Falls

[Rainscape]

I'm a newly licensed nurse and just started at a ltc facility. There is a resident there that has fallen and injured himself six out of seven days. In one day he fell twice. With each fall he gets new injuries and he sometimes reopens old wounds. The facility is "Restraint Free". I am worried sick. I just don't know what to do to protect him. They don't have staffing for someone to sit with him. I have never worked in a ltc facility before and just don't understand how we can just sit by and allow this to go on. Does anyone have any suggestions? Please advise. Thanks

[nrsang97, BSN, RN]

Find out why the pt is falling so much. Do they have orthostatic hypotension? Have they had any cardiac testing done? What meds have been changed? I cannot understand why LTC is restraint free if no sitters. This is why I don't work LTC. I would deffinately be asking the doc for some tests.

[facetiousgoddess]

and the ever popular UTI....or depakote/ammonia levels....dementia with no impulse control??? We can go on and on depending on the resident's dx(s) and meds...

Is there a pattern to the falls? Are they related to basic physical needs? Does resident need to be toileted? Can you initiate chair alarm, bed alarm, mats, bed low to the ground etc???

I hear your frustation per State resident has "the right" to fall. But goodness help us all when they do fall, we are accountable...

Tres

[Wildwood Flower]

I work on a med psych unit where no restraints are used and it is a challenge to keep your patient safe as well as keeping your job{our hospital hasa zero tolerance for falls so when one happens there better be a GOOD reason}.The other nurse and tech that work with me have found that bringing them out in the hall in their beds at night and geri-chairs in Am is one way of keeping them safe!

[TheCommuter, BSN, RN]

I have never worked in a ltc facility before and just don't understand how we can just sit by and allow this to go on.

Ask any state surveyor and they'll tell you, "The resident has the right to fall."

[Rainscape]

He is on Klonopin and Primidone. He sways and looks as if he could topple over with each step. Labs have been ordered. I hope that we can find a way to keep him from getting so banged up. We are not allowed to use alarms. He does have a pad on his floor beside the bed. He refuses to use the call light.

Thanks so much for your input.

[morte, LPN, LVN]

He is on Klonopin and Primidone. He sways and looks as if he could topple over with each step. Labs have been ordered. I hope that we can find a way to keep him from getting so banged up. We are not allowed to use alarms. He does have a pad on his floor beside the bed. He refuses to use the call light.

Thanks so much for your input.

why no alarms? in this case they may not be particularly usefull anyway....what we used to do before alarms, was to pin/clip the call bell to the johnny....(so they could find it, of course, LOL) when they got up they would pull it out of the wall, setting it off....good luck

[facetiousgoddess]

Klonopin, because it is benzo is associated with increased fall risk....or he could be experiencing a paradoxical response. Plus primidone can cause veritigo, ataxia, increased confusion and a whole lovely list of nasties...

Update us curious to see how your gentleman (and you) are doing..

Tres

[GeneralDogsbody]

Does he have a zimmer frame he can hold onto? We have some very tottery olds who have benefited from using zimmers or walkers.

[LauraF, RN, ASN, CNA, LPN, RN]

We have a guy at our LTC facility that fall often too. The nurses have to drag the guy around with them where ever they go, and God forbid if they have to go to the restroom. Per the state the alarm could be considered a restraint because the resident may be intimidated by the sound when they get up. Geri chairs? Please another restraint. He has BPD and feels like he needs to pee all the time. We take him pee and sometimes he can go other times he can't. Urine is clear. Depakote is WNL, he is in a wheelchair he is just not strong enough to walk, but he still tries to stand up and ends up falling.

[GeneralDogsbody]

We have ,in the past ,used bean chairs but I think these are now frowned on as well! We can use a lap strap on a wheelchair but only when the chair is moving!We have call mats but usually by the time you get there they have already fallen! When you think about it 'dragging someone around with the nurses' is as much a restraint to freedom as sitting them in a nice cosy geri-chair!

[KYGrace]

Check the residents diagnosis list. We had a resident with frequent falls recently. He had a diagnosis of BPH on his list, so we got the MD to order a PSA. Turned out that his PSA was 3 times above the normal limit. A good rule of thumb---always look outside the box!