What to do when a patient falls?

[Nurse_Tricia]

Being a new nurse of just 2 months, I have been working in the LTC and have had 1 patient fall on my shift and another fall on my shift but was the other nurse's patient (although I was first to respond to her patient although she was closer but the latest 2 minute gossip was more important). The first patient I was told was lowered to the floor by the aid. Since I had only been working as a nurse for about 14 days, the other day nurses came to assist me. I guess I want to get more comfortable with what signs to look for and when do I leave them on the floor and not move and when to assist them up.

Obviously if they are in pain or obvious fx, I leave them on the floor and do not move them and call 911. But what do I do for someone who fell and says they don't have any pain? I know I do visual assessment and vital signs. Do I do range of motion and see if they have bilateral, equal grips? What do I do if they fall and are in an uncomfortable position and want and are trying to move? How do I know they don't have an injury that they shouldn't be moved? What other types of assessment do I do before assisting them up to make sure I am not going to harm them more by assisting them up? I am trying to get answers and research situations that I am uncomfortable with so if they happen again (and in LTC I am told they will) I can be more prepared.

[foreverhopeful]

I'm just wondering WHEN or what situation do you NOT help the patient get up and just call 911 instead???

[CapeCodMermaid, RN]

I leave them on the floor if there is an obvious deformity of their hip, leg.back, whatever. If they are screaming in pain I leave them on the floor. Otherwise..up with assist.

[gentlegiver, ASN, LPN, RN]

AlmostABubbieRN said:

You should have a protocol in your facility.

If they hit their head, neuro checks.

In my facility if it's an unwitnessed fall... Neuro's Q15 x1hr, Qhr x4hr, Qshift x48hrs. If head injury is suspected

--> ER, if c/o pain -->ER. But remember to watch them for a long while after a fall, even when Neuros are completed. I had a resident who fell, no c/o pain-discomfort, Neuro's wnl, continued to do self care. 4 days after the fall, the CNA's reported to me that she was walking funny, having a hard time standing, sent her to ER, DX---> Broken hip, needed surgery. Sometimes it takes a while for injuries to show themselves. Another Pt (non-ambulitory) fell while out of building, (nothing reported to us) 3 weeks later she comes to me c/o leg pain, has a real nasty bruise around her lower leg, ---> ER, DX---> broken fibula, 3 weeks old, already calcifing. Scary but true, just be aware of your Pt's baseline, history, and don't freak out! Your a new Nurse, all this will come with time. I had an instructor that told me it would be 5 years before I felt confident in my judgements, she was right!

[A C Gambino]

I agree with the short term interventions mentioned here and feel an emphasis must be placed on having a clear definitive protocol for addressing the incident. Having a wide range of fall cases litigated for both plaintiffs and defendants I can say that a clearly defined process and a staff that is well educated and versed on that process will not only save you in the court room, it will (most importantly) result in proper, timely care of the resident/patient.

[fluffypancakes]

I too a new RN. I was left to handle 30 patients by myself (no preceptor) after a week and 3 days training. I had my first fall last Friday and didn't know what to do. A nurse from another floor helped me all the way. Reading the previous post, I would like to ask a question. If a fall wasn't reported, as in the previous post, and it turns out weeks later that patient has a broken bone, who is at fault? How do you document that to cover yourself?

[lauriepat, ASN, RN]

ROM, skin check, did you hit your head? CP, HA, dizziness? SOB? If there is a deformity i leave them on the floor until EMS gets there, vitals, grips equal BL? Perrla? A&o x3? Mental status baseline? Then i do an incident report/notify family.

[NutmeggeRN, BSN]

When someone falls I click my heels and ask to transported to another dimension......when that fails I do all the above and we do neuros q2 hours x24 on any injury involving the head or unwitnessed fall......and then we also do vs qshift for 72 hours with a note written every shift.

My least favorite thing about working in LTC

Resident falls

Resident deaths

Staff call in

in no particular order!

