Unit Design Blamed for Increase in Falls - page 2

by abundantgrace 3,816 Views | 20 Comments

I work at a 175-bed hospital. I work on a med/surg unit that has been open about 6 months. This unit is different from other units because it is split into 2 separate units, one on either side of the floor. Needless to say, this... Read More


  1. 1
    Quote from MrChicagoRN
    The first thing is to ask WHY they are falling
    seriously??? you are asking why? Do you work in a hospital?
    We get so many advanced dementia/alzheimers patients that have no idea what's going on. People who haven't walked without assist/walkers for years forget that they need these things. Tell them to stay in bed? They don't remember to do this. They just get up. And Fall!We are not allowed to use any restraints at all.
    It is soooo extremely frustrating to have these patients , as in reality , they need a full time babysitter!! Family never helps. Staffing doesn't allow for this.Then they fall, break a hip, get a brain bleed, etc. And who is blamed for this??? THE NURSE...

    Op i am so sorry. It sucks to have this kind of liability. Makes you wonder if you should look for a new facility?
    weemsp likes this.
  2. 0
    Hey,
    Thanks for your response. I'm new to this. I just saw your reply. Anyway, it's extremely frustrating, management doesn't care about acuity, just filling beds. When we do have need for a sitter, no one wants to work, because when they come to work, they are overwhelmed and burned out. Thank goodness we can use Ativan, Haldol, and as a last resort, restraints. Many patients who are self care may only see me 1 -2 times per shift because I'm so busy with the confused patients. I feel badly for them, but it can't be helped.

    Part of our hospital core value statement includes the words "patient first". I don't think management cares about the patient or staff, only about the bottom line. It's very sad that healthcare has been reduced to this.
  3. 0
    My floor is 20 beds and is mainly walkie-talkies, but we do get a fair amount of confused elderly. We usually put those people close to the nurses' station where we can watch them and sprint to the rescue, but there's 16 other beds that are out of our line of sight. Everyone gets a bed alarm but at least those folks are watched a little more closely. I hear what you're saying though... sounds like you are understaffed unfortunately.
  4. 0
    What type of Fall Monitor are you using? Have you tried the Bed-Check or TABS Monitors in your facility? I was wanting to learn more about monitors and found some info at www.fallsrus.com but wanted to check with everyone else on what they utilize for fall reduction. The staff need to know how to use the alarms as well. Education of the applied systems are very important.

    Mary
  5. 0
    Bed alarms have little use according to studies because of exactly what you described - it takes too long to get to the patient!

    This is a really hard situation. Maybe ask if you can go to these meetings with the higher ups and explain it from the direct source? I don't know what they could do - hire sitters? There's really no way around it - cameras? I don't know these are just ideas.
  6. 0
    Your facility is way understaffed and I feel your frustration. 2 nurses and 1 aid for 15 patients is crazy. You are doing the best you can possibly do.
  7. 0
    What you didn't say is what shift you work. Confused elderly or dementia patients who sundown can be worse overnight than during the day. If you're working nightshift and the very least you should have one more aid.

    Of course, that said, you need more staff on all shifts....
  8. 0
    Quote from pamelalayn
    Your facility is way understaffed and I feel your frustration. 2 nurses and 1 aid for 15 patients is crazy. You are doing the best you can possibly do.
    I wouldn't go so far as to say it is way understaffed unless this is day shift. On nights, we get 6-7 in intermediate card tele, which should generally get fewer pts than med surg. If this is days, then I agree. Otherwise, I'd say they are slightly understaffed.

    Anyway, we have a huge unit with huge rooms and four nursing stations. We also have camera rooms that used to be CCU beds. We put our RTF pts in camera rooms first, nursing-station-adjacent next (the camera rooms are all close to the stations anyway) and if we don't have one of those options available, we generally refuse the pt on safety grounds and they might go to our sister unit instead. They all get bed alarms.

    We still have falls. But we drop everything and run for bed alarms and are doing a study on our recliners (a lot of our falls revolve around them, so we are testing new ones for the hospital.). We also post falls in our staff room to bring more awareness. It has been enlightening. The techs have been told to get handoff report near their rooms instead of where the schedule is posted because of falls happening at shift change. Every little bit helps.

    I was just thinking about falls and AN yesterday. Someone posted that she had 3 falls on her last shift and just laughed it off. This bothered me a lot for a lot of reasons (not the least of which being my anti coagulated aunt died s/p fall c bleed.). Do other nurses really have such a cavalier attitude? I really take every step I can to keep my pts from falling and just can't fathom brushing it off with, "it happens."

    And OP, sounds like someone really needs to start tracking all available details of your falls to pinpoint common denominators so they can be addressed.
  9. 0
    I forgot to mention that we are lucky enough to be able to sit confused pts in the recliners next to a secretary or the monitor tech. They are being stretched too far when this happens (the monitor tech also watches the camera rooms) but it works okay short-term.

    OP, good luck. Falls suck and it sounds like you are sound what you personally can to prevent them.
  10. 0
    The nurses on our medical-surgical floors are expected to take up to 8 patients each. We are not allowed to use restraints, as our hospital calls itself a "restraint-free facility." Say what you want to about bed alarms, but they certainly work for us. We have long halls, too, but if a bed alarm goes off, someone manages to get there quickly. We rarely have falls, even with our dementia patients (which is most of them.) Asking family to sit with their loved one is usually useless~ there is always some reason they can't (or won't.) When they do, the family member can be more time-consuming than the dementia patient!


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