Fall prevention

[dontbetachy90, BSN, RN]

I have a general question in regards to fall prevention and am looking for some ideas to bring to my unit!

Our unit (as most units do) takes fall prevention very seriously. We do safety audits every two weeks, we safety huddle each shift to notify the crew which patients are high risk or bed alarmed, we hourly round, and we bed-alarm like it's nobody's business.

That being said, it seems we are still struggling keeping our patients off the floor. Maybe every two weeks or so, it seems we have another fall. One issue we run into is staff forgetting to turn a bed alarm back on, or family leaving the patient's room at night and when they leave, nobody checks to make sure the bed alarm has been turned on. Last week we had a perfectly oriented, independent 40-something year old patient misstep and fall and smash her face.

What fall prevention strategies (aside from alarms, sitters, non-skid footwear, hourly rounding) do your units and departments implement? What are some lapses you have witnessed and what steps were taken to resolve the issues, or has a resolution not been reached?

Thanks!

[MunoRN, RN]

Part of the problem might be that you are overusing bed alarms, which may actually increase the incidence of falls.

Bed alarms haven't been shown to reduce falls, and in one study the incidence of falls actually increased when bed alarms were used more frequently, this may be due to the fact that falls are associated with delirium, delirium is exacerbated by stimuli that trigger the sympathetic nervous system, and bed alarms are strong triggers of the sympathetic nervous system.

The most proven interventions to reduce falls are increased staffing, early mobility, and proactive measures to reduce delirium.

[Okami_CCRN, BSN, RN]

As MunoRN mentioned, delirium is a huge component to falls. Assessing your patients for delirium and instituting ways to cut down excessive noise and stimuli may help decrease your fall rates.

With that being said ensuring that your patient have non-skid fotowear/socks on/available is important. Getting patients out of bed and walking is also important and helps develop and maintain a steady gait. Also, educate patients about utilizing the call bell when they want to get out of bed to ambulate to the bathroom, educate them on sitting on the edge of the bed for a few minutes before standing up to prevent postural hypotension.

[hppygr8ful, ASN, RN, EMT-I]

[h=3][COLOR=#1a0dab]Catch a Falling Star | I Advance Senior Care[/COLOR][/h]https://www.iadvanceseniorcare.com/article/catch-falling-star

[Daisy Joyce]

We use silent alarms--they don't sound in the room, but to our phones, and we catch people a lot before they fall, but without scaring or startling the patient.

Some people move fast, though--the advantage of the alarm for them is they won't be on the floor for too long before we know about it...

[Accolay]

What kind of unit is this?

[NurseSpeedy, ADN, LPN, RN]

I agree that overuse can be an issue. Patients HATE bed alarms. The alert and oriented ones will figure out how to disarm them after a few times.

The confused ones can get the crap scared out of them as they are starting to stand and then this screaming alarm goes off and DOWN goes the patient.

We use a fall score. The number dictates a mandatory bed alarm. So, forgetful little old lady from the nursing home gets admitted. She's more stable o her feet than some of the staff, but because she has an iv (reseal only, no active infusion), uses a walker, and is forgetful, she received a high score. Now, the alarm goes off, annoys her, she is now reaching OVER the chair, bending at the awkward angle that we always have to do to get in between the bed and the bedside table on the wall where these are mounted to press the reset button. She resets her own alarm by the time staff can even get there and is off to the bathroom steady on her feet and fast too. Now she's getting bowl prep and is insistent on turning the thing off and cannot remember to call for help. The bed alarm is more of a fall hazard with her trying to turn it off each time than a fall preventer.

This cookie cutter way of assigning fall prevention measures is one of the problems. Some require an individualized approach.

[Accolay]

This cookie cutter way of assigning fall prevention measures is one of the problems. Some require an individualized approach.

Absolutely agree. If everyone is a fall risk, then no one is a fall risk if you take my meaning. Use that fall risk score/

[dontbetachy90, BSN, RN]

Thank you everyone for your input!!

Certainly we use the Morse Fall Risk scoring system diligently; required assessment is once per shift and with changes in LOC/mentation. Nonskid footwear, hourly rounding, 1:1 sitters which are seldom available for use, call lights within reach, moving high risk patients closer to station etc; we are definitely succeeding here (I think?) but still having issues with falls. Last week an AOx4 gentleman (of the non-compliant/obstinate variety) who was very unsteady on his feet tried to help himself to the bathroom, did not call out first, and face-planted into the toilet bowl with an INR >7. A trauma consult and many bags of FFP later... imagine our disdain...

I can see how over-utilizing bed alarms can cause issues especially in our confused patients, however in a 20 bed (very spacious!) acute care unit it is difficult to justify turning them off on the night-shift. I like the idea of silent alarms; this is something I would like to research further and bring up in quality care meetings, so thank you for that!

We recently implemented (or tried to implement) a strategy utilizing little pink music-notes that we stick on bed-alarmed patients doors to notify staff that they are high risk for falls, in addition to the white (low risk) or yellow (moderate risk) plaques on each patient's door; the thought is that this will prompt staff to round more frequently or double-check those fall prevention strategies during [mandatory] hourly rounds. However, in the acute care setting, we find patients are quick to change LOC and these little music notes are so easy to overlook, not to mention overkill in addition to the fall risk plaques, and after a few weeks of implementing this process it seems we have fallen off the wagon, not that I felt the music notes had much of an impact to begin with.

Falls are going to happen, I just wish they would happen less. Thanks again for your input!

[osceteacher]

We use Clip in our trust. So if we have a high falls risk bay one person is given 'the clip' which means they can not leave the bay at any point. It can be a tedious brain numbing job but we tend to share it around. It's worked wonders for us. Bed alarms are not effective.

[Buckeye.nurse]

Over half of the falls on our unit have been assisted (patient is walking to the bathroom and knee buckles, or they become weak). We use gait belts and bedside commodes as appropriate to help with this. Bed exit alarms are actually helpful on our unit for the very high risk patients b/c we have 12 bed pods set up as a square with the nursing station in the middle. It literally takes just a few seconds to run to any of the rooms. On my previous floor (a very large, sprawling 39 bed unit with one nursing station), bed exit alarms were practically useless. A lot of it depends on the set up of the unit, and whether responding to alarms is a priority of everyone (and not just assigned staff).