Falls-alarms,etcfalls,alarms

SionainnRN · Dec 30, 2012

Do you have vests? They tie around the waist to the bed allowing the pt to move their upper and lower body, but not twist out of bed. Was the pt near the nurses station? Do you have different settings for the bed alarm? Ours had a setting that if there was a light shift in the weight on the bed it would alarm, rather than the 50% weight change most alarms are set for. Sorry that the pt hurt themselves but hopefully some change can come about to keep anyone from getting hurt.

martymoose, BSN, RN · Dec 30, 2012

we cant use anything that would be considered a restraint.we arent allowed to even have the vests.available options are mitts, elbow immobilizers, and chair/bed alarms.we were allowed have floor mats, but there arent enough to go around.vail bed is a restraint available,as are soft wrist restraints, but we never get the dr order to use those. Instead we get spanked by the state for having reportable events.This job sucks.

Nismo · Dec 31, 2012

i work in trauma and have many neuro patients in icu. That is too bad in your case that you don't have many resources. We use bed alarms. If inadequate we must use restraints. Posey vests first. But sometime can use wrist restraints. Don't have to have then tight. Give 10" of slack. Will give then freedom but will keep them in bed. Use bed alarms too. If the alarm went off when patient out of bed already, seems it was set to bed exiting mode. Try to keep sitting mode alarm on, then it will alarm when weight is distributed to one side of the bed. But most importantly...in your case....chart, chart, chart. Report it to md at beginning of your shift. Make md aware. CYA. Srry to hear that you had a fall. It seems this can be a big issue in your hospital. Simple policy changes in your hospital may save them a lot of $$$. A fall can be highly costly. Mention it to your sup and maybe can bring it up at the next meeting. A posey alone is inexpensive and very effective. Doesn't restrict patients to a high degree.

martymoose, BSN, RN · Jan 1, 2013

Actually when we spoke to the PA who assessed the pt- he even said that there are studies that say the alarms arent effective.

The pt in question was not my pt.

We are having meetings to see how things can be improved. My opinion is that we NEED to use restraints if it's been proven that alarms are ineffective- ie: pt has gotten up 6 x in one hour. It is not unusual for our floor to have 2/3 or more of the floor on bed alarms. Sometimes so many of them are going off at the same time, we can't even tell what room to go into first. This is an acute care floor.

I dont want to restrict anyone, but if it's been PROVEN that they are such a high risk that unless we restrain them, they are at great risk for injury.

A lot of the pts we get sometimes were wrist restrained in the ICU, but stepdown to us and suddenly don't need that anymore?

I'm just so positively frustrated.

Also, not sure if it's a state thing-I think posey's were outlawed where I live.Available to us to use without order: mitts,elbow immobilizers,and "hipsters"( which we have none) floor mats( which we have none) and bed alarms.Oh, and the bed alarms are on or off- supposedly based on pt weight, but no other settings like sit, etc. Things req. Dr order soft wrist restraints and vail beds.I dont think its overkill , esp if it prevents a fall.

Any other thoughts?

BrandonLPN, LPN · Jan 2, 2013

I've never once seen a bed alarm prevent a fall in LTC. Occasionally they'll alert us to a fall that already occurred, which is better than nothing. But to act like they're a preventative measure is naive.

Jrwest, I surprised you don't have floor mats. Shame on your company for not buying them for you.

martymoose, BSN, RN · Jan 2, 2013

We had 2 sets of mats. Like I said, we have 2/3 of the floor on bed/chair alarms at any given point. They might as well pad the whole floor in bubble wrap.Maybe I'll suggest it at the next "meeting".

amoLucia · Jan 3, 2013

To OP - You must work LTC, so I understand your dilemma re the restraint issues we have to deal with. Acute care just doesn't understand us and the regs.

We all know that alarms only tell us that pt is moving... They don't stop the falls!

I don't see any mention of psychoactive medications; of course, that's another whole can of worms...

Another alternative could be LOW BEDS. Of course, your place would have to buy a few, or they might be able to rent them. But from your posts, I guess mgt is CHEAPO, so... We found low beds to be fairly effective; pts usually didn't have the ooomph to get up off the bed (or the floor mats if they rolled). Oh, but they were back breakers for the staff!

As a last resort, we bring them out near the desk to sit with staff "for close observation". We do the diversional activities, snacks, toileting, etc. (It's all charted!) And the staff and I have all made rounds with the pt just outside whichever room we've been in. (Med pass is a unique experience when a climber is with you!)

I wish I could be more help, but you do have my good wishes.

PS - I like the bubble wrap idea!!!

BrandonLPN, LPN · Jan 3, 2013

But padding the whole unit would require too much bubble wrap. We should just roll the residents up in the stuff....

martymoose, BSN, RN · Jan 3, 2013

LOL- you would think this was LTC, but it's acute care , believe it or not. But many of these pts are from LTC.

I like the bubble wrap idea.

Silly question- if a pt falls out of a low bed onto the floor mats, is it still a reportable fall?

We cant even use the geri chairs with the trays on them like we used to years ago. They're a restraint.

Duhhhhh, don't they get it- of course we are trying to restrain them from breaking a hip or worse.

Oh well, day by day then.

mercurysmom · Jan 3, 2013

LOL- you would think this was LTC, but it's acute care , believe it or not. But many of these pts are from LTC.
I like the bubble wrap idea.
Silly question- if a pt falls out of a low bed onto the floor mats, is it still a reportable fall?
We cant even use the geri chairs with the trays on them like we used to years ago. They're a restraint.
Duhhhhh, don't they get it- of course we are trying to restrain them from breaking a hip or worse.
Oh well, day by day then.

The Geri chairs...

At one understaffed facility, I remember being told that the residents could use the Geri chairs with trays for "meals, snacks, and activities.". Well guess what? Every resident in a chair always had a snack, book, playing cards, mound of wash cloths, etc in front of them. Now that I look back and think about it, it must have looked kind of crazy! No one fell on my watch, though. ;-)

amoLucia · Jan 3, 2013

To OP - I would have sworn you were LTC, then I reread your 2nd response. Hospitals have a little more leeway re restraint use. In LTC, we're even restricted with the use of mitts, so we become very creative when IV, GT & FC tubings are in use!

Low beds can be either stationary PVC-type frames, maybe 12 inches off the floor, without siderails. Or they do have electric beds that go hi-lo, and the low can be reeeeally low, again like 12 inches, but with siderails. We push the beds against one wall to decrease opportunities to climb amd we're able to pad the floor on the one side. (Have you tried using multiple thick blankets; but you'll use up all your blankets then probably?) And yes, even if pts roll off the low beds to the floor, it is considered a FALL with all the required documentation. But NO injuries that I can remember!! The only problem is if there's tubes to tangle up.

Gerichairs and recliners are considered restraints because by definition a restraint is anything that prohbits a pt's free range of motion/mobility.

I've even had a pt who slept on the floor with mats specially arranged (officially approved). He was extremely high risk MR/DD/seizure.

I still like the bubble wrap idea, esp Brandon's improvisation. Maybe we can get the pts to POP the bubbles to keep themselves busy!!!

I know we're just trying so hard to protect pts from injury, but there has been misuse and abuse that have to be avoided.