Another Vent...About a Frequent Faller!

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OMG! I thought yesterday was bad, well, today I had a fall! This resident is a "frequent faller". I've been at this SNF for 3-4 weeks and he has fallen once a week since I've been there. His chart is full of post fall assessments. Okay, so yah, I feel bad that he fell, again, but ok it happened and that's that.

At the end of my shift, I'm giving report to the night nurse, and of course I mention the fall. WHY, please WHY does she ask "how come he always falls on your shift?" ARGH!! I don't know why he chooses to try to get out of bed or somehow slide out of his bed during the PM shift. I just felt so accused!

I think the real question is, how do we prevent this resident from falling so frequently or ever again? We can't strap him to his bed...BUT we could, quite possibly, get him a bed with more than just siderails at the head of the bed. Maybe a middle side rail, or the four side rail beds. We're not a restraint-free facility, so I don't see a reason to not have a better equipped bed to prevent more falls from occurring. I even suggested it on my incident report tonight. Ohhh, I'm sure I'll hear about it from our extremely over-opinionated, self-appointed supervisor of all, judgmental, unprofessional night nurse. I'm sure she's reading everything I wrote and scrutinizing it and waiting for our shifts to coincide so she can tell me all about what I did or didn't do that was wrong. Grrr....I wish that night nurse would BUTT OUT!

Luckily I'm off for 2 days ... a very much needed 2 day break.

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Have you spoken to your DON about the problem there are ways to help. A DR's order to do a soft tie around his waist during HS. Or a lower to the floor type bed putting pads on the floor. I would really speak to your DON and your SS Director. I'm sure your place can up with something before he really gets hurt. Now i know they tell you he has a right to fall and i never understood that part. But on the other hand they speak of fall prevention. Just start speaking until someone listens and Chart Yes i said chart how many times he crawls out of bed and that you have spoken to DON, ADON, Nurse Manager,. This covers you just incase he does get hurt from a fall. These are my thoughts use them as you wish

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Specializes in MED/SURG STROKE UNIT, LTC SUPER., IMU.

Do you guys have low beds and fall pads? In the facility that I used to work for, if you had the bed low and the fall pads in place and a pt fell out of bed without an injury, it was not considered an incident. Do you have body alarms or bed alarms, so that if he starts to get close it will go off you and have a few seconds to get to him? Just some ideas.

As far as the pt is concerned: has the doc ordered a UA C&S to check for a UTI? This may be normal behavior for this patient, but it is always good to check if this is a new behavior for him. I am constantly amazed what a UTI does to an elderly pt's body and mind.

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I agree with the low bed and fall pads.

Seems like more bedrails and waist restraint has the potential for more injury.

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If the night nurse had wider experience she would know that evening shift is the shift where most incidents occur. I suspect it has something to do with the fact that residents tend to be more confused on that shift. Also, might be due to the fact that day and evening shifts should be equally staffed because they are equally busy but they are not.

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Hello. You wrote that you have been at this facility "3 to 4 weeks", so you are still "learning the land" of this facility. I agree with the writer who suggested that you arrange a meeting with your director of nursing to help you learn the approved options to help prevent falls at your facility. One of my pals is a director of nursing at a long term care facility and she says the "low bed and fall pads" plan is one of their patient safety strategies. Long ago when I worked at a rehab center, we had a "frequent faller" on the unit---one of our strategies was to kindly persuade him to stay in a wheelchair at the nursing desk with us as much as possible so that we could take turns monitoring him for safety(no restraints were allowed). Best wishes!

