fall interventions

Bird2 · Feb 5, 2006

We run into the same problem with falls. Our numbers look bad after dinnertime. The nurses are busy with the medpass and every CNA is trying to get their hall tolieted and ready for bed. We are thinking of having an activity person on the schedule for evenings so they can run a group for our frequent fallers. The goal is to have the CNA's come to the group to get them when it is time to toliet/get ready for bed. Our main goal is to make fall prevention every departments problem not just nursing.

dian57 · Feb 5, 2006

We have the same issue (doesn't everyone in LTC?). We instituted 1/2 hour activity "bursts," as we've determined our population doesn't have much more than 30 minutes worth of attention span to devote to any given thing.

We started with the evening shift as the fall numbers were greater, we've since expanded to the dayshift, too. I've changed the program names to minimize identification of our facility. But feel free to use any ideas that might work for you. No matter how short, however, we always have a staff member with the group--in 1/2 hour assignments.

3-3:30 pm--TOASTing. Give everyone a 120 cc cup of juice/water. The person running the program makes up toasts. "Here's to the President of the United States!" and everyone takes a drink. "Here's to your grandchildren!" This is good for increasing hydration. Ask the residents who should get the next toast.

3:30-4 pm--Sing-a-Longs. These are videos that have a Sing along with Mitch kinda feel. The patriotic ones are big sellers here.

4-4:30 pm--reading aloud the newspaper or the National Enquirer (not exactly fine literature, but it keeps everyone's attention)

4:30-5 pm--Book reading program. We advertise a book and each day read a chapter or two till it's finished. If it doesn't take the full 1/2 hour, we ask questions about what was just read. Takes us about 2 weeks to finish each book. Start with Charlotte's Web.

5-6:30 pm--dinner music with a featured artist each week--Glenn Miller or Count Basie weeks are most popular. I like the Andrew Sisters.

6:30-7 pm--Getting settled. This is mostly getting people out of the dining room and situated in the room with the big TV in preparation for the movie of the night. The drink and snack cart also comes in with them.

7-8:30 pm--Featured movie (previously advertised and discussed during dinner to increase attendance). The old black and whites are popular, so are the Judy Garland/Mickey Rooney ones with musical numbers. The aides come and remove people for PM care-they can return in their pajamas or go right to bed.

8:30-9 pm--sensual therapy. Hand massages, nail care and manicures. Soothing music.

9:30-10 pm--most are in bed by now. The die-hard fall risks are still up or back in their pajamas. We put in another movie and continue with the sensual therapy or hand out the PM nourishments and snacks and put on music.

Want to know a neat trick I learned at a fall seminar? Fold up a white sweater and put it on a female resident's lap. They don't want to risk dropping it on the floor and will sit holding it for a long time. A baby doll or Bible also works sometimes (depending on the level of dementia).

If you have some that no matter what you do, can't focus on the activity--try seating them near a pile of towels and pillowcases and ask them to fold them for you. That keeps some people busy a long time.

Bird2 · Feb 5, 2006

We have the same issue (doesn't everyone in LTC?). We instituted 1/2 hour activity "bursts," as we've determined our population doesn't have much more than 30 minutes worth of attention span to devote to any given thing.
We started with the evening shift as the fall numbers were greater, we've since expanded to the dayshift, too. I've changed the program names to minimize identification of our facility. But feel free to use any ideas that might work for you. No matter how short, however, we always have a staff member with the group--in 1/2 hour assignments.
3-3:30 pm--TOASTing. Give everyone a 120 cc cup of juice/water. The person running the program makes up toasts. "Here's to the President of the United States!" and everyone takes a drink. "Here's to your grandchildren!" This is good for increasing hydration. Ask the residents who should get the next toast.
3:30-4 pm--Sing-a-Longs. These are videos that have a Sing along with Mitch kinda feel. The patriotic ones are big sellers here.
4-4:30 pm--reading aloud the newspaper or the National Enquirer (not exactly fine literature, but it keeps everyone's attention)
4:30-5 pm--Book reading program. We advertise a book and each day read a chapter or two till it's finished. If it doesn't take the full 1/2 hour, we ask questions about what was just read. Takes us about 2 weeks to finish each book. Start with Charlotte's Web.
5-6:30 pm--dinner music with a featured artist each week--Glenn Miller or Count Basie weeks are most popular. I like the Andrew Sisters.
6:30-7 pm--Getting settled. This is mostly getting people out of the dining room and situated in the room with the big TV in preparation for the movie of the night. The drink and snack cart also comes in with them.
7-8:30 pm--Featured movie (previously advertised and discussed during dinner to increase attendance). The old black and whites are popular, so are the Judy Garland/Mickey Rooney ones with musical numbers. The aides come and remove people for PM care-they can return in their pajamas or go right to bed.
8:30-9 pm--sensual therapy. Hand massages, nail care and manicures. Soothing music.
9:30-10 pm--most are in bed by now. The die-hard fall risks are still up or back in their pajamas. We put in another movie and continue with the sensual therapy or hand out the PM nourishments and snacks and put on music.
Want to know a neat trick I learned at a fall seminar? Fold up a white sweater and put it on a female resident's lap. They don't want to risk dropping it on the floor and will sit holding it for a long time. A baby doll or Bible also works sometimes (depending on the level of dementia).
If you have some that no matter what you do, can't focus on the activity--try seating them near a pile of towels and pillowcases and ask them to fold them for you. That keeps some people busy a long time.

