Fall Prevention!!

PPL, BSN, RN · Jul 30, 2000

Hi Smitty. I work in rehab, and it's been my experience, that MANY times, the patient was just trying to get to the bathroom. We almost always have just two nurses, so it's easy to get tied up in a room; meanwhile, the rest of the floor's going down the tubes. While I would like to blame it on confused patients and "strange bathroom behaviors," ha-ha, the bottom line, once again is short staffing/nurse/patient ratios. So, don't overwork yourself on this action plan. Simple things like more frequent toileting, pt. education re calling for assist/mobility issues, etc. This is a perfect time to point out how staffing issues affect pt care and outcomes. Let's hear some other suggestions too. Oh, and don't forget, don't come up with a plan you know you can't possibly implement; they'll expect you to, and probably won't give you the staff to do it! Keep it simple! Good luck.

bunky, BSN, RN · Jul 30, 2000

Smitty I work on a surgical unit. PPL is right on about most of the falls being due to bathroom needs. The thing that I see most often is elderly surgical patients climbing over the siderails at night, despite having a cast on their leg or a fresh ORIF incision, having already pee'd the bed. FOLEY'S! Suggest a Foley cath protocol! For the life of me I don't know what goes on in the doctors heads when they send us someone with a hip fracture or a total knee replacement patient and they don't order a foley! Also, proper sedation orders for people who in your judgement are going to need it. Try having the evening shift GIVE the PRN's at hs too! It can make a huge difference. People whose pain is controlled tend to sleep.

Unfortunately PPL is too correct on the expectations you will create with a plan that is too nursey nurse. Don't tell them what they want to hear about just how much YOU are going to do. Use it to point out staffing inadequacies, and how safety needs can't be adequately addressed without enough staff to implement them.

Good luck!

bunky, BSN, RN · Jul 30, 2000

PS. Smitty go to the Nursing Specialties part of this BB and look at the Geriatrics section. They have a couple of different topics related to fall prevention and some of them are excellent ideas! You should find some really good ideas there!

bunky, BSN, RN · Jul 31, 2000

No thanks necessary, just be sure to include us as your sources in the foot notes, or perhaps in the dedication.

Smitty,RN · Jul 31, 2000

You guys were right on target. 3 of our 4 falls were people trying to get to the bathroom. All of them were disoriented to a degree and didnt follow directions and were getting up to the bathroom. I appreciate your suggestion to not get too wild with the action plan. I am new in my care coordinator position and my first idea probably would have been to set too high expections. Thanks again.

dianee · Jul 31, 2000

Hi Smitty,

We just revised our Fall Prevention Program and I'd be happy to e-mail it to you. Why re-invent the wheel. I probaly have lots of stuff you can use in your new job. Just e-mail me and I'll get you whatever I have. Di-

NRZNANZ · Aug 9, 2000

Hi, Smitty,

I have been looking at reduction in restraints as a hospital wide project. We are considering a comprehensive plan to use aides to do rounds esjpecially between shifts and in the early hours to toilet people. In addition, we are considering the use of a TABS monitor to alert us when someone is getting up. It has a voice option that triggers a 10 second message that can be programmed in easily in any language. We have so many patients who do not speak English, we thought this would be most effective. The alarm is LOUD so shoudl bring help soon. We are somewhat concerned it will wake up the whole place but to prevent a fall , it might be worth it. Has anyone tried this monitor? I would appreciate feedback

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NRZNANZ