resident falls in a long term care facility - page 3

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   kayhaw
    I am an LVN on an Alzheimer Unit in a long term care facility. To answer you question is there any real true way to prevent falls? This is a continuing happening at our facility we have a 30 bed AD unit and most of falls occur with problems resulting from restraints of different types. We do not allow residents that have a lap buddy to have their wheelchair locked. The biggest help that we have is a 1 to 7 ratio of cna to resident that way they are closely monitored and also the added benefit of having the same familiar face helping them at all times.
    Originally posted by Heather27:
    Hi.
    Falls are always a reasonably traumatic thing for the residents/patients, families, and staff included! We always think, "Could I have done something more to prevent this?" Even if a person doesn't get injured from the fall, it would be wonderful if it never happened at all!!
    Of course physical and chemical restraint is ONE way of preventing falls, but the facilities that practice that are, in my opinion, not worth their funding....
    We find that certain residents seem to fall in "patterns" if you will...For example...some when they have missed their afternoon "nap"...some when their grandchildren have just visited (? because they are excited/overtired)...some with the classic "sundowning".
    The key is to know your residents. I often hear from my staff, "Mrs. X is a fall waiting to happen!" We then take extra care to always know where she is, and try our best to keep things out of her way...make sure she doesn't get agitated...anticipate needs...toilet regularly..make sure she has glasses/dentures/shoes/ "safe" clothing..
    I don't think there is any "magic" way of preventing falls completely. Be observant, be careful, and be relaxed. There is nothing like tense staff to rile up residents!!
    Good luck!!
    Heather


