Falls in Psychiatry

[MrChicagoRN, RN]

Inpatient psych is different from inpatient medical in that we actually want our patients to be up and ambulating outside the rooms as much as possible.

But, as you know, our population aare often impulsive with impaired judgement, and receive medications to alleviate their symptoms. Plus, no call lights in rooms.

This causes a higher fall rate compared to medical units. We need to reduce this.

Does anyone want to share their fall rate and/or prevention strategies?

Either here, or by PM would be great.

Thanks in advance.

[Mish56, BSN, RN]

HUGE problem for us also! Can't wait to see the responses here. We end up putting an awful lot of geriatric patients on constant observation.

[Whispera, MSN, RN]

For the geriatric patients, we use bed alarms so we know if they get up and we can get there quickly. If someone is likely to fall out of bed, we put the mattress on the floor, so there's a shorter distance to fall.

Falls haven't been a problem for non-geriatric patients.

[Meriwhen, ASN, BSN, MSN, RN]

Keep in mind that I don't work gero-psych.

Most of my patient falls aren't due to medications or psychosis. They are due to flat-out carelessness that is mostly on the patient's part: rushing down stairs or in the hallway, wearing footwear with no support or traction, not using assistive devices as they were supposed to, not paying attention and missing the chair as they (try to) sit down...

Anyhow, there's only so much that we can do: we can educate, we can remind them to use/wear the appropriate gear, we can keep their surroundings as clutter-free as possible, etc. But ultimately it's the patients that need to change their habits.

[Davey Do]

On the MN Shift, ALL of the Typical Stuff (Non-Slip Footwear, Bed in Low Position, Identifying Accoutrerment, etc.) including the Higher the Fall Risk, the closer to the Nurses Station.

If a Fall is Imminent, the Pt is placed on 1:1 or the Floor Nurse/Tech is stationed outside of their room where they sit at their Work Station in between Rounds and Patient Care.

Sometimes Mats on the Floor by the Bed helps out, too. They may Fall out of Bed, but the liklihood of Injury is Decreased.

[WillyNilly]

Every person has a bed alarm at night. No exception. Explain it is for safety reasons, most are agreeable. Slipper socks on everyone as soon as they walk in the door. Orthostatic vitals daily. During the day, most are pulled to a common room to encourage socialization and to keep eyes on everyone. Staff members must be with them at all times. If high risk for falls, follow them to the bathroom and back. We walk a lot with our patients. Station the computers outside a cluster of rooms at night and answer those lights in person. With everyone clustering, charting is getting done and patients are getting quick care. We can place mats on the floors, restraint free alarms on people, bed alarms, nonskid socks, every 15minute checks, hourly rounds (toileting, etc), utilize quiet areas, activities, etc.

[ChristineN, BSN, RN]

Every person has a bed alarm at night. No exception. Explain it is for safety reasons, most are agreeable. Slipper socks on everyone as soon as they walk in the door. Orthostatic vitals daily. During the day, most are pulled to a common room to encourage socialization and to keep eyes on everyone. Staff members must be with them at all times. If high risk for falls, follow them to the bathroom and back. We walk a lot with our patients. Station the computers outside a cluster of rooms at night and answer those lights in person. With everyone clustering, charting is getting done and patients are getting quick care. We can place mats on the floors, restraint free alarms on people, bed alarms, nonskid socks, every 15minute checks, hourly rounds (toileting, etc), utilize quiet areas, activities, etc.

There is absolutely no reason for every single pt to have a bed alarm. You are going to be discouraging your independent walkie talkie pts from getting up. Plus if you are just using an alarm on everyone there is no nursing judgement going into who actually needs it and who is not a fall risk

[Whispera, MSN, RN]

I think it's demeaning for every person to have a bed alarm. Many wouldn't even want to get up to use the restroom if they knew the alarm would go off.

Awhile back I worked at a place where, if a person had EVER fallen, anywhere, any time, he or she would have soft wrist restraints applied when in bed or sitting in a chair. This was a med/surg unit. I hated that procedure and wonder if it's still being done. How awful to go to the hospital for help and be treated like a prisoner!

[ChristineN, BSN, RN]

I think it's demeaning for every person to have a bed alarm. Many wouldn't even want to get up to use the restroom if they knew the alarm would go off.

Awhile back I worked at a place where, if a person had EVER fallen, anywhere, any time, he or she would have soft wrist restraints applied when in bed or sitting in a chair. This was a med/surg unit. I hated that procedure and wonder if it's still being done. How awful to go to the hospital for help and be treated like a prisoner!

So the 20 something that had a trip and fall would be restained?! That is insane, and if I were the pt I would love to see what they did when I refused

[imapsychrn]

A lot of our falls are behavior. Either being careless or just silly and then also the "I need attention" falls.