Decreasing Falls in the ED

Seriously, I find that most of the time people climb out of bed without help when they feel like they have to pee. So I check on my at risk patients more often for that.

On the humorous side, someone posted this once and I still giggle every time I see it:

I found it really weird when I was pregnant & went to the ER twice for killer migraines. They gave me IV benadryl THEN had me give a urine sample. The IV benadryl makes feel more drugged than any other IV drug I've been given.

So there I was drugged, pregnant & making my way to the toilet. It was a fun experience to do, twice.

I feel like the units I've worked on (in four different ED's, too), the fewest falls occurred in units that addressed call lights rapidly and reliably... see above about pts that need to pee. They'll get up, with or without help.

Oh, yeah, and have Samuel L. give the look as above, followed by his Pulp Fiction monologue...

I feel like it would be fantastic if there were a CNA or two who would be assigned to only answering call lights.

Having to prioritize care in the ER, it's hard to answer a call when we are doing the inevitable moderate sedation, code, adenosine, etc.

I discussed this with my coworkers (now ex-coworkers since I quit ED) before and we came to the conclusion that adequate staffing is the best way to improve patient fall rates in the ED. Our hypothesis, however, just you stated, is not supported due to lack of research which shows the correlations. Most research harps on vague things like anticipating needs or hourly rounding as decisive factors to prevent falls, but this only convinces us that the researchers and administrations are working in conjunction to find ways to dissuade the support for adequate staffing and also find ways to point fingers if fall rates increase. We know in real life that this "rounding" isn't really possible unless you are not busy, and ED is acronym for busy.

Adequate staffing is foundation for quality service, safe practice, and employee AND patient satisfaction; this does not only apply in nursing, but also in any other career fields, and our own administrators are turning blind eyes to these facts because they are focused on money, not patient satisfaction or quality service or wellbeing of their employees. We will not improve jacksheet until everyone act upon this.

A written agreement for high risk patients to sign that states they agree to use their call bell to ask for assistance. Time consuming, but reduced our falls.

How does that work for your geriatric demented patients ?

Not so well! But it also prompts the RN to identify that the patient is high risk and implement precautions - leave curtain open, offer toileting, bed alarm, siderails up etc.. The contract always has to be addressed - so the RN, at a minimum, needs to document that the demented pt is unable to sign. Hopefully the next line states that precautions have been initiated.

So the contract, in this situation, prompts the nurse to be proactive.