Handling the ones that are constant fall risks

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Specializes in hospice, ortho,clinical review.

I have 4 out of my 24 that are constant fall risks. The one that I'm looking for tips on, sleeps most of the day but is up all night with us (3-11) She's in a broda chair and can self propel by shuffling her feet. We are sometimes able to ambulate her with a 3 person assist, she can handle about 50 feet, but lately that doesn't tire her out. And we can't consistently do this as I only have 2 aides and I'm on a skilled unit, these folks are intermixed with the ones w/more needs.

What we've always done is no longer working. First she is getting into things/other rooms at the beginning of the shift and she can pull up on the hand rails in the halls. After dinner we usually put her behind the gate at the nurses station. She has always "pulled up" on this, up and down and back in her chair. (wheels locked)

In addition to her needing to go to the nurses station after dinner, we have to sometimes put her there before dinner as I mentioned she's started to get into things, back bathroom, ending up on the floor etc....

The problem is she's gotten so strong she can pick up the locked broda and move it! Before she couldn't do that, this repostions herself away from the gate and gives her open space in front and at that point she can end up on the ground. She never really "falls" she more or less slides and ends up on her butt, but that's still classed a fall and all the paperwork that goes with it.

If we let her self propel, she'll end up on the ground as she scoots. Plus she can manuever herself from the broda to one of the tv area chairs, there's no one in there to watch her.

Any ideas? This is a big source of stress for me keeping track of the fall risks. I was told that "if they fall, they fall"...aside from not liking that rationalization, the paperwork requires us to come up with a plan so it doesn't happen :madface: Of course they don't want to hear more staff to supervise or anything that would remotely help. We already have a body alarm on her. She falls about once a week.

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if a resident has the ability and is determined to get up and go, there ain't much you can do, unless a doc gets involved and changes the care plan, but that generally isn't going to happen until a resident actually hurts themself and proves they are a danger to their self.

just document, kya.

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Specializes in LTC.

Are her adls being met?

Does she have a uti?

Can you use a safe belt?

We have lots of falls as well and we can look in to the causes of the fall but most of the falls are hard to prevent

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Specializes in hospice, ortho,clinical review.

Thanks

No, she doesn't hurt herself, so I guess it is something I just have to learn to accept and not let it affect me. At least her daughter is v. understanding and really they aren't falls.

Yes, her adls are met, no infections and no, we can't use a belt...heck we have a hard time getting the okay to use the mitt for another resident that pulls her g tube out.

I guess lately too, it's coinciding with another resident who has major health issues, including hypotension which 1/2 the time her lasix has to be held so she gets worse. She has no conception of the call bell and will constantly get up w/o assistance and has also been known to fall. It just so happened last night as we rounded we caught her 4 different times thus preventing a fall, but the thing is...the family doesn't "get it" That daughter was in and is not nearly accepting of us not being able to prevent her falls even though she admits she sees we are short of help for what we're dealing with. So it's making that call that "mom was found on the floor" and the irritated responses of why, etc etc...

Ah, well that's LTC I guess.

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Have you tried a Merry-Walker?

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Specializes in hospice, ortho,clinical review.
Have you tried a Merry-Walker?

Sue! I'm bummed...that very item was mentioned the other night by one of my co-workers. After it was explained to me, I agree...it would be perfect for her.

Our facility is against them :( (They said they can tip etc plus they said not enough room for them...however I can only see the need for one right now.)... The nurse for this has countered with the fact they can be weighed down in the front....but still, so far they don't want to hear it.

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Lap Buddy?

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Specializes in hospice, ortho,clinical review.
Lap Buddy?

What is that?

Oh, we have Paro, the 6,000 seal that we can borrow sometimes. Doesn't amuse her, she sets it back on the nurse's desk and says "that dog makes too much noise" :)

She's a cutie I just wish we could keep her safe.

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A "lap buddy" is a restraint that looks like a cushion. It tucks into the front of the wheelchair. The more industrious and determined remove them.

We have two ladies in Merry-Walkers and neither have ever tipped over. One aims it at the wall like a NASCAR vehicle and keeps walking! But she's never tipped.

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Specializes in Gerontology, Med surg, Home Health.

I'm not a huge fan of Merry Walkers but sometimes they really are the best option. It's all about the risk vs the benefit. If this woman can propel herself in a Broda Chair, she should be able to use a MW. Will your management at least let you trial it?

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Specializes in LTC.

We had a resident in a merry walker and she loves it! Shes very confused and tries to get up out of her w/c (and sometimes succeeds) so she got the merry walker.

It takes up a ton of room in the hallway. But I think its a great idea.. It keeps her walking, moving around and quite happy than her being in a w/c.

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Specializes in hospice, ortho,clinical review.

Ha, Thanks Sue for the NASCAR visual....

CCM, No at this point they won't even allow for the trial.

When I went in on Friday, I talked to PT and also the nurse that heads up the planning for preventing future falls. They were both on board with at least doing a trial on her. Her daughter came in and I explained to her the risks/benefits...assuring her that of course we're not going to just let her go, we'd monitor very closely to see how she did and even if it was workable it would more or less be like an "activity" for her b/c she does have back issues and the MW wouldn't give the support that her padded broda does.

Well then of course this all had to be run past the unit mgr who is dead set against them. She said she has too many horror stories in her head of residents toppling over and one particular one where the resident's head was cut open and there was blood everywhere...... Can't really blame her I guess if she has all those bad experiences, she has nothing good to say about MW's.

So, I guess it's just keeping a vigiliant eye when we can and if not....like I mentioned she more or less scoots out of it. Sometimes though she'll stand and be able to turn, even in the tiny area of the nurse's station where we have her postioned. (there's a gate in front, and she pulls up on that, a wall to her left and the nurse's desk to the right...she can still manuever! That's where it gets tricky and I was up probably 5x while I was charting to get her to sit back down.

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