Unit Design Blamed for Increase in Falls

[abundantgrace]

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 is a very large unit and a lot of walking is done during every shift.

Each side has its own med, supply rooms and nursing station. There is no centralized nursing station which is the typical set up for a hospital floor with patient rooms. Each side is staffed with 2 nurses and 1 nursing tech. The unit can hold 15 patients on each side.

The unit typically gets many patients who are very confused and they often try to get out of bed. Many times it is necessary for 2 staff members to be in a room to care for a patient. This leaves 1 staff member for the other 14 patients. The problem is that we are being blamed for an increase in falls.

This is not our fault. We work very hard every shift. Our staff works well together and have a great spirit of teamwork. We don't have a "that's your patient" philosophy, but when there is a need, we all rise to the challenge.

What do you think we can do to decrease falls? Obviously we can't change the unit design.

Thanks for your suggestions.

[Morainey, BSN, RN]

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.

[Mary Johnson]

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

[roma4204, BSN, RN]

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.

[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.

[Isabel-ANP-BC]

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....

[dandk1997RN, MSN, RN]

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.

[dandk1997RN, MSN, RN]

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.

[applewhitern, BSN, RN]

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!

[anon456, BSN, RN]

I agree it's the design of the building combined with not having enough staff. I work on a unit almost exactly like the one you describe. We have 24 beds on our side, it's rectangle shaped with no central nursing station, and med rooms and supply rooms in the middle of the rectangle. The difference is that I work peds, and we have 3-4 patients per nurse, not your higher number that you carry. So we have probably 5-7 nurses on the unit depending on acuity level and census. We have one nurse's aide, too. So when two nurses are in a room together holding a patient down for labs or something, there are still enough nurses to keep an ear and eye out. It really sounds like you need some extra nurse's aides or something.