I need help...i have to do an inservice

[Tiggur]

I have to do an inservice on falls... i work in a geriatric psyc unit our fall #'s have been up so there was a group of us picked to be on a fall task force and do some research on how other facilities deal with falls ? one big question was if you walk in and find a patient on the floor lying sitting etc with no apparrent injury is this considered a fall and do you document as such...and the other question was all of our patient are of course high risk for falls because our patients are 65 and older and most are on some sort of psychotropic medication..but how do other facilities differentiate between higher risk than others so that all staff know OH hey i need to watch close if i see this patient up and about? well this is my delemma .. and my first in service to present......so an and all help will be greatly apprreciated .....Thanks tina

[gwenith, BSN, RN]

Try this site

http://www.joannabriggs.edu.au/pubs/systematic_reviews.php?pageNum_rsSysReviews=3&totalRows_rsSysReviews=35

Since it is a systematic review you cannot get a better more valid resource for you talk.

[Tiggur]

The web site was wonderful good help ....But any personal input would be great...on how your units deal with falls .....Big Thanks .....Tina

[Crazy Mama]

The web site was wonderful good help ....But any personal input would be great...on how your units deal with falls .....Big Thanks .....Tina

This is always a concern of ours. On the gero psych unit were I work, We range about 1 fall QOD. At other times its up. Of cours we do 15 min rounds on all pt's unless they are Q5min. We use wheelchairs w/ lap buddies and use the medical restrant. If a patient is in a GC with the tray, it is a restraint unless the pt needs the tray for eating, reading, writing. If a pt. slides out of a chair it is not a fall. But usually everything else is. once they fall 2 times in a 24 hr. period then we place them on a 1:1 for 24hrs. Von

[Tiggur]

thank you von ...von do you guys document a fall if you just find a patient on the floor ....do you guys have ways of identifing higher risk patient then others ... i have heard other places use like a stop light sytem they put dots on the doors of there rooms were just looking for different ideas ...and then we are going to brain storm ....

[Crazy Mama]

thank you von ...von do you guys document a fall if you just find a patient on the floor ....do you guys have ways of identifing higher risk patient then others ... i have heard other places use like a stop light sytem they put dots on the doors of there rooms were just looking for different ideas ...and then we are going to brain storm ....

Tiggur, State says you document every fall, but there are times when the pt has a habit of sliding out of a chair, or is able to tell you that he/she slid to the floor when trying to stand. These are not occurances and we do not doc. on them as such. We do state in the pt record that the pt stated he/she slid to the floor. You really have to use your own judgement. I really hate to say this, but there are times when a fall should be documented but because it would be 2 in a 24 hour period which means we would have to place the pt on a 1:1 , it become a sticky situation. we usually do not have enough MHT's to cover what we have. No one is willing to come in because we are not allowed to have even an hour of OT. so we will place the pt up close to the nurses station in a GC w/a tray and place a book,snack or drink on the tray. we draw a fine line at times to keep the patient safe. As far as knowing which pts are high risk, we have an eraser board at the nurses station that we write the pt 1st name, code #, MD's, Q15FP (fall precaution) and we will change this if the pt is Q5 along with this info is Sz.prec. DNR status, Last BM/bath, SW, If they are a diamond or an emerald and their intake status(vol. or OPC/ED) We give report to our Techs and they do a good job of watching them.I know this is not much help, but falls are a big issue. the state ties our hands on the psch unit. We are not allowed to use posseys or wrist restraints. we have chem. and a seclussion rm. there are three forms that have to be filled out for them. Be glad to throw stuff back and forth. Thanks, Von

[LPN4Life]

Yes we document every fall, even if it wasn't witnessed, but we don't chart it as Resident found on floor, we chart, resident observed to by lying, sitting, etc, then do the head to toe.

We started using one of the assessments that we do on admission and quarterly as a guide to who needed to be on a fall prevention program. It is effective because you can add or delete residents from the program, and keep up on it more closely, residents may be high risk one time, but then need re-evaluation too. The assessment is the Fall Risk assessment and can be ordered through briggs, if the score is higher than 10, I think, then the person is placed on the fall program. We used the falling leaf program, placing a leaf on the pts door, w/c or walker, above their bed, and inside the pt's chart.

[Crazy Mama]

good idea about the leaves. CP are done for falls on each pt, once the goals are met the fall prec. checks are lowered. we also doc. that while making round we observed the pt on the floor etc..