Is a fall occurrence of "zero" possible?

[nursidosis]

Its every facilities goal to have no falls occur each month. But, is it possible? Most of you are probably thinking, no it is not. I disagree. It is possible. It is possible if certain areas of need are met. It takes a team effort that goes beyond the techs and nurses on the floor. Why is preventing falls such a big deal? Because falls cause injury to our patients, injuries to our patients lengthen their hospital stay, and if a fall with an injury occurs the hospital is now financially responsible for the patients care from there on even after discharge and long term care if needed. Here are good ideas you can take to your team at work and utilize to help your fall problem.

• Every bed has the alarm turned on. Even if the patient is ambulatory. It seems silly. But is the extra 2 minutes taken out of the day to help the patient who can walk on their own go to the bathroom and help them with their IV pole or make sure they have anti slip footwear on a big deal if it prevents a fall?
  
• Anti-slip footwear
  
• facilities like to go cheap and place a yellow arm band on the patient. No one who is not a floor personnel really notices them. How about yellow anti-slip footwear or gown? its more noticeable so that PT or the speech therapist who helps your patient to the bathroom can really notice that patient is a high fall risk patient.
  
• Frequent rounding! we are busy, i know. Take turns with your tech every so often to check on your patient.
  
• Change your call bell alarms. We all fall victim to alarm fatigue. If we have a new noise to learn we can subconsciously pay more attention to that alarm.
  
• Educate your patient about falls and that your floor is adamant about not having them. Encouraging them to use the call bell every time they need to get up can make a difference.
  

I know that proper staffing is the biggest problem with preventing falls. The fact is we have no control over that. We have to make do with what we have and what we have access to. Preventing falls needs to start from management down. Its a long boring process. But one fall is financially crippling and we need our jobs. We need money to staff and maybe one day be properly staffed. One fall can be more costly than a MD's yearly salary. Now imagine having 1-3 a month in most facilities. I hope this can help some of you and I encourage all of you to add some more of your ideas and best practices in the comments below.

Thank you for your support on Instagram. Look me up @nursidosis and follow for nursing education and humor.

Your fellow nurse,

Frank Trujillo

[Pangea Reunited, ASN, RN]

What good are bed alarms without adequate staffing? What good are any of these suggestions without adequate staffing? In any case, I've heard it all before and I'm sure I'm not the only one.

[dream'n, BSN, RN]

• Every bed has the alarm turned on. Even if the patient is ambulatory. It seems silly. But is the extra 2 minutes taken out of the day to help the patient who can walk on their own go to the bathroom and help them with their IV pole or make sure they have anti slip footwear on a big deal if it prevents a fall?
  

Let's be real. It's not 2 minutes out of my day, as it usually takes 10 minutes or so. Then we can do the math: 10 minutes x 5 patients every 2 hours=50 minutes out of every 2 hours. Therefore, 50 minutes x 6 (every other hour) and that is a grand total of 300 minutes per shift. Which is 5 hours. Now some patients have catheters so may not need to get up to urinate, but some of those 10 minute patients can also be more like 15-20 minutes after all is said and done.

And what about your confused, demented LOL who WILL NOT stay in a chair or bed? Who follows her around all shift?

Now if I could restrain every single patient at all times, then I agree with you. A fall count of zero would be possible.

[MunoRN, RN]

I applaud your attempt to reduce falls, that's certainly an important goal, but I don't think your suggestions really move us any closer to significant fall reduction.

Every bed has the alarm turned on. Even if the patient is ambulatory. It seems silly. But is the extra 2 minutes taken out of the day to help the patient who can walk on their own go to the bathroom and help them with their IV pole or make sure they have anti slip footwear on a big deal if it prevents a fall?

This is quite honestly a really horrible suggestion. You correctly point out later on the problem of alarm fatigue, but here you're suggesting creating a huge alarm fatigue problem, not to mention creating improper prioritization of already limited time.

One of the best ways to prevent falls is to identify which patients are higher fall risks than your other patients and as much as possible devote 'spare' time to reducing their fall risk. Spending time (which is far more than 2 minutes per trip) assisting a patient with absolutely zero fall risk is a distraction from keeping fall-risk patients from falling and only increases the risk of falls overall.

The use of bed alarms has been studied and it does not actually reduce falls, there's some indirect evidence that when used indiscriminately they may actually increase falls through unnecessary disorienting stimuli, which many patients respond to by stumbling out of bed.