[x19amanda]

If anybody falls, you immediately assess the postion that they have fallen in, and begin vitals and a head to toe assessment. Ask the res if they remember how they fell, if they hit there head (if they did Neuro's should be started) and check for ROM and any skin integrity issues. After reviewing all that, get res. back into bed etc. If the res. experienced any skin issues begin skin treatments etc. If it's a serious fall I'd call the ambulance before calling the doctor for an order because obv they wount say no. Next call the doctor or we have a doctor book to leave the message on how it occurred etc. Call family members next. STart documenting on the incident with incident reports, on house report, in the charting. Take steps to prevent reoccurence such as if they need a floor mat etc. It will happen often so be ready.

[geriatricRNBSN, BSN, RN]

I am sooooo sick of falls I could scream. I had 32 falls in a 77 bed facility last month. One resident fell oob so many times we put the mattress on the floor and she fell off that too! Caregivers cannot give good care with a resident on a mat on the floor. I believe the focus should be preventing injuries. If the intervention prevents injuries, shouldn't that be the point? If the resident rolls oob nightly onto the mat and is not injured, why count it as a fall? Problem solved to me. Ok, they roll oob bed nightly onto the mat but by george, there was no injury. Why continue to write that up as fall with never-ending paperwork if the intervention works. Our policy states a NEW intervention should be instituted with each and every fall. Well, try and think of 101 interventions. Half of them to me are mickey-mouse and retarded. Anyone else truly struggling with this or am I the only one going crazy over this? I truly think the focus should be on preventing INJURIES.

I know I have an attitude tonite but I am sick of it. Just needed to rant a little!!!

[KRSLPN, LPN]

Quote

Im just wondering WHEN or what situation do you NOT help the patient get up and just call 911 insted???

One instance, off the top of my head, if upon assessment it's obvious a lower extremity is fractured (hip, leg, ankle) I would not move them, just summon the ambulance

[Beetee]

Sadly about a month ago my wife passed away. I haven't got the complete autopsy report back but I have a feeling why she died. My wife was a fighter and had fought lung cancer ( it was non active) and she had copd. To make a long story short she was in micu and fell out of bed trying to scoot over the bed rail I suppose to use the restroom. This happened at 12am and I had just left her at 9pm. I wasn't notified that she had fallen until 10am that morning and that was by a team leader who ask me had anyone called me which is standard procedure. My daughter witnessed the room recording of her fall. She said it was obvious something happened when she fell because she acting like she had been knock out. The RN on duty did call me at 5:40 that morning to inform me my wife's vitals were not that good and I needed to get there to see the dr when he came thru. He never mentioned her falling only her vitals weren't very good. I got there and she was non responsive and had a bruise above her right eye. This upsets me very much because 1 I was never called and I don't believe the RN followed proper procedures for possible head injury. I was told she was 98% in a vegetative state and would not make it. How does someone be fine at 12 am and able to throw her legs over bed rail become a vegetable by 6am that morning? I'm very upset about this and I feel she was cheated out of her chance at life by some lazy employee who had only 2 patients to watch and couldn't handle his job. Now my best friend is gone because of his action or non action.

[downsouthlaff, LPN]

Depends on facility policies and procedures. I have been a Nurse in the nursing home for nearly 2 years and have worked in nursing homes for five years. Sad to say but from my experience falls are an every day thing. The nursing home at which I practice doesn't have any strict guiding policies and procedures on falls. As the LPN on duty at night and the highest credentialed Nurse in the building on the noct shift since RNs are only there during banker hours, I assess the circumstances and the residents C/O. One of the first things I do is a neurological assessment and establish if there was a good possibility if the res hit there head. Just because the res hit there head does not necessarily mean they are automatically going out for eval. Usually the attending physician will take into account numerous things such as is there swelling ? Raised area? Pupillary response. Change in LOC. B/P and pulse. Most often with none of these S/S he will just order neuro checks per protocol. Then I assess for physical injuries.Bruising, pain, ROM. Using all of this objective data I will make a determination to either with CNA staff assit to lift patient from floor back to bed or chair, or keep on floor for EMS transfer and then document all of this data in a nurses note and I&A. Falls are one of the best occurences in LTC to practice and gain good assessment and nursing judgement skills if your state allows you to do so as an LPN/LVN.