Frequent Faller

[txdon]

I have a resident who "slides" out of bed onto the floor when trying to ambulate to wc. She is a one person assist and has a transfer pole to promote more independence to and from bed. When she slides out of bed onto the floor she is unable to get up. She uses her call light for assistance. When we ask her what she is doing sitting on the floor is will say,"I didn't fall. I am sitting on the floor looking for somethig, playing cards, etc." She knows we have to treat it as a fall and start neuros, etc. The problem my staff is facing is how to continue to careplan this appropriately. We have ran out of interventions to use to prevent this from continuing to happen. I know when the surveyors look at this pattern they will question our lack of effective interventions. One reason for perhaps her slips out of bed is the fact she insists on wearing silky nightgowns. That is her perference. Can anyone think of additional interventions my facility could implement or any new fall prevention measures to prevent the resident from getting up and ambulating without assistance? And how should this be careplanned?

[CapeCodMermaid, RN]

Do you use fall mats? That way if she does slip at least she'll sit on a soft mat and not the hard floor. Make sure you care plan the silky nightgown. I had a resident like that. The surveyors wanted to cite us but we showed them it was clearly resident choice...and of course, we had gone over the risks and benefits with the resident. Do you use bed alarms? Tab alarms? For our highest risk residents we try a room closer to the nurses' station and sometimes use a motion detector.

I've never heard of a transfer pole......pole dancing at the nursing home!

[debRN0417]

If the resident is not hurt, then your interventions are working. You cannot stop a resident from falling. You just have to try to prevent them from an injury when they do. It sounds as if this resident is going to do what she wants to do whenever she wants to, so the best thing you can do is try to make it as safe for her as possible. Like CCM said, make sure you care plan everything- the silky gown, the fact that she does what she wants and is non-compliant with calling for assistance, try some of the interventions CCM suggested if you haven't already, and then STOP doing all those neuros and stuff! If she slides out of bed on to a fall mat and is not hurt, denies hitting her head, why do you want to draw attention to the fact that she fell 10 times in one day (just sayn) by all those neuros and stuff? I mean, simply state, "Resident found on floor on fall mat. No injury. Intervention (fall mat) in place and effective in preventing injury"...or something like that. I see this all the time and as long as the facility has tried everything possible and the resident isn't hurt when they fall, then the interventions are working. It is only when you have not attempted several things that there could be a problem, or if everything is not careplanned. Do you have risk meetings or fall meetings? Make sure you have all this documented in those meetings of you do...

[VivaLasViejas, ASN, RN]

Some things to consider (if you haven't already): Why is she trying to ambulate to the w/c? It should be sitting at her bedside so she can get straight into it from bed, if she's determined to do this independently.

Has she had PT/OT evals recently?

Is there an incontinence problem or UTI?

Review her meds. Does she take a lot of BP meds or narcotics? Both, obviously, can contribute to falls.

Review past incident reports to see if a pattern emerges, e.g. time of day when most of her falls occur, or what she said she was trying to do at time of fall.

If she insists on silky nighties, be sure to care-plan for it. Maybe a scoop mattress to prevent her from 'slithering' out as easily?

Frequent (Q 1 hr) visual checks for safety?

etc., etc.

[PammyRN,CEN]

has anyone went bed/chair alarm free? That is my task now to complete... Just wondering how some of you completed this? Please share your plan.

Thanks,

Pam

[txdon]

Why would your facility want you to do away with bed/chair alarms? We use them not as a form of restraint, rather as a reminder to seek assistance before getting out of bed for those who are impulsive and forget to call for assistance. Alarms don't prevent residents from getting out of their bed or chair. It is used to "alert" staff to help them to this in a safe manner.

[txdon]

Thanks debRN for your comments. At my facility our policy is whenever the resident falls and it is unwitnessed, we have to do neuros. How should I go about changing that if that if that is the policy? Also, we have had a high number of falls last month. As a result I have been asked to write an action plan. I have never had to do this before. The falls have decreased signficiantly this month but they still want an action plan. Any suggestions on what the action plan should consist of?

[CapeCodMermaid, RN]

Why would your facility want you to do away with bed/chair alarms? We use them not as a form of restraint, rather as a reminder to seek assistance before getting out of bed for those who are impulsive and forget to call for assistance. Alarms don't prevent residents from getting out of their bed or chair. It is used to "alert" staff to help them to this in a safe manner.

Some facilities consider alarms to be noise pollution and annoying to the residents. Personally, I don't know what we'd do without our alarms.

For you action plan...count the number of falls. Arrange them first by shift and then by what the resident was doing at the time of the fall. If the majority of the falls occur because of toileting needs, start a toileting program for that resident. If the falls happen at change of shift, perhaps flex a few CNAs so someone is always watching for falls.

Your plan should include your goal and how you are going to make the goal. Good luck.