Falls prevention

redge03 · Aug 10, 2011

Are you in a hosptal or LTC? Well I deal with a lot of falls too...unit manager(LTC). Are these falls on any certain shift? I assume you work night shift if you are waking them up to toilet. Look to see if diuretic meds are given at appropriate times, not before bed. Also track the voiding patern and use that as a tool to anticipate toileting times. Are they slipping in urine due to incontinence, is the lighting inappropriate, are they weak, educated repeatedly on call light use, offered plenty of fluids during the day to reduce UTI that causes confusion, frequency, urgency? It is going to make a difference on the setting you are in (IV fluids) and what the population is like (dementia). Try to think outside the box to see why these people are falling. Do they have mixed incont? A bladder training program or even pelvic floor excercises by PT can help with that. In my opinion, waking someone up every hour to toilet is barbaric. Yes we want to protect them from injury but would you like to be waken up every hour when you are sleeping? To me that could have some adverse effects from interupted sleep. Also every patient has rights and you are the advocate! Congrats on not having a fall, you must be doing something right. However it happens to the best! Hope this helps. Good luck!

pmshiftrn, BSN, RN · Aug 10, 2011

Thanks for you response! I'm on a medical oncology unit. People have been reporting after the fall that no one has been in to help them go to the bathroom, so that is what prompted the nurse manager to request hourly rounding whereby we tell the patient, "I'm taking you to the bathroom now." I usually ask my patients if they want to be interrupted at night. Some do, but most want to sleep! It's the most frequently heard request from my patients. Honestly, i do round / peak my head in to their doors as much as i can, but I'd be lying if I said I do it or could do it every 2 hours on every shift! Some of my patients are not sleeping, and they are up with other issues that require a lot of my time and I just don't have the ability to check on those who are less needy or who are sleeping.

Thanks again for you input. I'll be looking at meds more carefully now, and I'll check more conscientiously on those who have UTIs, also.

Penelope_Pitstop, BSN, RN · Aug 10, 2011

Honestly, i do round / peak my head in to their doors as much as i can, but I'd be lying if I said I do it or could do it every 2 hours on every shift!

This statement alone says a great deal.

I know that when a nurse is new, it is more difficult for him or her to get everything completed in the time allotted, but if you aren't able to at least physically see each patient every two hours, there must be some other problem in your department.

Are you staffed appropriately for acuity? Do you not have helpful coworkers?

As for the fall issue, something like this happened on my floor a few years ago. I know that our boss was getting in trouble with her boss over this issue, so she was reacting for the sake of reacting. What happened for us was that every patient HAD TO have a bed exit alarm, even 21 year olds with kidney stones. It eventually went away when our fall numbers decreased. I suspect this will happen to you as well.

I personally think it is ridiculous to toilet every hour. I know that effective toileting really does decrease falls, but this is overkill.

ckh23, BSN, RN · Aug 10, 2011

Asking someone if they need to go to the bathroom every hour is ridiculous. Most facilities are employing hourly rounding to prevent falls and also increase patient satisfaction. The hourly rounding usually is to ask if the patient needs anything, not specifically to go to the bathroom.

It is very unrealistic and and insane to wake up someone every hour while they are sleeping to see if they need to use the bathroom. After about 24 hours of interrupted sleep you may see these patients become confused and disoriented because of sleep deprivation. I have seen this with younger people that have been on q1hr neuro checks for more than 24 hrs.

When you do your initial assessment you should be able to pick out the people you really need to watch and the ones that are capable of hitting the call light for assistance.

JDZ344 · Aug 10, 2011

I think waving everyone up every 1 hour is cruel, and also not very productive. You (general you, not you specifically) do not get up every hour to go pee as a rule, if you were you would be hopefully seeking medical attention as it's not really normal.

Where I work the layout is different, there are few private rooms so if we have someone at high risk of falls, I just pull up a chair and sit in the middle of the bay so I can see if anyone is trying to get up. Since that is not an option for you, is there anyway you can leave the doors open or ajar to the rooms? Wlak around every hour, see if anyone is awake and offer them the toilet? I am assuming they are not alert enough to use the call bell for help? Is having a bed side commode left by some of the beds, with soft lighting, an option?

