Another Vent...About a Frequent Faller!

[king_of_the_hill_fan]

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.

[chorkle]

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.

I take it this is a parody, although possibly unintentionally so.

[Nascar nurse, ASN, RN]

Along with a low bed, floor mats and bed alarms...we also use mattresses with built in bolsters on the edges. They look kind of like built in baby bumpers. Sometimes this can be enough to "define" where the edges are for them. If they continue to roll out of bed we change from the thin floor mats to a mattress next to the bed (to provide more cushion).

Another thing to consider..some bigger people do better in a bariatric bed even tho they are not necessarily bariatric size. Very few people have slept in a twin size bed since they were a kid so of course they are falling out of bed...they think it's wider than it actually is.

I haven't "tied" someone in a bed in at least 15 years..can't imagine going back to that.

Side note that is completely off topic. The word THE is only one extra letter from the word DA. Essentially it takes no extra time to type and makes the writer look 100% more intelligent. It is difficult to take these types of posts seriously.

[CapeCodMermaid, RN]

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.

Can't use posey restraints in long term care and certainly can't use a mesh tent. We'd get cited for sure. We couldn't use a waist restraint either and side rails pose a greater hazard.

I have no time for other staff members who point fingers and assign blame.

I'm voting for the low bed with a fall mat.

[TakeOne]

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.

The falling resident doesn't need to give you "a straight answer" about what he's doing. "Alert" doesn't mean oriented and rational, and "alert" doesn't mean absence of short-term memory impairment. He likely WAS trying to get to the bathroom (falling and/or combative residents often are), no matter that he's incontinent and in briefs. He likely was trying to reach a book, or get up to look out of a window, or get to a phone, or go see his mother, or any one of the myriad explanations that demented residents give us for their behaviors all day long. Fallers fall because to them there is no reason that they shouldn't get up and motor when they want to. That's how it is, and that's why injury prevention is instituted. There are beds that are even lower than the lowest bed position. There are beds that are only a couple of inches off the floor. They are used in conjunction with floor mats. Residents can't fall out of them because there isn't enough of a rise between the mattress and the mat to allow a fall. Sliding out of these beds is common, but that's not falling and injury from sliding out of bed is uncommon.

It sounds as though you are new to long term care. Don't worry. Take these things in stride while learning the nature of LTC residents and expanding your knowledge base about their often frustrating behaviors, as well as the regulations that dictate how LTC is done. Soon it will all start to make sense.

[ktwlpn, LPN]

And try putting him to bed a little later-after a snack,toileting and maybe some tylenol.

[king_of_the_hill_fan]

Wow TakeOne...I don't even know what to say. I never said he has dementia. He is physically ill, not mentally ill and since he is A & O x3, there is no reason why I can't ask him about what he was doing before he fell.

[indigonurse]

If someone is falling I would review their care plan and revise it. Obviously people fall more on other shifts due to their activity level. I would make sure that the interventions to prevent this person from falling are in place. If they are then I would see if there was more that could be done. Unfortunately some people need to be under direct supervision 24/7 and most facilities are not staffed that way. If nothing works then maybe this person needs to go to a different facility that could maintain safety better.

[SolaireSolstice, BSN, RN]

Hello all - Thanks for the advice and suggestions!

Yes, his bed is always at lowest position with a fall mat in place. .

There's "bed in the lowest position", and then there's the "low bed". A low bed at my hosptal is a bed that lowers all the way to the floor. If a patient rolled out of a low bed, the fall would be about 5 inches, whereas a fall from a regular bed at lowest position, especially when reaching for something, could be about 2 feet, onto their head. Which is your patient on?

[CloudySue]

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.

This is an example (of which there are many) of what's happening to people's writing skills in this day and age of texting. Now there's predictive texting, but for a while there was only that choppy shorthand. I'm afraid the damage is done to a whole generation who were too busy texting under their desks while the teacher was trying to teach spelling and grammar. I always get the feeling I'm reading Prince lyrics when I see "U" for "you"!

[daimere]

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!

Those are great questions. Ask your CNAs if he has a wet brief during his fall. A lot of our fallers, especially our biggest risk, always falls after he pees. This man though holds it and holds it multiple rounds (completely dry) and then tries to get up to go. About 95% of the time when he falls, I know he went to the bathroom.