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 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.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
Sometimes the bias of LTC administrators amazes me. MWs are clearly not for everyone, but they are the "bees knees" for many elderly and confused patients who desire to be up and active but are not safe in doing so alone. I completely understand that some facilities simply do not have the room for them, but most that I have been in do...
I too have never experienced a patient falling over in a MW although I have seen a couple get into some pretty interesting positions in the contraption.
It really floors me that management restricts the use of safety measures on ideological basis but then neglect to provide any other tools for the nursing staff to actually meet the safety needs of the patient! It sounds like y'all are playing a game (not by your choice) of cya while you wait until this patient actually injures herself and/or someone else in a fall incident.
Besides CYA with documentation, I would ask for a floor meeting and invite your supervisor(s), social worker, physical therapist and recreational therapist to discuss the problem and come up with a multidisciplinary approach that recognizes that there are times when the (limited) staff are busy with other patient care activities and it is unrealistic to expect 100% coverage at the current conditions.
Too bad for the close mindedness of your supervisor, but you have to work with that handicap,
What did she say about the Lapbuddies?
What does this patient like to do that might keep her busy, would listening to music (even with headphones) calm her down?
I would also see what I could do to change her circadian rhythm back to normal.
Besides CYA with documentation, I would ask for a floor meeting and invite your supervisor(s), social worker, physical therapist and recreational therapist to discuss the problem and come up with a multidisciplinary approach that recognizes that there are times when the (limited) staff are busy with other patient care activities and it is unrealistic to expect 100% coverage at the current conditions.
Too bad for the close mindedness of your supervisor, but you have to work with that handicap,
What did she say about the Lapbuddies?
What does this patient like to do that might keep her busy, would listening to music (even with headphones) calm her down?
I would also see what I could do to change her circadian rhythm back to normal.
That'd be great if there could be a team approach. It won't work though, as I'm told we fill out slips and have whatever dept evaluate them. My mgr thinks so far we're handling it, so no problem, yeah until next time
Lapbuddies won't work b/c of the type of broda chair she has. I'm told they work with wheelchairs not these, and besides as someone pointed out, the more industrious can get them off and that she is!
Sorry, but music won't work, she'd never leave headphones on, calls everything noise. She's very much "out there" she'll act like she sees people and things and has total conversations with them, sometimes involving us, sometimes not. But mostly not ever making sense but not gibberish. Ex. How many cows are going to come with us? Things like that. She'll get on different loops of things sometimes too. A couple times she's been filled with terror and will get on morbid death thoughts either herself dying or some other "her" that's in trouble. She'll ask us to help "her"(not the resident herself, some other female she sees in her head) and when we try to calm and say no one is there and she's safe etc she'll go on a tangent.
She loves food! So we give her snacks and root beer. That she likes, then she may doze back off for a little while. Then back up to the pulling up etc...
OH! and the circadian rhythm...I would love it if they were receptive to that. But my mgr says that you can't change that in people that's just how they are and they refuse to even try. Doesn't make sense, b/c that would solve many of our problems with the ones that we have to keep out around the nurses station. But I asked that a long time ago, and it was immediately shot down and an unreasonable solution.
I have never witnessed a resident being hurt with a merry walker, but I HAVE witnessed the resident in the merry walker hurt other innocent bystanders/residents. After several damaged toes/feet/shins we took the merry walker out of our facility & I hate to admit it, but I would never consider using the device again. But, admittedly our hallways are pretty narrow so it wouldn't take much to accidently run over someone.
We have a resident in a merry-walker...this woman is bound and determined to get out of it. She will come up to various staff, residents and even visitors and try to sell the thing to them :), Very cute...Will tell us that she already made all the payments on it. One time she took a pair of scissors off a med cart and cut herself out :) gotta love it!
We have a resident in a merry-walker...this woman is bound and determined to get out of it. She will come up to various staff, residents and even visitors and try to sell the thing to them :), Very cute...Will tell us that she already made all the payments on it. One time she took a pair of scissors off a med cart and cut herself out :) gotta love it!
lol cute. I can totally picture the resident that we have in a merry walker doing that. and trying to cut herself out of it too.
An obvious suggestion, but something that she might not be able to do - washcloth folding? A stack of papers she can riffle through?
Sue! Too funny again. She does love to riffle papers and will do that, however sometimes she'll get her hands on important ones before we catch it. The other day since she wouldn't just give me it, I had to trade her a Lorna Doone for the paper! She's tough, but loves her cookies! We had to move her from the one end of the station to the other, b/c the daylight secretary was getting aggrivated as she was destroying the desk calender that she had! Kinda looked like some cats and raccoons got into a scuffle on top of it! So we've moved her to the other end for several months now.
No, she doesn't have pain that we're aware of. She can respond appropriately sometimes. She will say if she has a headache for example. They have her on Tylenol TID "just incase". Hasn't changed a thing in her behavior though.
Just so happened yesterday as soon as I walked on for my shift, it was discovered she was on the floor in the dining area yet again. We did the only thing we could at that time and that's put her at the nurse's station behind the gate.
One of the higher ups that is usually gone at that time, ended up taking her out and letting her roam the hallways again. I caught this and asked who let her out? She said we can't keep her there b/c it's a restraint! I explained she will harm herself more if left to wander, just as I said that the resident almost pulled the linen cart on herself! She then asked why we can't walk with her now etc... Well just so happened for 24 residents we were short and I had one aide, trying to tend to everyone, toliet them etc... Needless to say, it's impossible when I have my two let alone one I can't even believe she suggested that.
I enlisted the one of the other nurse's who was (everyone wishes this person would just stay in her office and away from us as she has nothing valid to offer) She located the care plan book that clearly stated from 2 years ago that we are allowed to have her wedged where we do as it allows the resident to pull up thereby exercising her legs. Even her daughter who came in later said if she herself is fine with it, who does this other person think she is to change things? She even had the audacity to say the resident looked like a dog behind the gate! We've never treated her or thought that of her. It's just keeping her safe the only way we are allowed to.
And it so happens the other one of my 4 that are constant fall risks, was also on the ground 20 minutes later! So there was me and one aide for the hall with most fall risks. Plus the other one that is a fall risk was trying to get OOB q hr during our shift. Talk about feeling you're in a juggling act. The only one of my four that is a fall risk that wasn't trying to get up unassisted just wanted to escape! She asked me if I was driving home last night, I said "yes" then she asked where I lived...I asked why...she said she wanted me to drive her home :) That was pretty tame for her, usually she starts to undress every day around dinner and topless will hang her clothes on her tray table, we've said we need to install a pole in her room The best was around Easter when one of the aides had bunny ears on and went in as was alarmed b/c our little nudist was well nude! I just told the aide, well she saw your ears and thought, when in Rome....
The whole thing is just a mess. For now all we can do is keep on doing what we are since they won't listen to anything else.
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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We had to move her from the one end of the station to the other, b/c the daylight secretary was getting aggrivated as she was destroying the desk calender that she had! Kinda looked like some cats and raccoons got into a scuffle on top of it! So we've moved her to the other end for several months now. 
She then asked why we can't walk with her now etc... Well just so happened for 24 residents we were short and I had one aide, trying to tend to everyone, toliet them etc... Needless to say, it's impossible when I have my two let alone one I can't even believe she suggested that.
The best was around Easter when one of the aides had bunny ears on and went in as was alarmed b/c our little nudist was well nude! I just told the aide, well she saw your ears and thought, when in Rome....
SuesquatchRN, BSN, RN
10,263 Posts
Freakin' Houdinis.