RNASHLEY · Aug 10, 2011

Doesn't your hospital beds have bed alarms? I work nights as well and it seems barbaric to wake up patients every hour. We get a lot of older/confused people on my floor and falls are a problem...by a porblem I mean one or two every month or two.....every couple days is extreme! Our biggest tool for fall prevention on confused patients who don't call to get up is a bed alarm that starts sounding as soon as they start to try and get out of bed so we can run to the room and stop them. We also have alarms in the chairs that can be set if they are up in the chair and try to stand up.

pmshiftrn, BSN, RN · Aug 10, 2011

Thank you. we do have bed alarms and I plan on using them more often.

pmshiftrn, BSN, RN · Aug 10, 2011

You hit it on the head by asking about the acuity and nurse/patient ratios. We have 5 pts per night. One night recently, of my 5 pts, 2 were total care and on contact isolation, 2 others were receiving blood transfusions, and the 5th patient was on seizure precautions. This last one was down a different hallway, but fortunately had a sitter in the room. The other nurses are helpful, but they are also busy and I hate to keep asking for help. I ask a lot anyway cause I'm new and have questions, but I try not to ask people to do parts of my job for me such as rounding or sitting with patients when a new bag of blood is just hung. I'm thinking the unit needs a nurse to just float around esp for the first few hours of the shift to help out with those sorts of things.

pmshiftrn, BSN, RN · Aug 10, 2011

I think waving everyone up every 1 hour is cruel, and also not very productive. You (general you, not you specifically) do not get up every hour to go pee as a rule, if you were you would be hopefully seeking medical attention as it's not really normal.
Where I work the layout is different, there are few private rooms so if we have someone at high risk of falls, I just pull up a chair and sit in the middle of the bay so I can see if anyone is trying to get up. Since that is not an option for you, is there anyway you can leave the doors open or ajar to the rooms? Wlak around every hour, see if anyone is awake and offer them the toilet? I am assuming they are not alert enough to use the call bell for help? Is having a bed side commode left by some of the beds, with soft lighting, an option?

I usually do just offer toileting to those who are awake and I agree that waking people is neither fair to them or productive for the nurse.

tma0312 · Aug 10, 2011

I bed alarm everyone UNLESS I am 100% positive that they have no problems walking and are not tethered to a monitor / IV pole and are not taking narcotics. I also get bedside commodes for the ones who need quick access. I always give people gentle reminders that I'd rather clean up their pee in the bed than have them fall and get a broken hip. Usually that is all it takes for the oriented ones to call every time.

StrwbryblndRN · Aug 10, 2011

I am for implementing falls risk solutions. But people are people. I have had a/ox3 94 year old with a walker who was 100% self care. She was awaiting d/c the next day after an exacerbation of CHF. I was not about to take her independence away from her. But documentation and frequent rounds kept me in check that she was doing well. (There was an order by md for "up ad lib") I will not put a bed check on her, nor round hourly to make her go to the bathroom. She proved she could do that on her own. This is just one example that each pt needs to have their fall risks fine tuned to meet each pt needs. My post surgical pt who needs to ambulate with an iv pole should not need a nurse to walk if they are able to walk by themselves. (except for first walk after surgery to assess stability)

However pain meds and pt stability could make this different.

Last fall I had a pt decided to get up to go to the br with their walker. 50 some year old with a walker due to back surgery. She was a/o x4 and usually called. Well she decided this time she was going to do it on her own. She slipped in her urine cause she could not hold it. She said she did not want to bother me. However documentation showed I was in her room just 17 minutes prior and that I asked if there was anything she needed. She does have a mind of her own, i refuse to force anything on her. I did everything in my power at the time, other than stand outside her room, to prevent her fall. Sometimes it is just going to happen. A bed check did not seem necessary prior to the fall. Besides we do not have enough in the hospital for everyone.