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    kim
  2. by   rnanita
    In North Carolina, we are not allowed to use chemical or physical restraints, therefore we have HAD to come up with alternatives, like the Merry Walkers, Lap Buddies & Velcro Seat Belts. I worked in LTC when we used the physical restraints. Some of these residents could get out of them, no matter what.
    I feel the nurses and nursing assistants just have to know their patients, and be always alert for anything.
  3. by   Lois1949
    I don't know the laws in other states but,in Indiana, the residents have "the right to fall and hurt themselves". I have been told by administration I cannot restrain a resident in their wheelchair or their bed because it goes against their rights! Why are we here if we can't protect our residents from injuries from falls? When I asked this,what I thought was a sensible question, I was told the staff's job is to watch these people all the time. Do you believe this? How can you keep tabs on 7o-8o residents,individually, when you have one nurse and two cnas? Some nocs I may have three cnas---someone always calls off.We as nurses are suppose to use our sensible judgement in caring for these people.Not only am I responsible for the resident's safety but,if the cnas don't do their work,I am responsible for that,too!So,am I a glorified babysitter? I feel we should be allowed to do whatever is necessary in order to protect these residents from hurting themselves.Just be sure there is good documentation as to why you used restraints and what restraints were utilized. This is the number one problem in the nursing homes around here. Second is skin breakdown;that's a story in itself!
  4. by   Nancy1
    In Wisconsin we are not to use restraints, the State Surveyors have said I need to reduce the risk of injury, I will never be able to prevent residents from falling. What we have done is purchased special beds, as I have mentioned before. It is not a perfect solution, but it has cut down on injury. NA
  5. by   MEG4
    GOOD CALL ON THE BENZO'S TO MOONSTONE MIST. I AM A NURSE MANAGER FOR AN ASSISTED LIVING FACILITY. I TRY TO REMIND MY STAFF ABOUT POSSIBLE MEDICATIONS THAT MIGHT BE CAUSING DROWSINESS ETC. THAT MAY LEAD TO FALLS, AND ALWAYS CHECKING RESIDENTS APARTMENTS FOR SAFETY HAZARDS (CARPET SWELLED,WET FLOOR/TILE, LOOSE HAND RAILS), GRANTED IT'S NOT THE 100% THE WE STRIVE FOR, BUT IT IS AN EFFORT THAT MAKES US PROUD. I DID HAVE A RESIDENT THAT FELL SEVERAL WEEKS BACK, FORTUNATELY SHE SURVIVED WITHOUT ANY MAJOR PROBLEMS; HOWEVER I WAS VERY CURIOUS TO FIND OUT WHY, HOW? I QUESTIONED HER AND FOUND OUT--1. IT WAS THE MIDDLE OF THE NIGHT (WHICH IS FINE FOR HER, SHE DOES IT ALWAYS); BUT, I DID FIND OUT SHE HAD BEEN HAVING SOME DIZZY SPELLS JUST DAYS PRIOR AND SHE DID NOT TELL THE STAFF BECAUSE SHE THOUGHT NOTHING OF IT, WELL AT HER AGE OF 91, SHE MAY STILL BE GOING STRONG, BUT NOT THAT STRONG. IT TURNED OUT THAT SHE MADE IT TO THE BATHROOM SAFELY UNTILL SHE HAD ANOTHER DIZZY SPELL AND FELL. NEEDLESS TO SAY SHE GOT CHECKED OUT WAS GIVEN PRN MEDS FOR HER DIZZINESS AND HAS BEEN FINE SINCE. WE DO MAKE IT A HABIT OF ASKING SEVERAL TIMES A DAY (ALL SHIFTS) IF SHE IS DIZZY AND MAKING SURE THE STAFF CONTINUALLY FOLLOWS UP WITH HER AND OTHER RESIDENTS. AS FAR AS PATIENTS/RESIDENTS WITH DEMENTIA/MEMORY LOSS/FORGETFULLNESS, I TRAIN MY STAFF TO ASK THEM SPECIFIC QUESTIONS ABOUT HOW THEY ARE FEELING. IF I KNOW MRS. SMITH HAS BACK PAIN BECAUSE OF AN OLD INJURY OR JUST OLD AGE, EVEN THOUGH SHE HAS DEMENTIA DOES NOT MEAN THAT I CANT ASK HER IF HER BACK HURTS, AND IT DOES NOT MEAN THAT SHE CANT SAY "OH, YES, IT HURTS SOMETHING AWFULL TODAY". KNOW YOUR PATIENT/RESIDENT, THEIR MEDICAL/SOCIAL HISTORY. I AM SURE IF MRS. SMITH'S DOCTOR HAS PRESCRIBED DARVOCET TID FOR HER BACK PAIN, IT'S PROBABLY FOR A REASON. WE NEED TO KEEP THE COMMUNICATION OPEN ALWAY, WE SHOULDN'T WAIT FOR THEM TO COME TO US, WE MUST GO TO THEM EVERY DAY! THAT IS WHY WE ARE THERE. HOPE THIS HELPS.
  6. by   SHEEPY50
    I WORK IN A 106 BED FACILITY THAT HAS BEEN RESTRAINT FREE FOR OVER A YEAR. WE HAVE OCCASIONAL FALLS BUT NOTHING SERIOUS. WE USE TAB ALERTS, BED ALARMS THAT RESIDENT'S LAY ON AND ALARM WHEN GETTING UP. WE USE DPM MATTRESS THAT ALLOWS GETTING UP BUT MAKES IT ALMOST IMPOSIBLE TO ROLL OUT OF BED. WE USE BODY PILLOWS AND FLOOR MATS. WE HAVE SEVERAL BEDS THAT ARE ONLY INCHES OFF THE FLOOR WHEN IN LOW POSITION AND RESIDENT IN BED. WE HAVE PT ASSESS FOR "AMBULATORS AT RISK" AND THEY ARE ALWAYS SUPERVISED AND WALKED WITH A TRANSFER BELT TO DESTINATIONS. NO ONE USES A WC UNLESS THEY REMEMBER TO SET THE BRAKE OR NEED TO BE TRANSFERED BY STAFF ONLY. AT THE SAME TIME WE WENT RESTRAINT FREE WE ALSO "PARRED" DOWN STAFF WITHOUT RISK TO RESIDENTS. THE BIGGEST
    OUTCRY WAS WHEN WE GOT RID OF THE BEDRAILS AND MOST OF THE YELLING WAS FROM FAMILY MEMBERS OF RESIDENTS. EVERYONE SOON REALIZED IT WAS THE BEST THING WE HAVE DONE.
    WE TOILET RESIDENTS Q 2HR. JUST MAKE ALL STAFF ACOUNTABLE FOR REDUCING FALL NOT JUST THE NURSING ASSISTANTS.

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  7. by   Christy, RN
    Hi. I work in a 180 bed facility. We, too, have taken many procedures to see that falls are minimized. We use personal alarms, bed alarms, Merry-Walkers, Fall Ease Mats, and Low-Rider beds for our residents who have repeated falls. In addition, we have a system where we tag the residents door with stars. A Red star means that the resident is at risk for falls. A Blue star means that the resident is a Frequent faller. This helps to alert staff to fall status of that resident. I do believe that number of staff plays a role in falls. The facility I work in is frequently understaffed. It seems that when we are short staffed, more falls occur. When we fill out an incident report on a fall, we also have to fill out a Fall Investigative Report. This report investigates whether the fall occured because of a slippery floor, ect. I think that the key to preventing falls is adequate staff and observation. Good Luck, and If you find a way to drastically minimize falls, let me know.

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    Christy, RN
  8. by   WenRob430
    Originally posted by Nanaimo:
    I was curious what people actually thought of the push for 'no restraints'. I work as a geriatric nursing consultant in private practise, but also work casual in a long term care facility. One shift, there were six falls resulting in one broken hip, one fractured humerous and some broken ribs...not to mention numerous cuts and bruises.
    Though there is much lip service paid to 'environmental interventions' such as regular toiletting, I agree with Jen who states that there are frankly not enough staff around.
    If those of us in the healthcare profession truly believe in 'no restraints', then it is clearly unacceptable to simply remove these restraints without implementing REALISTIC replacement interventions.
    FYI:
    The mortality rate for a hip fracture is over 50% in the first year!

