Found on floor - ? fall

Gabie Baby · Apr 25, 2006

I was taught as you were. I'm really very surprised that The Top Two at your facility don't want all the paperwork they can get on this. I guess you can still do an IR, chart, call Doc and family. If you don't and it turns out the pt was harmed, you can bet it will be YOU who gets in trouble and TTT will deny telling you not to proceed in the standard fashion. Have they put their directive in writing? If so, keep a copy of it off the premises.

I guess the very low beds serve the purpose of not permitting falls from high up but they create another problem, it seems.

ktwlpn, LPN · Apr 25, 2006

My nursing home recently moved into a new building. We also have all new furniture. All of the new beds are the type which lower down to within 8 inches from the floor. We have found that some of our residents are being found on the floor at times, we think that they are either crawling out or falling that few inches after rolling in bed (there are no true side rails - only partial "enabler" bars to assist them in repositioning). Our administrator and don say that they don't think an incident report is necessary in these cases. I thought that anytime someone was found on the floor and the circumstances of them getting there were not certain, an incident report had to be completed. I was wondering if anyone had any input from what is done at their facilty in a similar circumstance?

We've debated this over and over at our facility. One important factor to keep in mind is no one expects us to completely prevent every "fall" but they want to see us prevent injury as much as possible.We will turn our low beds and push the side up to the wall and then put a mat on the floor for residents like this-we do NOT consider this a "fall" Unless you SEE a fall it's a "found on the floor" When we find a resident on their mat it's not an incident for us-it's a behavior and we've care planned the floor mat and the bed postion....Now if you find them out in the middle of the room we consider that a "found on the floor" and report it accordingly....If you have a resident that is consistently restless like this then you have to think outside the box-is it discomfort? hunger or thirst? toileting? Maybe they are being put to bed too early....

suebird3 · Apr 25, 2006

We have the PVC beds that are right on the floor, with mats next to the bed. 2 patients have these beds at the present. One has some "Sun Downers" going on.

Like ktwlpn, it is a behaviour to us. And unless we WITNESS a fall, we chart any incident as "observed on floor".....

Suebird

indigo girl · Apr 25, 2006

We've debated this over and over at our facility. One important factor to keep in mind is no one expects us to completely prevent every "fall" but they want to see us prevent injury as much as possible.We will turn our low beds and push the side up to the wall and then put a mat on the floor for residents like this-we do NOT consider this a "fall" Unless you SEE a fall it's a "found on the floor" When we find a resident on their mat it's not an incident for us-it's a behavior and we've care planned the floor mat and the bed postion....Now if you find them out in the middle of the room we consider that a "found on the floor" and report it accordingly....If you have a resident that is consistently restless like this then you have to think outside the box-is it discomfort? hunger or thirst? toileting? Maybe they are being put to bed too early....

This is how most places I've been in handle it also, and the behavior generates the questions, and our subsequent interventions.

(LOVE your grandmother quote!!!)

GooeyRN, ADN, BSN, CNA, LPN, RN · Apr 25, 2006

I always did an incident report for those kind of things. I didn't call it a fall, since I didn't see a fall. I just "Found on the floor, in XXX position", and a breif assessment note and if the resident has anything to say about how it occurred, dr., PT, and family notified at XX time, and if any new orders or interventions are written/planned. . I would rather do the headache paperwork so it doesn't come back to bite me 5 years later and I don't remember a thing.

But then again I am always being told I don't need to fill out one for this and that. I write one out every time an IV infiltrates, the pt. pulls one out, every tiny little scratch, bump, etc.

CapeCodMermaid, RN · Apr 25, 2006

Going from the bed to the floor even if the bed is low and there is a mat on the floor is still in my facility considered a fall and we have to do the IR and all the rest that goes with it.

The only case we didn't consider a fall was a woman who was seen and known to sit down anywhere on the floor. It was in her care plan and she never got injured.

Besides which, if you are old and have osteoporosis, a fall of even 8 inches can cause serious injury.

st4wb3rr33sh0rtc4k3 · May 6, 2006

In my facility, if the resident has a low bed, has a pad, alarm, etc. it isn't considered a fall, and no incident report is necessary. The only patients that have these are the ones that are prone to falling out of the bed. It is considered behavioral.

emeraldjay · May 6, 2006

In my facility anytime a resident is found with any body part other than their feet on the floor, it is considered a fall and documented as such. We have a few that will deliberately sit on the floor in front of staff just for the attention, and actually have said as much. The state must love us when they come to visit.

Daytonite, BSN, RN · May 6, 2006

The last nursing home I worked in had these same beds. We did not consider the patients as a "fall" if they were found on the floor. If there was any injury then we would have just reported the facts and made out an incident report. However, I can't remember any injuries from patients rolling out of those beds. We had them in all the rooms of our Alzheimer's unit and there was very minimal furniture in the rooms as well, so not much for the patients to bump into or hit if they rolled out of the bed.

CapeCodMermaid, RN · May 7, 2006

As an aside---pushing a bed against a wall is not allowed in my state for 2 reasons...it's considered a restraint if they can't get out of the bed, and it is against the life safety rules. The staff must have access to both sides of the bed in case of an emergency unless the patient specifically asks to have the bed up against the wall.