Falls

[busy-bee]

In our LTC we have personal alarms placed on residents to notify staff and resident of unsafe movements related to residents inablility to recognize their own limitations. We place these on admission for 24 hours, if the resident uses their call light effectively, gait steady, etc we remove the PA. But if not, we continue with the PA. The question here is, if the resident is unsafe, constantely removes the PA dispite encouragement, should the PA be removed related to uncompliance? Understand resident rights and all, once we remove the PA then do we not need to implement another plan? Documentation on noncompliance is all well indeed but at least we are proving we are trying to protect the resident. But if we DC the PA with no other plan, can we be then held liable if she falls?

[Nurse_FF_EMT]

Falls are a delicate balance. Patients have a "right" to fall, but we have to show that we did everything we could to prevent them from getting hurt. You have to show that you used the least restrictive method to keep people from getting hurt.

Chair/Bed alarms are one way to remind the patient to call for help, and alert you when they dont.

Lab buddys, etc can be used to remind the patient not to get up without help. But they have to be able to remove them by themselfes, or it will be counted as a restraint.

Then they are restraints, but if you restrain a person who is A&Ox4, but is stuborn like a mule about fall safety, you open yourself up to a huge liability.

What I would do:

He sounds like he would just laugh at you if you tried a reminder like a lab buddy, and I'm not going to restraint him because he sounds like he is alert (just a horses behind). I would keep on placing the fall alarms, and document document document everytime he disables it. Chart what he does, what he says, how you tried to tell him that it is for his own safety, etc.....

[busy-bee]

When I refer to PA, it is a chair/bed alarm. In review, I work in a LTC facility and most of the resident do have dementia and or some sort of short/long term memory loss. Thus if the chair/bed alarm is removed by the resident then as nurses we should continue to place and chart the result. But to discontinue the alarm just because the resident removes the alarm could place us at fault? Now if we continue the alarm and she removes it and falls, then we would not be at fault for we tried to take precautions. However if we know she takes the alarm off then we must continue to check for placement more often. What a viscous circle..............I think just to discontinue the alarm is not the right thing to do when the resident is at a high risk for falls.

[VivaLasViejas, ASN, RN]

In our LTC we have personal alarms placed on residents to notify staff and resident of unsafe movements related to residents inablility to recognize their own limitations. We place these on admission for 24 hours, if the resident uses their call light effectively, gait steady, etc we remove the PA. But if not, we continue with the PA. The question here is, if the resident is unsafe, constantely removes the PA dispite encouragement, should the PA be removed related to uncompliance? Understand resident rights and all, once we remove the PA then do we not need to implement another plan? Documentation on noncompliance is all well indeed but at least we are proving we are trying to protect the resident. But if we DC the PA with no other plan, can we be then held liable if she falls?

In a word: YES!

In theory, residents do have the "right" to fall. They also have a right to be protected from falls, and personal alarms are only one of the many weapons in the fall-prevention orificenal.

A word of caution: As an LTC assistant administrator and health services director, I'm uncomfortable with your facility's use of PAs on all new admissions regardless of diagnosis or cognitive status. Blanket policies like this violate a resident's right to be treated as an individual; in addition, your facility can be cited for failure to have an individualized, interim care plan in place within 8-24 hours of admission (check your state's regulations).

Anyway, it is NEVER a good idea to discontinue one type of fall prevention without having others in place. Even in ICF, you can request PT/OT evaluations to assist with planning a restorative program and acquiring the correct adaptive equipment that helps the resident move safely. Medications should always be reviewed to see if those that are likely to cause or contribute to falls can be D/Cd or changed to something less likely to do so. The resident's physician should also be consulted and appropriate tests done to rule out latent disease processes, such as MS and Parkinson's, that affect gait and muscle function. Check orthostatic BPs on a random basis to see if that could be causing falls.

These are only a few of the things we can do to prevent falls in LTC, but it's best to start with the basics. Again, I believe placing alarms on all new residents in lieu of a short, focused admission assessment is wrong; people do not give up their rights at the NH doorstep, and they don't deserve to be treated like cattle.

Good luck!