    Regards,
    Jackie
    I am so sick of the falls committe I could puke I get pulled from my wing every Thursday for sometime 65 minutes to discuss the futile falls we have!! There is never enough staff to care for these residents and one minute they have the right to fall and the next they do not. Our wing looks like a hell hole with mats on the dirty floor filthy belts more alarms than I cant hear anymore its just outrageous and now I cannot even assess the initial fall we have to leave the resident on the floor till and Rn can come.2 hour toitleting looks great on paper but when u have 9-12 patients as an aid and 36 with 500 meds who has time for that! Im so sick of the people telling us nurses how are job should be done by people with degrees who never even worked the floor. My supervisors spend 2 shifts passing meds when they have to because of call offs and expect me to do it in 3 hours!! And then go to a 65 minute falls meeting where my input doesnt matter!And then there is the issue of Psych meds again oh its a crime ot medicate a nutball so lets just let them hit kick bite and fall all the time or shout till they have no voice !! Its a damn shame when there are so many meds we havent even tried!! Our residents cannot even have a sleeping pill without having to try every intervention under the sun When Im old and in pain and cannot sleep noone better come tell me I cant have a sleeper till I get a back rub or a drink or conversation etc!! Where did residents rights go anyways!!And if I fall because I had a sleeper well then so be it, there always trying to find that perfect answer Why!! Well there is a rational one I had sleeper and at least I slept good before I fell!!
  9. by   km rn
    Are you checking orthostatic blood pressures? We utilize a lot of the approaches listed above - chair alarms, bed alarms, toileting schedules, strengthening programs, etc.

    We focus a lot on injury prevention: geri-hips, fall mats, low beds, etc.

    Do you take your fall data and make control charts? Control charts help identify what are stable patterns in data versus special cause data. Control charts help with healthcare data since our patient population is every changing.

    Of note, one unit thought their fall rate was up related to "short-staffing". Ironically, more residents fell on shifts we were full staffed than shifts that were critically staffed.

    I think polypharmacy plays a huge role in resident falls. Our team has also been looking at that issue.

    How does your facility compare with other facilities re: fall numbers? - remember it is a quality indicator. Are your fall prevention ideas being consistently implemented or is there copy-cat charting that resident x was walked, toileted, etc?

    Good luck - please recognize and reward your staff for the things you have done. Try to get additional feedback from your medical director, consultant pharmacist, etc.
  10. by   Tiara
    While it's all well and good to come up with ideas to prevent/soften falls, the truth is when they did away with restraints the idea was to have optimum staffing to reduce falls. There is no alternative for adequate staffing, and unfortunately, this has become the nurses' problem. Why should the nurse be responsible for knocking herself/himself out to come up with a solution to an administrative problem?
  11. by   nursejanedough
    km rn, are you serious? Blaming the falls on meds or orthostatic hypotension? Tell us the truth, have you actually worked in LTC as a floor nurse for the last 6 months for at least 8 hours a day? Old, confused, wobbly, "unrestrained" people do fall. And get broken hips. No fault of anyone, but family and medical staff don't want to tie down everyone. Don't you think Ronald Reagan had the very best care? He fell and broke a hip. I wonder if Nancy Reagan is going to sue someone.
  12. by   AndreaMichael
    Hi "LittleBit"
    I manage a small rehab facility with an average LOS of 20 days and the vast majority of these are over 65's. Cannot say we have any innovative new ways to preventing falls -- that's a really complex question. However from reading your message I detect a unique way of review and I wonder if I could obtain a copy of your protocol for your weekly review of falls. I think this initiative is to be lauded. My email is andrea.corbett@waihealth.co.nz
  13. by   km rn
    JaneDough I am no longer a staff nurse - however, that does not negate what 17 years of nursing has taught me. Please try to see the bigger picture.

    Yes some falls are caused by staffing, some are not. It is very easy to blame everything on staffing yet you yourself acknowledge that gait, balance etc. are common problems with our residents. What kinds of things does your facility do to help residents with gait, and balance issues.

    Was Ronald Reagan wearing gerihips? Did he have a low bed and fall mat at bedside? Yes - falls and fractures happen...sometimes a spontaneous pathologic fracture causes the fall.

    Bottom line - meds need to be checked. On multiple occasions, residents have had significant orthostatic b/p issues - but a check of their meds revealed diuretics, and 2 anti-hypertensives. Please look at the studies that identify adverse drug reactions when residents are one 4 or more medications.

    I remember what it is like to work in the trenches - we can't beat ourselves up because a resident fell or a resident sustained a fracture. Control charts help prevent management from over-reacting to fall numbers and making knee-jerk reactions based on one month's high fall rates.

    If a fall/fracture goes to court, you can bet that the expert witness hired by the family's lawyer will be looking at medications, orthostatic blood pressures, strenghening programs, injury prevention devices, etc.



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