How do you reduce falls????

[JoeDEDRN]

Hello fellow ED RNs.

The ED I presently work at has just undergone a huge expansion of square footage. We are now seeing a rise in falls. The people falling are your usual folks, ETOH and demented folks come to the top of the list. We already have all the signage we need. Bed alarms in place. It seems the major problem is that, with the expanse of the ED, comes the decreased awareness of the alarms and the plant design itself makes it impossible to visualize these people every second. Any of you guys have any ideas. Thanks in advance.

[ohmeowzer RN, RN]

bed alarms.. thats what we use

[OC_An Khe]

Depending on how long it has been since the redesign, people working in the new design haven't yet developed a situational awareness that is in keeping with the new design. Give it some time. If that doesn't help you will probably need and increase in staff.

[wee_oneRN]

Place those at higher risk for falls closest to your station, or in areas with highest visualization.

Also, institute mandatory hourly checks. I worked a floor where the CNA's and RN's took turns signing off an hourly sheet posted on the door. (Not just peek in on pt but must talk to them and see if they need to use bathroom, call light in place etc.) Not only did it reduce falls but it also reduced the call lights and improved customer service scores. Pt's were less likely to hit the button or try to walk to bathroom solo etc.. as they knew a nurse would be by shortly to assist them. Hourly checks gave them a higher sense of security.

[Guest219794]

If you work in an area with many meaningless alarms, shut them off. It's a bit of a pet peeve, but if your pt periodically exceeds a hr of 120, and you are not alarmed, reset your alarms. I find that nurses frequently ignore frequent alarms. Then when something alarming happens, and the alrm alarms, nobody is alarmed.

[guy_nurse]

I find that nurses frequently ignore frequent alarms. Then when something alarming happens, and the alrm alarms, nobody is alarmed.

So true...."Shelia, has your patient been in V-tach all night?" LOL

If the patient is a altz or dem pt, see if the attending doc will give restraint orders, trendelenburg with head up (to keep them from scooting off the end of the bed), maybe some strategic use of carefully placed bed sheets---I'm just saying.

[Larry77, RN]

High risk patients that we can't put close to the nurses station we place on 1:1's with a CNA (hopefully from the floor otherwise an ED Tech). I can't remember the last fall I've had on my watch (now will probably be one today...lol). I have been known to move a pt closer to be watched if I was low on staff...we do not use bed alarms frequently and I'd rather not have any more beeping/alarming! Call-lights are paged to the RN and the tech assigned to the room then get paged to me as charge if they haven't been answered within a certain time so i can find someone else to check on them (usually me :))

[SuesquatchRN, BSN, RN]

Well, it isn't ED but my biggest fall risk is people too weak to walk wanting to use the toilet. And trying to. SOmetimes they make it, sometimes they drop immediately, sometimes they urinate before maling it to the toilet and then slip on their own urine.

[tewdles, RN]

Of course, one of the risk factors for falls in the ED is the fact that the stretchers (beds) are so danged high up in the air...