the unit comes with the incident report and reads it to the team, other members are PT, Act director, LNA 's . Any new ideas to prevent falls, would be greatly appreciated. I also should mention that our facility has 90 beds, 50 are a combination of short term rehab.. long term care and Palliative, the other unit is 40 beds which is a Dementia Unit where the largest portion of our falls occur.

    Thank-you in advance!

  3. by   theleader
    We had a high percentage pf falls in the LTC where i work over a year ago, but have gradually reduced it to less than 5% now. Our greatest people at risk for falls were those on the med Remeron. Our consulting pharmacist helped me convince our docs that we should try getting the residents of the drug to see what would happen. We kept behavior sheets on those residents for a month to monitor their behavior and also kept track of their falls. Once they were off the Remeron, the falls stopped. Also noticed through risk management, that most of the falls were occuring on the 2-10 shift at approximately 8 pm. And staffing was a contributing factor. So I started staffing a half shift( worked great for high school CNA's) and my falls were reduced from 25 (Over 50%) to less than 5% in one month. Now our fall rate is arounf 2% with minimal injuries. Good luck!!!!
  4. by   EJD-LPN
    i agree i have worked in a restraint free facility and the merry walker,lap buddies and velcro belts is what we used.we still had r falls but they were far and few between.i do thing that you have to know your resident and thier routine and thier needs.
    Originally posted by NH nurse:
    I work in a 160 bed long term care facility. Our facility is in the process of going restaint free. We also use the merry-walkers, and the alarm previously described in the residents wheelchairs, beds, and a personal chair in their room if necessary. We have also started using lap buddies and velcro seat belts which most of the residents are able to release on command. We have had much success with these alternatives. We also bring our high rick fallers to the lobby where they can be better observed. We have had few incident since we started these programs. Most of our falls lately have been the mentally alert, who "forgot to lock their wheelchair", or "just lost their balance". I hope your programs will be successful. God Bless


    [This message has been edited by EJD-LPN (edited January 23, 2000).]
  5. by   reeree
    Unfortunately falls happen. I found it quite effective to make frequent checks on my "At Risk Patients" I know that there is alot to do but it only takes a minute. This is the best way for me to know why they are trying to get up anyway. Restraints aren't the answer. These devices only give you a reason not to check them. If a patient is on a new drug for behavior watch them. The body alarms help some but if you are on another hall in a closed room, chances are you wont hear it. Don't depend on that alone. Train your staff, your aides (which are your back bone). "While you do your adl book take it outside Mr. Patients room and do it. I'll be
    in so-in-sos' room if you need me." You can never prevent all falls. But "keeping an eye" helps.
  6. by   NMB22
    I work in a 30 bed facility. Fall prone residents are watched closely during the day. I've noticed that most of the falls are at night, or between 3-11. We have recently increased our staffing for 2nd shift, which has helped out. During the night we use sensor alarms near the bedside. Every time they move around in bed we can hear them. We also have catch mattresses on the floors of the residents prone to falling. . Some of the restless residents have protective wedges on the sides of their beds so they won't roll out. Frequent rounds, and toileting helps out a great deal. Another good thing with our facility is that during the day most of the residents stay in the day room, right outside the nursing office, and have activities and tv to keep them occupied. This gives u a better chance to keep an eye on everyone.
  7. by   nurse2beee
    Hi. I am currently a Certified Nursing Assistant and in nursing school. I used to work at a local nursing home for my summer job. We had a lot of residents who had been diagnosed with alheimer's disease. So needless of say we had a lot of people falling. It really had nothing to do with the CNA'S on duty, just that the patients were suseptible to falling. We found that if we kept a close eye on our assigned patients for the entire 8 hours that we were there, we found that there was a decrease in the falls. I believe that it had a lot to do with attention. They no longer were "intentally" falling because they felt like they could get attention and love by just being themselves. Of course this does not help with everyone, but it can be a very effective and inexpensive form of preventing falls for some residents. I know that it sounds very trival but believe me even though it is just a small thing, it works.
    I hope this helps.
    Originally posted by little bit:
    I am a DNS in a 90 bed long term care facility in Vermont. I am looking for unique ideas as to how to prevent falls. We have tried everything in the book I believe and still have too many falls in my opinion. Some of the things we have tried are tab alarms, checking glasses of the residents who fall, checking their footwear, screening by PT , some residents are then put into a program for strenghtening, those are just a few. We also have a weekly falls team meeting to discuss falls that have happened during the week. Staff attending the meeting are myself, the nurse from the unit comes with the incident report and reads it to the team, other members are PT, Act director, LNA 's . Any new ideas to prevent falls, would be greatly appreciated. I also should mention that our facility has 90 beds, 50 are a combination of short term rehab.. long term care and Palliative, the other unit is 40 beds which is a Dementia Unit where the largest portion of our falls occur.