Frequent rounding! we are busy, i know. Take turns with your tech every so often to check on your patient.

Frequent rounding is an excellent idea, although it's not a new idea, in general a nurses' time is already saturated, they check on their patients as often as time allows and according to appropriate prioritization. Whenever someone suggest that we check on our patients regularly I can't help but wonder how it is they don't realize that this is how it's always worked, they aren't offering any new solutions to the problem.

Change your call bell alarms. We all fall victim to alarm fatigue. If we have a new noise to learn we can subconsciously pay more attention to that alarm.

I have no idea what you're basing that on.

Educate your patient about falls and that your floor is adamant about not having them. Encouraging them to use the call bell every time they need to get up can make a difference.

I don't think it's appropriate to suggest to a patient they're breaking some sort of rule if they have a a fall, they shouldn't feel like we're suggesting it would be better if they didn't ask to go for a walk because our top priority is to avoid falls.

[Anonymous865]

I wish I could like MunoRN's comment above 1000 times.

I'd like to add that alarming every patient encourages helplessness. The goal of the nurse is to help the patient regain their independence.

It promotes deconditioning.

[Anonymous865]

Here's a well designed study of over 27k patients that came to the conclusion that

"An intervention designed to increase alarm use in an urban hospital increased alarm use but had no statistically or clinically significant effect on fall-related events or physical restraint use."

Effects of an Intervention to Increase Bed Alarm Use to Prevent Falls in Hospitalized Patients

[Anonymous865]

Some things that will reduce falls include:

1. Keep the floors clear of trash and clutter (unnecessary equipment) which can be a trip hazard.

2. Make sure the rooms have good lighting. As people age they need more light to see .

3. Make sure patients have their glasses and other assistive devices close at hand.

My frail 82 yo mother was hospitalized recently at a "top 100" hospital. Every day when I went in to see her, I found trash on the floor - empty IV bag, used IV tubing, needle covers, alcohol swab packaging, etc. This trash wasn't just a fall hazard to my mother. It was a fall hazard to my athletic 83 yo father when he visited, to me, and to the staff.

[martymoose, BSN, RN]

Hopefully the hospitals will learn that keeping staff like techs will only help keep falls at bay. if you only have one tech for 15 acute care pts, and two of them are setting alarms off and the other nurses are tied up toileting their pts ( like the math another poster noted) then you can see why we are getting spanked for falls.

Wouldnt it be cheaper to keep a tech/aide than to eat a hospital admission and care for a fall? Who wants to do the math?

[JerseyTomatoMDCrab, BSN]

I know how to achieve a fall rate of 0!

Every patient is a nursing 1:1. Done!

Seriously. These interventions are useless without adequate staffing.

[ponymom]

Frank, this is one of the more humorous (if not head-banging and eye-rolling posts I've read on here).

Every healthcare worker who's spent more than ten minutes in an ltc already knows this in spades. Only thing you're leaving behind is the only thing that will solve the problem, and that is adequate staffing. Until then, just forget it, because it will remain status quo. These problems are unsolvable without proper staffing.

I know you're a nurse, but you sound like a pencil-pusher. Safe care just cannot be accomplished without enough people to provide it.

And by the way, I can barely get myself to the bathroom in two minutes.

[1056chris]

Staffing really makes a difference. Also making a patient a fall risk on admission. Bed alarms, Ive seen them fell. Some patients are very determined, very confused or both. Sun downing, some patients really need sitters which is not feasible and usually not ordered until they fall. Calling family members in for a confused wandering patient helps, but they often don't want to come. Restraints, nets, leathers, Ive seen it all at different times. Sitting them at the nurses stations, medications, putting items in reach, reminding them to call and frequent checks don't always work. The other problem is nurses are busy and sure enough that is when it happens. My best advice is making a patient a fall risk on admission based on certain criteria, keeping their tubing untangled, SR up, door open, offer assistance to BR after meals before bed, room close to nurses station and good documentation.

[quiltynurse56, LPN, LVN]

I work in LTC and a fall rate of 0 is not going to happen. We can go several months without a fall and then we may have several falls. What is needed for us is more staffing. Also, those who have alarms, when we help them to the bathroom, we must stay in the room until we get them back to their chair or bed. Depending on how long they need to use the toilet, we can be in there a good 5 minutes or more. With 3 CNAs and 1 nurse on the evening shift for 33 residents, we can't be everywhere at once. Elderly, in particular, are fall risks due to the aging process.