Great ideas. Have you had sucess with pulling departments other than nursing and activities in the loop?

suebird3 · Feb 5, 2006

We have Activity people scheduled from 4-8. Depending on what day, we may have Movies on Friday and Saturday, a guy who plays the banjo and plays alotta "old" songs....

We use after dinner for relaxing; showers, self care.....retaining the functions they can handle..... The "wanderers", well, we walk with them (the few) so when they DO get worn out.....someone is with them. Luckily, this isn't until a bit later. Guess these people are "aware" of the routine.

Bird2 · Feb 5, 2006

I know I am asking a lot of questions but please bear with me. Did you see the fall rate decrease with supervised activities during the peak times?

dian57 · Feb 5, 2006

Since we initiated the supervised activity program the only falls we've had are rolls out of bed (onto bedside mattresses) and late night wandering out into the bathroom (although staff was alerted by bed alarm, couldn't get there in time to prevent fall). However, NO injuries, which is great.

After 3 pm we really don't have other departments available for inclusion in the program. SW goes home early, dietary is busy cleaning up, rehab is still doing programs/therapy of their own. After 5, when LTA goes home, it's all nursing. I'd like to include them in the daytime supervised activities eventually. Years ago we had an All Hands On Deck kinda program--everyone (including Administration) came out of their offices and departments, handed out the meal trays and stayed to help feed. We were MUCH smaller then and unfortunately this has since gone the way of the dinosaurs.

Sometimes the nurses take a wanderer with them on the med pass or rounds to keep them busy and supervised.

CapeCodMermaid, RN · Feb 6, 2006

We have ALL HANDS ON DECK however most of the other departments don't show up no matter how much we've tried.

I have to say, the "toast to......" is one of the best ideas I've heard. Can't wait to tell my activities director and the CNA's.

loriannlpn · Feb 6, 2006

I am empressed: Kootos to you and your staff... I may have to suggest that to our facility... most falls are those who eat and are ready for bed, of course they all want to go to bed at the same time.....

TBLPN, LPN · May 20, 2006

We have had SO many falls at the facility I work at. Numerous head injuries while one resident has an active "slow bleed" from all the falls. We now have initiated for our "dementia" type patients in wheelchairs, self release belts with alarms, they are nice, have reduced falls considerably. The only draw back is if the CNA neglects to turn on the alarm!!!! They are not considered a restraint considering the resident can release them, while the alarm will sound notifying staff that resident is attempting to self transfer. Just a suggestion. I don't know if all facilities would allow this type of intervention. We were desperate for awhile!!!

chadash · May 20, 2006

One of the best interventions to prevent falls is adequate staffing. There is nothing worse than an alarm going off and there being no one in ear shot to answer it.

RN1964 · May 27, 2006

HI to all

We are working on a program in which we utilize the interdisciplinary process all hands on deck so what we have tried to do is keep our high profile areas staffed at all times and use the down time of each department and have that person run impromtu activites while the Cna's are putting people down after supper it has decrease falls by 30% in the first month for the time frame of 6 pm to 830 pm

Every little bit helps

loved all the ideas

RN1964