Fall Risk help

[bandas]

I'm a brand new nurse. A few days ago I had a elderly patient who had orthostatic hypotension. He kept getting out of bed without assistance and nearly fell twice.

I did the what I could think of: fall risk assessment; call light, phone, and remote within reach; urinal at bedside; offering BR q 2 hrs; room by nurses station; reiterating the importance of calling for assistance; TED hose on per Dr; had the patient sit on the side of the bed for a few minutes before getting up; and talked to the Dr. about the situation.

He continually refused to put on his call light. He said that it was ridiculous to call for an aide everytime he wanted to get up and that he was just fine. He told me that he didn't care what I thought and would continue to get up on his own. Eventually I put a tab alarm on which he would promptly take off the moment I left the room. Later, I went to a floor pressure alarm. I was upset about doing this because I know he was really upset about it. And the thing is. it wasn't that he was confused and getting out of bed, but that he just refused to admit that he needed help. Even though he admitted that he had recently fallen at home and broke a hip.

So I guess the question is: what could I have done differently to create a better and safer environment for the patient?

[MisterSimba, BSN]

It sounds like you did everything you could! I can't think of anything you could have done differently! :redpinkhe

Based on what you're describing, it sounds like the patient was embarrassed about needing help/not wanting to admit to himself that he needed help, and wanting desperately to to maintain his independence.....

[al7139, ASN, RN]

Hi,

IMHO, This pt sounds like lots I have had! They are basically independent at home, and hate to have to rely on another person when they really need help (sound familiar? I'm right there in their shoes!). They are afraid of losing control, and although it seems like they are noncompliant, it really is an assertion of their independence, and being able to control some part of their hospitalization. In cases like this especially when I have older patients who may have had a fall at home, I try to first discuss with them the circumstances of the fall (the person who was a high fall risk on admission, may have been playing football with the grandkids, and tripped (true story!)), and therefore is if it is not directly related to the reason for the admission, I ask them to walk for me to assess their mobility. If it is directly related to their admission (i.e. syncope), then I very nicely ask them to call us to be present if they need to get out of bed to the BR, or chair, whatever. I let them know why I am concerned, and I acknowledge their independence, and state that we just want to be able to assess how they move. I assert the facts of their case (they were found on the floor of their house, therefore a fall probably happened), and that we have an obligation to see that it does not happen while they are here in the hospital. I tell them that I am not their keeper, but it is my duty as a nurse to ensure their safety, so would you please allow me to be there when they get out of bed to ensure that they are safe? I assert that I do not need to be there to watch them eliminate, nor brush their teeth, but that I want to be sure they are safe. If that doesn't work, sometimes the "do it to make me feel better" statement works. As a last resort, bed alarms, chair alarms, etc.

If a pt is a true fall risk you will know, and like me, check on them often, and offer help to the bathroom.

Keep in mind patients will fall no matter what the precautions taken.

Amy

[iluvivt, BSN, RN]

Please document all of your great efforts and make sure you are following your employers policy to the letter

[mpccrn, BSN, RN]

if he was confused you could have put him at the nsg. station, but he wasn't. sounds like you did all you could. perhaps explaining the repercussions of his decision to get up alone despite your efforts had an impact on you as well. when completely frustrated with a non-compliant alert patient, sometimes i just tell them i have 2 kids in college and need to keep my job to pay for tuition, if you fall while in my care, that is jepordize.......it's lame, but sometimes works...