Assisted Fall: I'm Scared

hookyarnandblanket · May 31, 2016

Were you using a gait belt?

Nobody00 · Jun 1, 2016

Hello,

I've never worked in LTC so policies and such are probably different.

Falls happen. You were there and could ensure no injuries occurred. I've seen so many elderly post fall pts admitted to our unit, unfortunately it's very common.

If she was just next to the toilet why not lower her back to it, instead of the ground? Or did she walk to the sink a bit?

Now, checking care plans/wherever in the US mobility is recorded is good however it may change. Patients may feel tired, drowsy, just had their medications etc. I've had LOLs running up the halls with a 4WW and next day needing a commode transfer bed to bathroom as they weren't steady on their feet enough for me to walk with them. I'm now able to judge how to assist pts as have been at the job for a while.

When i was new I had a pt fall with me: mobility board showed physio rv as standby assist; meanwhile she could barely walk. I followed the board and assisted her to the toilet where her knees crumbled half way there. I lowered her to the ground and got help from a nurse walking by. It was my fault that I made her walk despite her obviously struggling and I know better now. I was not in any trouble, vs were good, doctor rv her and all was fine.

The point is, if you have toileted her before and she did fine you had no reason to use lift. If its not written somewhere lift may be required you cant be blamed for that. I understand in LTC its not expected for residents condition/mobility to change as much as it can in the hospital but it can still change and you are the judge for how to assist them safely. Obv relay the concerns to nursing staff if resident is not their usual self.

Do you get report at the start of the shift? They should be including mobility in the report so you don't have to chase after people in the busy time checking what the instructions are.

It's very scary to be new, you will get used to it, and get to know the residents so will be aware of their mobility. Good luck

PS: whats a gait belt? Never heard of them before

Viviann · Jun 1, 2016

Hi dont worry. Im a new cna as well. I had also had a assistive fall. I was placed on dementia unit but patient complete deadweight.The pt was a 2 assist but my co worker lets say was not the friendliest so I tried it myself and by a inch I could not get from bed to chair so I thought it was best to slowly let on floor. I placed a pillow behind pt was ok didnthave injury or anything. The the charge nurse was very nice and the Don did talk to me but they just told me they understood I was new as well the communication with other co worker. I was afraid that would get in trouble especially knowing she is a 2 assist. The thing I didn't ask for help was also prior issues with co worker . But dont worry you should be fine. Explain what happened. And at my facility I saw a few falls.if you would like my email I would love to chat . I get nervous myself being brand luck cna. And I have a few stories to share that im learning. Good luck

hookyarnandblanket · Jun 2, 2016

Hopefully you had a gait belt in place. If you didn't, make sure from now on that you have a gait belt on the patient/resident before you stand to transfer or ambulate. You will save yourself some major lectures and your facility an unnecessary visit from state inspectors.

Never assist someone to the floor if you can sit him or her back on a bed, in a chair, in a wheelchair, on a toilet, or even on your knee until someone can assist you. Even a near miss must be reported. If it appears that the resident is having difficulty walking or standing with standby or 1x assist, then get help.

There has to be documentation in regards to the patient's lift code. And your facility will likely have a limited lift policy as well. I have never known a care plan to not say anything about how the resident transfers. Get in contact with the care plan coordinator, the physical therapist, the occupational therapist, or your shift's charge nurse and get the codes for your patients.

Falls happen to everyone. Some are preventable and some are not. If you have done everything you can possibly do to prevent a fall and it still happens, there isn't anything else you can do. Patients have the right to fall, but we are also obligated to maintain their safety. Take this as a learning experience, and use what you've learned to prevent the next potential fall.

Missingyou, CNA · Jun 2, 2016

I have never heard of the transfer status not being on a care plan. It must have been noted someplace that you have access to. As a CNA you MUST know what the residents transfer status is BEFORE you transfer! If you don't know it, and it's not listed anywhere where you can see it, then DO NOT transfer the resident. If that person falls when you transfer them as one assist because you think it can be done and they fall and it turns out they are a 2 assist or a mechanical lift, you can lose your job. Gait belts go around the person's waist so you have something secure to hold onto to balance the resident. The belt should be snug around their waist. Where I work, it is required to use them with all none mechanical lift residents during transfers.Falls do happen no matter how careful you are and the facility knows this. You had just better be sure you know and follow whatever the care plan says. Always check. Even if you have taken care of them yesterday and you knew the status then. Things change.

Tashbun · Jun 3, 2016

I think you did the right thing by assisting the fall. If the pt was already at the sink it's unlikely that you could get the pt to a bench or the toilet. I'd be afraid to try and get the pt that far if the pt was already going down as the pt could get hurt on the way to a chair and if an assisted fall to the floor seemed safer. I worked ltc for a VERY short period. It seemed almost all of the pts were a two person assist or hoyer lift. So if someone calls you in to look into the fall be honest. You thought you could do it, the pt seemed fine. If anything this is a learning curve to always double check and ask for help if you think it's necessary.

hookyarnandblanket · Jun 3, 2016

I think you did the right thing by assisting the fall. If the pt was already at the sink it's unlikely that you could get the pt to a bench or the toilet. I'd be afraid to try and get the pt that far if the pt was already going down as the pt could get hurt on the way to a chair and if an assisted fall to the floor seemed safer. I worked ltc for a VERY short period. It seemed almost all of the pts were a two person assist or hoyer lift. So if someone calls you in to look into the fall be honest. You thought you could do it, the pt seemed fine. If anything this is a learning curve to always double check and ask for help if you think it's necessary.

Assisting a patient to the floor should always be a last resort. They must be documented and reported in the same manner as an unassisted fall and most RNs, DONs, administrators, and state inspectors don't like a pile of fall reports on their desks.

Livetoride · Jun 4, 2016

The only thing that will save you from being in a load of trouble is a gait belt. you need to use them unless otherwise documented in the resident's care plan. Always know your transfers beforehand. All facilities should have a care plan for the residents and you should treat it like the bible. Ask for it if you are even the least unsure about a resident.

Falls do happen. The facility is not going to be happy regardless because it was a fall. Just remember in the future that gait belts and care plans can really save your butt in these situations.

Nobody00 · Jun 5, 2016

Heya :)

Since this post came up and everybody brought up gait belts it made me curious. I've never seen one, and i work in 2 major hospitals on general medical where 5/30 are self caring the rest require ADLs assistance and average age is about 80.

We get annual patient manual handling training and have full range of lifts and slide sheets and such, never gait belts though. Had to google what they are.

Do you use them at LTC specifically or at hospitals in your areas as well?

hookyarnandblanket · Jun 5, 2016

Heya :)
Since this post came up and everybody brought up gait belts it made me curious. I've never seen one, and i work in 2 major hospitals on general medical where 5/30 are self caring the rest require ADLs assistance and average age is about 80.
We get annual patient manual handling training and have full range of lifts and slide sheets and such, never gait belts though. Had to google what they are.
Do you use them at LTC specifically or at hospitals in your areas as well?

I've used them in both LTC and the hospital. I currently work in a hospital.

If we get caught not using one, we are severely reprimanded and with good reason: It is the first thing a state inspector will look for in a fall report. The charge nurses write people up for not using them.

Unless a patient comes in able to ambulate on his or her own without an assistive device and/or for long distances without variation in gait, or it is documented in the care plan not to use one, I will not ambulate or transfer a patient with out one on the patient. It just isn't worth risking my certification.