Having the "Right to Fall"

marjoriemac, LPN · Feb 24, 2008

I think it is a term that can be interpreted in many ways. If we are talking about risk involved, then sure, someone who is mbile but may be a 'high' risk of falls has the right to continue to mobilise if they are aware that risk is present. If they are not aware of their own risks, we have a duty to protect but not to restrain from normal meaningful activity. We do not have to restrain to prevent falls, we can use our investigative skills to see why residents are more mobile at certain times and to move obstacles out the way etc.

On the other hand, I have heard regulators say we cannot put a lap belt on a tilting chair of a resident who is severely demented and unable to walk as it is their right to fall. I find this ridiculous as the person cannot walk anyway so it is a foregone conclusion that they will not voluntarily get off their chair, so we are not taking away a right?

I think a lot of it goes down to the paperwork regulators push on us that categorises people into a high risk group or low risk group depending on various conditions. Sometimes we cannot prevent falls, sometimes we can, we just have to make sure our desire to 'help' someone does not inhibit their desire to 'act'.

I walk out my home, I trip and fall, I was not looking, is that my right to fall, I know there is a risk in anything I do that I migt have an accident???

SuesquatchRN, BSN, RN · Feb 24, 2008

marjorie and nightmare, "the right to fall" is a U.S. nursing home mantra.

Who coined it, ladies? Is it from stae? Fed?

withasmilelpn · Feb 25, 2008

We need to be able to protect our residents! They (regulations) make it very hard to do that!

Hospice Nurse LPN, BSN, RN · Feb 25, 2008

Hmmmm....Whenever I hear that, I wish they'd walk a mile in my shoes down my floor.

CapeCodMermaid, RN · Feb 25, 2008

We need to be able to protect our residents! They (regulations) make it very hard to do that!

As a previous poster mentioned, some of these regs were backlash from the 'old days' when residents were restrained all the time. If you have tried less restrictive means and if you document them and do a really thorough assessment, you are allowed to use restraints. On our last DPH didn't take issue with the fact that one of the women had a restraint. They did, however, say that the interventions after every fall were not documented to show that we didn't jump from nothing to a seat belt. We had tried everything but the surveyor didn't agree with the way it was documented.

I wouldn't hesitate to use a restraint if I thought it was the only way to keep a resident safe. That said,we have restraint/falls meeting once a week and try to get rid of as many as we can.

squeakykitty · Feb 25, 2008

I don't think it is possible to keep some residents safe without something to keep them from falling. There was a resident at the LTC I worked at who had a soft waist restraint. One time she talked a family member into taking it off. Later she tried to stand up and had a fall. She forgot that she could no longer walk. She was always trying to get the CNAs to leave it off or take it off.

nightmare, RN · Feb 25, 2008

Do you have hip protectors in the US? These are like pants but with a sort of padded 'shell' on each hip.

crazdmomof4 · Feb 26, 2008

I had this problem this weekend. I got a hospital dump, lied to by social services, the floor nurse etc. Long story short I did the admissions. No psych meds at the hospital, but ativan being given.

Pt was having visual hallucinations less than 3hrs after admission, not reported by hospital staff in report or charted in prog notes from hospital, yet daughter states she had some at the hospital. Pt was aggitated taking her w/c footrest off and swinging it at staff. I called the MD and order for 0.25mg ativan was given. Didn't touch her. So the MD was called back again and gave an order for 1mg ativan. Finally pt calmed down and slept for 2hrs before getting up out of bed and falling. Now mind you hospital reported no attempts were made to self ambulate even though she had been 1:1 care until the am of the 23rd.

Next evening when I came on shift my floor manager is upset we got an order for ativan. So along with the right to fall, they have the right to beat us with objects, then fall and break hips and whatever else.

We have alarms, are short staffed, yet management will be the first to point out when an alarm is going off, and that we need to get to it. Now mind you we are working a full medicare LTC unit with 23 pts 2 aids and 1 nurse evenings and weekends, yet we can't let them fall. And of course they have the right to fall. Something has got to give at some point.

We are now having commercials running on local channels about suing for families who have had loved ones injured in LTC's from falls etc. There is now winning for staff nurses. We certainly don't want to see our confused pts suffer more.