    Thank-you in advance!


  8. by   Dayannight
    Like some of the above responses already pointed out, I'll bet staffing is an important contributing factor to these falls. While you'll never be able to eliminate falls entirely, I'll bet you'd notice a significant improvement over the next three months if your staffing of aides were to increase particularly during the hours when most of the falls are occurring. Let's face it, most long-term care facilities are notoriously understaffed....
  9. by   pfoley
    Originally posted by Dayannight:
    Like some of the above responses already pointed out, I'll bet staffing is an important contributing factor to these falls. While you'll never be able to eliminate falls entirely, I'll bet you'd notice a significant improvement over the next three months if your staffing of aides were to increase particularly during the hours when most of the falls are occurring. Let's face it, most long-term care facilities are notoriously understaffed....
    I have read the postings with great interest and sense that falls are of particular consideration in your organizations, as of course they should be to us all who work in long term care facilities. In Nova Scotia, Canada and generally right across this country, falls in geriatric clients are important challenges we face on a regular and consistent basis and we too search to find means to reduce the numbers and severity of them. There is an acceptance, however, of the right of the client to "risk", and the accompanying question of benefit and burden in deciding on approaches which might be employed in a particular client's case. We not only look at what the options list is in terms of safety measures to "prevent" or "eliminate" falls, we also place great weight on the impact the alternative measure potentially will have on the client's quality of life. There are clients then for whom alternative measures reduce quality of life experience; these clients will not have measures imposed. With congnitively intact clients, discussion has been held with them to outline the potential risk so that they have understanding of the consequences. With cognitively impaired clients, about all we really can provide is more frequent monitoring by the entire care team, and an altering of environmental factors which may be increasing risk potential. Of course family is directly involved.
    It is my understanding that legal liability issues are a main consideration and motive in deciding care approaches in America. My question is how far do these very real considerations move the focus away from the client and more toward the meeting of regulations and legal liability concerns?
  10. by   Katele
    I am on a fall prevention team at my facility and I agree with some of the others about looking at what type of drugs they are on especially antianxiety drugs and tranquilizers....if you can work together with a pharmacy consultant you can probably assess and possibly eliminate that certain drug with something else like an antidepressant. Or instead of having that type of drug as a routine med. maybe PRN would even do it. This approach has decreased falls in our facility and also we have to get together with our assistants in order to determine the causes for these falls, if you get to understand the behaviors of the pt. you will likely be able to find the most appropriate intervention because no pt. is the same.
    Originally posted by little bit:
    I am a DNS in a 90 bed long term care facility in Vermont. I am looking for unique ideas as to how to prevent falls. We have tried everything in the book I believe and still have too many falls in my opinion. Some of the things we have tried are tab alarms, checking glasses of the residents who fall, checking their footwear, screening by PT , some residents are then put into a program for strenghtening, those are just a few. We also have a weekly falls team meeting to discuss falls that have happened during the week. Staff attending the meeting are myself, the nurse from the unit comes with the incident report and reads it to the team, other members are PT, Act director, LNA 's . Any new ideas to prevent falls, would be greatly appreciated. I also should mention that our facility has 90 beds, 50 are a combination of short term rehab.. long term care and Palliative, the other unit is 40 beds which is a Dementia Unit where the largest portion of our falls occur.

    Thank-you in advance!

  11. by   monica f
    We use fall risk assessments. Those patients that are considered "high risk" are put in rooms closest to the nurses station sometimes. Other times we use bed alarms. These are placed in either the bed or chair that they are sitting in. This has prevented people from sneaking out of their chairs and beds.
  12. by   espressoqueen
    I worked in a facility that utilized pvc pipe framed beds which put the beds pretty close to the floor, making a fall from bed pretty harmless. The theory was, if they are going to fall, make the fall less likely to be injurious. The beds were equiped to have the heads raised if neccessary. Also, we used tab alarms which alerted us of care needs. Toileting needs, pain needs, and rest needs were also addressed on a continual basis. In this facility, no restraints or bed rails were used to prevent falls.
  13. by   Nancy1
    Hi,
    I have a question about these PVC pipe beds. Are they hydraulic? If not, how are staff backs holding out with beds so low to the floor?
    My facility purchased hydraulic beds that can raise and lower. They go down to about 15 inches and then there is a mat on the floor, which believe it or not we got from Sam's club for $30, instead of going through a medical supply place. This has reduced the significant injuries, at least the number related to beds. If anyone is interested, I will get the company name. Please e-mail me directly. NA

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