Fall precautions

[sonsonly]

Hi, my name is Laura Jones. I am a RN pursuing my BSN through University of South Alabama. I am working on one of my final projects for my degree and would appreciate your help. I am to have a discussion with a nurse that is working in the area I completed my practicum (which was rehab). It has to be in another region of the country. (I live in Louisiana) I would like to know who you are, where you work and what the current protocols for fall precautions are at your facility. Does your hospital use bed alarms, wheelchair alarms, vail beds, something else? Do you use hip protectors at your facility, if so, on which patients? Please provide any other information concerning fall precautions that you think I might like to know. Thank you so very much for your help! It is greatly appreciated! Laura

[RosesrReder, BSN, MSN, RN]

Hello and welcome to the wonderful family of allnurses.com. Enjoy your stay, and best of luck to you. :)

[MS._Jen_RN, ASN, RN]

Hi, I'm in Michigan. I work in a 40 bed acute rehab unit. We use the following to prevent falls and other injuries:

Bed rails up X's 4

Lap belt restraints

Pelvic restraints

Net beds (that's what we call them- I think you said Vail-that's a brand name)

Bed and chair alarms

Soft wrist restraints (at times to prevent untying the lap belts)

Moving the patient to a room near the RN's station

Signs in the room to remind the patient to call for help

Appropiate foot wear at all times (no-skid booties, shoes etc)

A personal companion (sitter)

It all depends on the patient and why they are a fall risk. If you have any further questions post here or PM me.

~Jen

[Seasoned]

In addiion to those listed by MS. Jen RN (very very good!!). I will add:

• "Red" skid proof footies used on the geri unit at Peachford Hospital (Atlanta) to catch those who made it up walking but were non-compliant with the precaution directive
  
• A removable star that has fall risk printed on it to put on pt's chart, armband, door, etc. used at Emory University Hospital
  
• removable signage on the door and over the bed used at Emory Wesley Woods
  
• Special colored arm band that indicates fall risk used at Southern Regional Hospital (Atlanta)

[rehab3]

Working in LTC in a 292 bed facility; we are restraint free and use alarms as fall/injury prevention with a variety of success/failures. We look for alternatives for all situations such as Med changes, labs, timing secondary to staff shift changes and more important try to find out "WHY" they were moving or what went wrong. We have an active Therapy program and follow up Restorative exercise program to improve balance and strength as fall preventive methods. A team decides what to trial as much as possible with least restrictive methods trialed first. Often a room check will uncover the cause if there is too much clutter or items blocking a pathway; possibly the room can be rearranged to make everyday activities easier to perform. It is always a challenge to keep people as mobile as possible and safe at the same time.

[Schmoo1022]

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[Rehabme]

Hi in Australia - We use falls risk signs, arm bands and assesment tool that is meant to identify who is going to fall. Generally all patients have low low beds and call bell in reach. In a 35 bed unit we average between 10 and 20 falls a month (neuro and amps patients) which depends on clients. Most falls happen when patients get their fist taste of freedom and will happen in bathroom. (first taste of freedom = just starting to walk) My next step is to add signs telling patients to call.

[WVRehabnurse]

Hello I also work on a rehab unit, now for 8 years. We have tried and are still trying to find ways to prevent falls. We use the Net Beds, Rear fastening seatbelts, Posey Vest, SR up x 4, and still some months are better than others. The patients are being told they are doing well, and getting stronger, so I think at times they feel they can do things on their own. We have falling stars posted on the charts, and chart boxes on those at risk for falls, and then the patients who have fallen we place an orange armband to indicate they have already fallen.

[rehab3]

Just came from an inservice on Fall Prevention; Visual perception and use of multi use lenses( trifocals and bifocals) viewed as unsafe; suggested change to distance glasses and "readers" if still reading to avoid accomodation necessity. Also big on footwear and safe surface for standing, not slick tiled floors. suggested mat that has gripper edge so that it seamlessly blends with flooring and center of carpet. this allows proper foot position and body position to stand; "Nose over toes". One more; postural hypotension after meals, significant research to validate position as fall potiential hazard. And always good rehab programs to maintain strength/balance. Rehab3

[lavender rose]

Just came from an inservice on Fall Prevention; Visual perception and use of multi use lenses( trifocals and bifocals) viewed as unsafe; suggested change to distance glasses and "readers" if still reading to avoid accomodation necessity. Also big on footwear and safe surface for standing, not slick tiled floors. suggested mat that has gripper edge so that it seamlessly blends with flooring and center of carpet. this allows proper foot position and body position to stand; "Nose over toes". One more; postural hypotension after meals, significant research to validate position as fall potiential hazard. And always good rehab programs to maintain strength/balance. Rehab3

Usually when reading the screen for them and see that they have alzheimers or Dementia that's usually a light that tells me they need to be on a bed alarm. Due to their memory they won't always realize they are in a different place where they have to follow rules. IN their mind they'll think oh I can get up like they always been doing before they came. In notes i put due to Hx of Alzheimers (or dementia) call bell alarm put on patient for safety precautions (or fall precautions). If they try to get up after call bell is on then I will give them patient education to use the call light before attempting to get up on their own but will also consider too a safety lap belt. But depending how bad their memory is sometimes all that won't work and 1:1 supervision with Dr order is needed. Some input here of mine.

[ayla2004, ASN, RN]

in the uk in acute care

falls assesment on admission and when any changes

traffic light signalling in bed areas

beds at lowest postion

call bell within reach

sitter if needed

good footwear and work with ot/pt on equiment

frequent observation

[Sally1010]

As a medical facility surveyor, I have read with interest the responses to fall prevention and applaud comments by rehab3. Thank you for your efforts.