CapeCodMermaid, RN · Feb 26, 2008

Do you have hip protectors in the US? These are like pants but with a sort of padded 'shell' on each hip.

Yes..we have hipsters. From what I know they are not comfortable and tend to make the demented resident even more agitated. I tried a pair on one day and I don't think I'd be inclined to wear them for more than a few minutes!

RN BSN 2009 · Feb 27, 2008

if LTC patients were to be a 1:1, it would be better if they were just at home or at their families home!

jjjoy, LPN · Feb 27, 2008

if LTC patients were to be a 1:1, it would be better if they were just at home or at their families home!

That doesn't make sense to me. Isn't LTC mostly for those who don't have someone at home to take care of them or have enough issues to merit a 24/7 professional nursing presence? If they don't need that much professional care and have someone at home who could care for them, home health visits would more affordable and preferable for most. But it IS an issue how to deal with the fact that as only the most needy patients are in LTC (and acute care as well), traditional staffing levels can't infinitely absorb the heavier work loads.

witchypoo · Feb 27, 2008

Clients have the right to fall.they have the right to keep as much dignity and independance as long as possible but if the educated staff of PT deems them incapable of walking, it is our job to keep them safe. and alarms are a help but by the time I race down the hall over the call light queens sitting in the door way waiting for bingo to begin or place their dinner orders to the kitchen and I have some one on the floor. :cry: because I can't jump a hurtle let alone a wheel chair with a person in it.

I wish we had the right to make the state survey team work on a live unit. Once a year like renewing your i v or cpr certification . :devil: I can see it now:rolleyes:

I want the unit of 35 understaffed one aide till 3 and one going at 10 am. and it is flu season on that unit. I want them to accidentally lock their med cart keys in the med room and have to wait an hour for maintaince to open the door:smokin:.

A full unit of call light queens, who really belong in assisted living and are just testing the call light to see that it is working and cause you are new to see how fast you answered and she waited 3.5 seconds so she call the state ombudsmans office which she has on speed dial. and could you please write down your name so she had it right for when her daughter comes in and for when the ombudsmen's office comes in she'll have it. and it is her shower day and she won't let a man shower her and we only have 2 male assistants:D

A Combative alzheimers patients who's families do not want any medications and that has you by your hair because you are a nazi spy, and Mary lou Ritton couldn't hold the back bend you are in, and he know you area spy because you spoke yiddish to the dying hospice resident next to him . :dzed: and you are like this for 35 minutes because your aide can't hear you call, one is in the dinning room for his 1/2/hour shift and the other one is in with your opera diva and she is singing on the top of her lungs and he couldn't hear her room mate over the din let alone you on the other hallway you finally get loose with the help of 6 after a visitor gets you some help .

Former violent psych residents who are refusing their meds and are angry because it is supposed to be pizza night and it was cancelled and are now lobbing feces into the hall way at anything that moves, and you have to move faster and with more twist and turns than Jackie Chan just to shut the door, and the 911 psych line is sending someone but you are not a priority right now. you're 15th, and because of some medical emergency, you are not getting any support help from your supervisors any time soon . :yeah:

Harry Houdini's. who climbs out of bed, wheel chairs, and anything else faster than a speeding bullet and can turn off the chair / bed alarm with the skill of a bomb technician.

A stripping patient that run down the hallway and into the lobby in their birthday suit for the corporate horse and pony show or better yet a live feed of a local tv crew for the art show. One of the visually impaired residents shows you the beautiful bird on the privacy curtain and it is a bat, now you call the administrator and tell him and it is halloween and what the heck do i do with it. I got it trapped in the day room. and the exterminator can't come till tomorrow.

Throw in a few disgruntaled families just to ice the cake. and lets see how well they handle it :rolleyes:

Well it's my fantasy that they handle some of the thing I have dealt with in my career. but it is unrealstic that the state would ever mandate their own work to be regulated by the same standards. Our state inspections have been late and they are not punished, They expect regulations they force on us,such as no side rails, no falls, food to always be hot and med passes in under 3 hours,when you have only 5 min per client 19 meds per resident and nurses only have 15 minutes per resident in an 8 hour day. it is a miracle if you pull it off in the allotted time frame and get to eat or go to the bathroom and get out on time.