pt falls - page 2

by ekeeven

The unit I work on has had 21 falls from Jan to end of Oct.. I need advice on how to decrease these falls... we do frequent rounding, yellow socks, armbands, signs, sect, and anyone his is not up ad lib is on a bed alarm... I... Read More


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    Bravo to your orthopedic unit! It sounds like there is a collective awareness on your unit of what needs to get done and I'll bet most staff are on board. I'm a firm believer in culture being the glue that brings all this together. There is so much variability from organization to organization, unit to unit, and sometimes even shift to shift. By culture I don't just mean unit culture (ex staff following protocols). While that is a biggie, how the organization is operated in terms of resources/staffing, etc, and leadership support play huge roles in the big picture of things.

    There are numerous toolkits online...almost overwhelming. Focus on trusted sources such as AHRQ, Joint Commission, American Geriatrics Society, US Dept of VA, and the CDC has a STEADI toolkit that is great.

    Infrastructure can be created with programs such as TeamSTEPPS and Comprehensive Unit-based Safety Program (CUSP), but this would be a huge undertaking and would need to be supported by leadership. Both can be accessed via AHRQ website.

    Understand what your improvement process is at your facility (DMAIC, PDSA, other) so you can ask what needs improvement? How can we improve? How do we know improvements are working? You will need a team and unit champions.

    Overall, falls prevention requires a multi-factorial approach that is standardized, yet also tailored to the needs of the patient. Patient/family centered approaches help even more, if possible. Assessment tools, assessment frequency protocols, attention to meds, rounding/huddle practices all enhance standard approaches to falls prevention (footwear, identification, call light, etc). From my experience, most falls are related to toileting and are unassisted. The link below is a nice presentation that was done by the National Patient Safety Foundation last February 2013. In there you will see the Joint Commission root cause on falls is related to assessments. Not just tools, but frequency and circumstance.

    Good luck! And be sure to measure your outcomes...you may even identify that an intervention done for all patients that is really only applicable to a certain risk level.

    http://www.npsf.org/wp-content/uploa...ion_LAG_MF.pdf
    herring_RN and GrnTea like this.
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    I have see falls from malfunctioning bed alarms, leaving people in the bathroom alone who are fall risks, low hgb/narcotic induced dizziness, slipping and falling on spilled water/urine. I would look at the source.
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    Yellow socks, schmello socks.. the only thing that can prevent falls is adequate stafffing.
    imintrouble, IowaKaren, nrsang97, and 1 other like this.
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    Quote from Been there,done that
    Yellow socks, schmello socks.. the only thing that can prevent falls is adequate stafffing.
    I like the assessment and protocols. The take time. Sufficient staffing will be needed to implement the protocols.
    AJN article: http://journals.lww.com/ajnonline/Fu..._Shift.21.aspx

    Nurse staffing and patient falls on acute care hospital units: http://www.nursingoutlook.org/articl...230-6/abstract

    Missed Nursing Care, Staffing, and Patient Falls: http://journals.lww.com/jncqjournal/...t_Falls.2.aspx
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    We have a 31 bed unit and our staffed about 4-5 sometimes 6 patients per nurse on days and one tech from 7-730 and a bath tech from 8-4 and no unit secratary . On nights the nurses have 4-6 often 5 or 6. And are lucky of they have one tech for the entire unit. Anyone who is not up ad lib such as 40 year old chest pain patients get bed alarms and we do yellow socks and hourly rounds
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    Do you have CNA on your floor? Get them involved. Talk to your supervisor, maybe it's time for a staff meeting. Patient safety is number one. You also have your unit's reputation at risk. Make a list and start from there. Make sure your include everyone. Get feedback from your patients that fell also. Start at the source.
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    Feel the need to expand on the yellow socks,schmello socks point of view.

    Each and every patient is a fall risk and needs to be so regarded.
    Each and every patient needs non-slip foot wear, etc.
    The time wasted putting on color coded socks, signs, arm bands.. may have actually prevented a fall.
    canoehead likes this.
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    I am a NA in the UK. Our situation is very different, because most of our patients are nursed in open wards (that look kinda like this one, but is not my hospital). So it is very easy to see all the patients, and if we don't, we normally get the pt in the next bed hitting their call light to say pt x is getting up.

    What we do:
    - Increased rounding on fall risk patients, especially at night. We offer the toilet, a drink, etc every 1 hour or sometimes more frequently. (we only offer at night if pt is awake)
    - Keep the high fall risk pts in the bay nearest the nurses station.
    - dim night lights at night so people can see their way to the bathroom.
    - 1:1 for very confused pts. Or sometimes 1:6, with a nurses assistant based just in that bay.
    - Screening for UTI and postural hypotension for patients on admission. (urine dip weekly for all patients, standing and lying BP on admission as part of falls risk assessment if they trigger it).
    - Side rails if a risk of falling out of bed (but not allowed to use them as restraint, only to prevent rolling out)
    - Family encouraged to bring in slippers or other non-slip footwear.
    - review weekly by nurse to update "falls risk" list. They look at changes to medication, mobility, etc.

    We are a busy unit with a lot of elderly, confused patients, but we manage to have a fairly low falls rate.
    herring_RN likes this.
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    Decades ago I worked on a 32 bed ward. It was common for a patient to call, "Hey nurse; look what he's doing."
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    That would be kinda nice ... but unfortunately all our rooms are private


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