Frequent Faller

anitame · Jun 15, 2002

Well, I don't know if this will help but when I worked long term care we had a few patients similar to this. One of our maintenence guys rigged up a laser light alarm. It's been a while so I can't remember what they're called but the nice thing is they're NOT restraints. We would set one up so the light beam was parallel to the bed. When the light beam was broken by patient (or staff!) walking through the light, an alarm would sound. Actually, it sounded like a doorbell. Much more pleasant than some of our other alarms. There was a choice of 2 tones and it could also be turned off while the patient was being assisted by staff. I don't know if you've tried something like this, but it really saved our butts when state came. It was one more intervention for the high risk for falls care plan and it really did work for some people. Also, it would free up your staff some at night! I hope this helps. Let me know if you want more info and I can contact the facility and see if I can get the name. Good Luck! I know it's frustrating!

Anita

anitame · Jun 15, 2002

I just thought of something else that might help during the night. A baby monitor with the base in the patient's room. I can hear my 2 year old breathing, it would be very easy to hear if she was getting up. The receivers have the ability to be run by batteries. I've seen them with 2 receivers too, one could be at the nurses station for those RARE moments at night when anyone's there! And the other could be clipped onto a lucky! someone's belt.

Again, good luck

Anita

bandaidexpert, BSN, RN · Jun 16, 2002

Stormy, I have worked in LTC for so long, these type of residents are so common. Have you tried a bed alarm? It's a strip that is placed under the sheet on the mattress. I have found this is very effective. The alarm goes off at the nurses station as well as the unit. There is also a chair alarm, if attached to the back of a resident's collar, it can be effective too. Good Luck. We just instituted a narrative with our admission packet that informs family and residents that falls, skin tears can happen. This facilitates calls from staff to family if a fall or skin tear etc. occurs. Non-compliant residents are very frustrating. I am sure you are doing what you can, while allowing independence.

ucavalpn · Jun 16, 2002

I don't think your pt. will go for it , but I once worked LTC and had a pt. who wore a helmet . He still fell but at least his head was protected.

LTC-LPN · Jun 16, 2002

For a *frequent faller*, at the nursing home I work at, we use a low bed (about 3 inches from the floor) with a foam mat next to the bed. If the *frequent faller* rolls out of bed, he rolls onto the mat. The low bed is a bit difficult for the staff to provide transfering, but we understand about preventing injuries to the resident in the least restrictive way possible. We also use bed alarms and w/c alarms (as described by bandaidexpert). Falls are difficult to prevent 100% of the time, despite our best efforts.

Good luck StormyCD,

Jane Ann

Catsrule16, RN · Jun 16, 2002

Have you thought about using a bicycle helmet to reduce the risk of head injuries? :idea: I realize the resident has the "right" to be free of restraint but the resident also has the "responsibility" to cooperate with the treatment plan. If you feel your facility has done everything possible to protect this resident and he/she continues to be uncooperative with the treatment plan AND you have the documentation to support this, you can discharge this resident. Make sure you read and follow the regulations regarding discharge. Can't think of the F tag for it but there is one. If you truly cannot provide the care this resident needs to remain safe, then the resident is inappropriately placed and it is the facility's responsibility to inform and assist the family with finding more suitable surroundings. Since the resident is able to pass all the neuro and psych testing, then he/she should also understand the consequences of his/her uncooperativeness with the treatment plan. Include your Medical Director and the resident's physician in the process.

night owl · Jun 16, 2002

Stormy,

I know EXACTLY what you're going through b/c we just went through an exact situation with an 80 y/o parkinson's. He wanted to be independant, didn't want any alarms, belt, helmets you name it. After the last fall where he had to have sutures on his head, we finally had to put him on a 1:1 COS for fall precautions. He understood everything you told him, but he never would be compliant with anything. He hasn't had a fall since b/c we did it for his own good. (and ours too.) He still gets oob and all, but someone is ALWAYS with him when he does, and it takes alot of worrying off the staff. I find that you may be going in this direction especially if your resident refuses to be compliant...It'll prevent any further injuries and it will only insure her safety.

jevans · Jun 16, 2002

Unfortunately if your patient has capacity she can refuse any form of treatment. I'm sure you've documented that she refuses to comply but that is as far as you can take it. I completely agree with your request for written confirmation from the family though. How ever they do not have to provide it [ because if a patient has capacity they are the only person that can provide consent or refusal]but if you document that you have spoken to them about the risks with another member of your facility present, then you will be covered

Must say I absolutely love Anita's suggestions and would apreciate more info please

Good luck

j

StormyCD · Jun 16, 2002

Thank you all for the support. Anita, yes I would like more information on that alarm. I'm sooooo glad I'm not the only that has to go through this....Thanks Again,

StormyCD

night owl · Jun 16, 2002

Anita,

That laser light alarm sounds like a great idea to me. Please if you can get any information about it I would certainly appreciate it, and so would my residents. Thanks a bunch.

PS. By the way 1:1 COS for fall precautions is a medical decision and at least in my facility you don't need resident permission or family's permission. If the Resident is endangering himself in anyway, it is the physician's decision to place a resident on 1:1 for the prevention of self harm, for the protection, and for the safety of that resident when all other avenues have been explored especially if the resident is noncompliant. I work for the Federal Gov. so the laws may be different for State regulated facilities... I'm not sure.

shygirl · Jun 16, 2002

Hi, Make sure you are charting every avenue that you have tried. Document document, document. Make sure it's charted that she is the responsible party and refuses any type of intervention from staff. Good luck ,Gilda