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Hello everyone in da facility I work they use bed alarm and it gets da resident attention and yours. So ask about da bed alarm and they have chair alarms too. I hope this help u it do work and always put da bed to lowest position when you have a frequent faller. I feel you but I have learn not to wait on cna to put them to bed when I take them too there room b/c they take so long to put them down. U have to be mindful b/c u can't be everwhere and I know u feel right now that da nite nurse feel that way but u is a good nurse b/c u do feel bad that he felled.:nurse:

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Hello everyone in da facility I work they use bed alarm and it gets da resident attention and yours. So ask about da bed alarm and they have chair alarms too. I hope this help u it do work and always put da bed to lowest position when you have a frequent faller. I feel you but I have learn not to wait on cna to put them to bed when I take them too there room b/c they take so long to put them down. U have to be mindful b/c u can't be everwhere and I know u feel right now that da nite nurse feel that way but u is a good nurse b/c u do feel bad that he felled.:nurse:

I understand your emotion behind this post, and I'm sure we all appreciate your advice. But please, please, please, just....I really don't know what to say without it coming across as snotty, so I guess I'll just leave it alone. To be honest, I didn't even finish reading the post, either the first time I read it or after I've reposted it.

OP, you have received some excellent advice. I would definitely go to the next in charge about implementing some safer changes to prevent the falls in the future.

I personally feel like out of all the workers at my job, all the "bad stuff" happens on my shift! I feel like I'm always calling 911 and the EMTs or have SOME sort of issue--it's like they all save it up for when I'm there! But no worries, as long as you provide your best care possible and do your best to try to implement some safer guidelines, then that is great! No matter how much he falls, even if it's once a week, you don't want the next time that he falls to be damaging. Good luck!! ;)

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I am wondering if you can get the bottom of the reason for the falls. Why is he trying to get out of bed? This takes some investigating if your patient/resident is confused. Ask the family. Did he have a routine at bedtime before coming to the facility and is he missing something? I mean, did he always drink a glass of milk before bedtime? If so, maybe giving him a glass of milk at bedtime would solve the problem. Did he always check the front door to make sure it was locked before going to bed? If so, maybe he is getting up to check the door. Do you get what I am saying? If you can get to the bottom of why he is trying to get out of bed, and thus, falling, maybe you could solve the problem.

Another thought, is he falling right after the linen cart is pushed down the hall? Maybe he is investigating the noise. Look at the times of the falls. Is it always about the same time? Maybe someone can check on him at that time. Is there something specific that is happening at the time he falls (like the linen cart going down the hall)? Is his room next to the breakroom and someone takes break at that time and cooks food? Maybe he thinks it's mealtime. Take a step back and really see, hear, and smell what is going on in your facility at the time he is falling.

Also, talk to the other nurses that work your shift. Ask them how their routine is different from yours. Maybe they would have some ideas on why he is falling while you work. Are they giving him his meds at the same time you are? Sometimes that hour leeway can make a difference. Maybe they are giving him his meds an hour earlier than you are, maybe one of the side effects of a med is lethargy and maybe he is asleep sooner while they work than when you work and maybe that is making the difference.

It sounds easy, and I know it's not. Sometimes there just is no answer or we never get to the bottom of it, but if a little investigation solves your problem it's worth it!

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Specializes in school nursing, ortho, trauma.

The low bed and fall pad may help. A posey vest may be helpful too... I have also seen a mesh tent made by posey that goes over a bed and zips closed. Would keep a patient safe without feeling tied down.

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The low bed and fall pad may help. A posey vest may be helpful too... I have also seen a mesh tent made by posey that goes over a bed and zips closed. Would keep a patient safe without feeling tied down.

Ya know... think about that for a minute. If you were confused and disoriented, and found yourself "zipped" into something and utterly unable to get out, how do you think you'd react? I think I'd feel worse than tied down, and respond in kind!

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Hello all - Thanks for the advice and suggestions!

Yes, his bed is always at lowest position with a fall mat in place. The first time he fell on my shift, I was still orienting, but he said he was trying to reach a book on his bedside table. The second time he fell, it was my shift and he said he was trying to get to the bathroom. He is on incontinent care with briefs. This time when he fell, he didn't really have an answer for us, meaning he didn't have a straight answer as to why he was trying to get out of bed. But he has fallen many times before I got there. He is alert enough so I can talk to him about the falls. Oh yah, he has a bed alarm, too.

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