Falls interventions

[CapeCodMermaid, RN]

So....do your staff nurses come up with interventions to prevent a second fall from happening? My nurses write the sos...call bell in reach and encourage resident to use it. Cripes...the resident is demented....let's be real.

Is there a list of interventions y'all use? I had a great web site from the VA saved on my computer but someone stole the computer! Any suggestions?

[Nascar nurse, ASN, RN]

I am in charge of falls in my facility. We actually have a fall committee; me, hskp supervisior, social service, therapist and maintenance. We do fall round first business day after a fall. We all go to the room and attempt to determine what events happened that led up to the fall. If the resident is alert, they are included. If the staff member that was present is in the building they come too.

Our fall interventions include lots of non-skid strips beside beds and in front of toilet. Also use anti-tippers, alarms, wedge cushions, stop signs (big red signs) taped to the inside of the foot board reminding them to call for help, stop signs in bathrooms, even a few stop signs taped to the arms of the w/c's. Have also requested orders for Vesicare on one constantly going to bathroom and forgetting to get help (turns out that after multiple falls - this actually worked and we could keep her toileted on a routine schedule and she wouldn't try to go inbetween times :))!. Therapy is required to screen all fallers. This adds positioning devices such as bolsters or even Broda chairs for those determined with no reasonable sitting balance and unable to propel self anyways.

Remember the basics too. Had a demented (but dignified) guy just this week that kept trying to get up. Kept telling him to sit down. Finally leaned down, looked him in the eye and asked "why are you getting up". He told me he was sitting on something. I helped him stand just a bit while an aide reached under him and found nothing on the chair. Put him back, but he kept trying to stand. After some more quiet questioning, he admitted he was "sitting on my balls" . Got help, got him all fixed and that was the end of that. (My funny of the week and so glad this was a fall prevention!).

Unfortunately, 75% of my nurses do not do a good job of initiating fall prevention methods at the time of the fall. They are finally doing a better job of including on the incident report if the alarms were sounding, if the floor was wet, if the resident had shoes on, etc.

PS, I was at some seminar within the last 6 months that indicated that in the future alarms may become considered psychological restraints... jeesh!

[CapeCodMermaid, RN]

thanks...I found the va website. I've also seen that article about alarms being abusive due to the noise. My nurses hardly ever come up with an intervention. I tell them and tell them that they need to investigate every fall....NOT to place blame but to prevent it from happening again. Usually they do the least amount of work possible and hope that the managers come up with something on Monday! We have a fall's team but lately all they have been doing is pitting rehab against nursing. And as for your demented dignified man.....ouchies!

[fibro2003]

So....do your staff nurses come up with interventions to prevent a second fall from happening? My nurses write the sos...call bell in reach and encourage resident to use it. Cripes...the resident is demented....let's be real.

Is there a list of interventions y'all use? I had a great web site from the VA saved on my computer but someone stole the computer! Any suggestions?

My exsperience as a pcna, if you have a patient who are use to being independant and forget to put on the call light and has fallen in the past you put on a alarm they have alarm matresses and clip on alarms so if the person get up without putting the light on the alarm will sound off and you will know when the patient is up out of the bed or chair, and if that don't work you and your co-workers can take turn watching the patient or get someone to sit with the patient if you have enough staff to make a pcna the patient private companion.

[SuesquatchRN, BSN, RN]

If someone has a spate of falls OOB in a row on the same shift with the same aides it can usually be traced back to their not having been toileted or changed and trying to avoid the uncomfortable wet spot.

OOB fallers we start with mats then go to body pillows then go to Posey rolls then mats then a low bed with mats. We have actually care-planned that the resident will not be injured if they roll OOB. They are all either clip alarmed or bed alarmed, depending.

People who keep forgetting they can't walk and trying to stand will get alarms. Depending on their Houdini-esque talents they will get a lap buddy or geri-chair with tray. We avoid both but careful care-planning and documentation can help.

We have two ladies in Merry-Walkers, which are wonderful. They are both still ambulatory but get weak so they can sit right down. And given that one is Houdini she now has WanderGuards on both her body AND the walker.

I have one guy who is fiercely independent AND modest and just came back after falling when transferring himself to the toilet s using his slide-board. We had had him sign an AMA about doing this because he is A&O enough to understand the dangers. He got back from the hospital last week and within ONE DAY I found him on the toilet - no assist - because his clip alarm was going. Of course, he unclips it when he remembers and sometimes he just uses it in lieu of the call bell.

[CapeCodMermaid, RN]

Thanks for all the replies. We try alarms but they just make noise and in the real world one aid for one patient is unrealistic. I know interventions...I've used them all. How do I get the NURSES on the floor to realize it's THEIR job to institute them.

[deleern]

Capecodmermaid, could you Link me to the VA site... I have a nice list I will see if I can scan it.

I am also incharge of our fall committee

[susanthomas1954]

Don't forget to send a UA on suspicious falls....lotta times it's a UTI

ST

[CapeCodMermaid, RN]

We send a UA on everyone who falls even if the cause is obvious. Just another case of nurses not being smart enough to think for themselves and having to be led by the hand step by step....no critical thinking skills.

[thomend]

Hey there could I get a copy of your list and the VA link. Thank you!

Tammy

[CapeCodMermaid, RN]

http://www.patientsafety.gov/SafetyTopics/fallstoolkit/

Lots of great information there. I've also found that the AMDA website has wonderful, helpful information about a variety of topics.

[thomend]

Thank you!! What a great site. Will be using it often.

Thanks for sharing!!

Tammy