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| No. 10 | 
Jul 26, 1999, 09:21 AM
I am a restorative nurse in a 50 bed dual diagnosed long term care center. I am also known as the "device queen" and fall risk coordinator. I have the worst scenario and I'm sure everyone has seen this. A very frail lady, extreme balance problem, unsteady gait (needs contact guard assist to ambulate) and she has alzheimers and has forgotten that she can't walk safely. After several months and several falls we finally have success. All of her meds and labs were evaluated, as were her sleeping patterns, toileting needs, and intake. She was taken off of all psychotropics and is now taking effexor for depression, remeron for depression and appetite stimulant,and megace for appetite stimulant. She has a pressure bed alarm with an adaptor for the call light system and a pressure chair alarm for her w/c. We use a very lightweight self releasing waist restraint and find that pulling her blouse over it keeps her from noticing it. The bulky waist restraints are annoying for most residents. The audiologist found excess cerumen and diagnosed her with vertigo. After a good regiment of wax removal we noticed an improvement in balance. New glasses with a strap to hold them in place also helped. Her appitite improved and she started gaining weight and is no longer wead d/t lack of nutrients. We also use a biocore mattress (defined perimeter). This allows her to get out of bed, but slows her down. So when the alarm sounds it gives us a few added seconds to respond. Hope this helps. And knock on wood she hasn't fell in 4 months...quite a record.
 | | Advertisement Sponsored Links | | | | No. 11 |
Nov 08, 1999, 05:35 PM
While doing research for a newsletter article on the changing standards in restraint use, I found a great website for alternatives to restraints called "Untie the Elderly" www.ute.kendal.org
One thing many people discussed was the floor- they have a good brief article on good floor care related to fall prevention. Also good info on how to gradually reduce restraint use, and be successful. It's worth checking out. | | No. 12 |
Nov 15, 1999, 03:06 PM
little bit
I hope i can help you. I have worked in a long term care facility in Indiana for seven years and I now practice in Ohio. In Indiana I worked in a 140 bed facility with Alzheimer's and Dementia patients. Alot of the things that have already have been posted are correct. Medications are a big factor in falls and also toileting residents is a main factor. We had devices there which were called Close Call Monitors. They are designed for our patients with high risk for falls. They are basically a small black device that is attached to a residents wheelchair or headboard while in bed. The device is attached to the w/c or headboard by Velcro and on the top of the box is more velcro which a strap is attached to. On the end of the strap is a metal clip which is attached to the residents shirt or gown. What is does is that when the resident tries to get up the Velcro comes loose from the box which causes an alarm to go off and the staff are able to get to the resident prior to the fall, the alarm is loud enough that you are able to find the resident quickly regardless of location. They are not considered restraints because they do not prevent the residents from moving in any way. Sometimes residents will remove the clips from their clothes themselves. In those cases you can clip it to an undershirt where they cannot see it. It has helped our facility to drastically reduce the number of falls without restraining our residents. I hope this information has been helpful and I wish you luck.
| | No. 13 |
Dec 31, 1999, 09:21 PM
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
| | No. 14 |
Jan 15, 2000, 07:45 AM
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!
| | No. 15 |
Jan 15, 2000, 08:00 AM
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!!!!
| | No. 16 |
Jan 23, 2000, 10:50 AM
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).]
| | No. 17 |
Jan 31, 2000, 07:08 AM
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.
| | No. 18 |
Mar 14, 2000, 06:31 PM
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.
| | No. 19 |
Mar 23, 2000, 06:05 PM
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!
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