Its every facilities goal to have no falls occur each month. But, is it possible? Most of you are probably thinking, no it is not. I disagree. It is possible. It is possible if certain areas of need are met. It takes a team effort that goes beyond the techs and nurses on the floor. Why is preventing falls such a big deal? Because falls cause injury to our patients, injuries to our patients lengthen their hospital stay, and if a fall with an injury occurs the hospital is now financially responsible for the patients care from there on even after discharge and long term care if needed. Here are good ideas you can take to your team at work and utilize to help your fall problem.
Every bed has the alarm turned on. Even if the patient is ambulatory. It seems silly. But is the extra 2 minutes taken out of the day to help the patient who can walk on their own go to the bathroom and help them with their IV pole or make sure they have anti slip footwear on a big deal if it prevents a fall?
Anti-slip footwear
facilities like to go cheap and place a yellow arm band on the patient. No one who is not a floor personnel really notices them. How about yellow anti-slip footwear or gown? its more noticeable so that PT or the speech therapist who helps your patient to the bathroom can really notice that patient is a high fall risk patient.
Frequent rounding! we are busy, i know. Take turns with your tech every so often to check on your patient.
Change your call bell alarms. We all fall victim to alarm fatigue. If we have a new noise to learn we can subconsciously pay more attention to that alarm.
Educate your patient about falls and that your floor is adamant about not having them. Encouraging them to use the call bell every time they need to get up can make a difference.
I know that proper staffing is the biggest problem with preventing falls. The fact is we have no control over that. We have to make do with what we have and what we have access to. Preventing falls needs to start from management down. Its a long boring process. But one fall is financially crippling and we need our jobs. We need money to staff and maybe one day be properly staffed. One fall can be more costly than a MD's yearly salary. Now imagine having 1-3 a month in most facilities. I hope this can help some of you and I encourage all of you to add some more of your ideas and best practices in the comments below.
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Having all patients on bed alarms will not solve the issue. Alarm fatigue as you stated. My alert and oriented non fall risk 40 year will not tolerate having a bed alarm >decrease patient satisfaction . Every so often even those not deemed a fall risk will fall. You may have a couple months of no falls and that is great but short of 1:1 nursing it won't be forever. Even if I assist a patient to the bathroom if they become syncopal and I gently assist them to the floor it is still considered a fall at my work, so zero forever is unreasonable.
I'm trying to decide if OP really believes in what she wrote. Those suggestions are laughable, at best, to put it kindly. The trend is to become alarm-FREE and she wants to slap a bed alarm on EVERY resident? They are considered RESTRAINTS. What loved one is going to agree to those 100%?
Patients have the right to fall and we have two in the facility I PRN at that are prone to "pity falls". Found sitting in front of their recliner, unwitnessed, NEVER a bump/bruise/skin tear, they truly just want a little attention.
We have people "go down" WITH staff in attendance and they are lowered gently to the floor. Still counts as a fall.
OP, please see how your survey is going so far. 100% no votes that a facility can be completely fall-free.
Pts will fall. No matter how hard we try, things happen.
We had a lovely lady with advanced dementia. She kept "forgetting" that one leg had been amputated - years ago. She kept trying to stand and walk. Poor little thing, just couldn't understand why that leg wasn't working!
Some pts figure out how to turn off the bed alarm
And sometimes, no matter how quick you are, you just can't get there where the bed alarm goes off. We recently had a pt that took 4 people to move - when your entire shift is 5, that meant one person would be out on the floor alone sometimes.
[*]Change your call bell alarms. We all fall victim to alarm fatigue. If we have a new noise to learn we can subconsciously pay more attention to that alarm.
I dunno about that. I have a Pavlovian response to certain alarm sounds at work. If you change what the alarm sounds like, I might ignore it completely because I'm hyper focused on everything else that I need to be thinking about.
Example: they recently changed the telephone ringer to a much more pleasant noise. It took several shifts for me to even notice the new noise and realize that "oh - that's the phone ringing. I should probably respond to that noise." I still don't register the noise every time.
For a truly fall-free department, the solutions are not good. Lots of PNA's, open wards where the nurse can see all patients(zero patient privacy), liberal use of restraints are not going to happen.
What I would like to see is more effective treatments for delirum, dementia, alcohol withdrawl and head injuries. There is a mental impairment behind the majority of the falls I have seen. No amount of patient teaching or having the call bell handy will help some patients.
Seriously. These interventions are useless without adequate staffing.
On at least one occasion, I had a patient with a 1:1 sitter fall. The sitter tried to keep him up, but he was combative, broke away, fell, and hit his head. That was not a good night.
Frank, this is one of the more humorous (if not head-banging and eye-rolling posts I've read on here).
I know you're a nurse, but you sound like a pencil-pusher. Safe care just cannot be accomplished without enough people to provide it.
OP identifies herself as having 2 years experience in a critical care environment - rather minimal time-limited and surroundings-protected. I don't know if I would quite classify her as a pencil-pusher, but I too thought about her role in direct clinical care provision. Suggestions made were well-meant, but ...
TO ME, the most unrealistic suggestion was that ALL pts be alarmed. Whatever happened to 'least restrictive environment', 'free of physical restraint', 'preservation of pt dignity', 'pt rights', etc?!?! How embarrassing and humiliating to A&O pts.
One of my places decided that we bed-alarm all new pts for 72 hrs and then further assess. One nite, my new pt adamantly, but very politely, refused. She was so 'offended' (HER word). She went to admin in the morning. That new missive was rescinded that day.
To OP - I admire that you wish to reduce falls incidence. But you are 'preaching to the choir' BIG TIME!! So many posters here on AN all lament the falls risks we face in our positions. Just read all the existing posts. But you've added nothing new. And to be honest, it feels like you've dumb-downed us. Your info is a good review.
We had a lot of falls on my floor and the hospital implemented a team to decrease them and they did but now when an alarm goes off, 5 people will dash to the room. They added to the bed alarm, a Posey alarm on the bed which sets of the call bell light and a really annoying alarm. If the patient is able to go in the recliner they have to have a seat belt alarm wedge cushion.
Off course all of the patients have a fall assessment done and are deemed to be "high" so they have on their magic yellow sock and FALL RISK bracelet. The fall mats are also placed on the floor. Hospital staff and family members are put in danger by those much more than them helping the patients since they seem to make it past them quickly once they are out of the bed.
More staff would help a great deal since we have so many going off all of the time!
RNKPCE
1,170 Posts
Having all patients on bed alarms will not solve the issue. Alarm fatigue as you stated. My alert and oriented non fall risk 40 year will not tolerate having a bed alarm >decrease patient satisfaction . Every so often even those not deemed a fall risk will fall. You may have a couple months of no falls and that is great but short of 1:1 nursing it won't be forever. Even if I assist a patient to the bathroom if they become syncopal and I gently assist them to the floor it is still considered a fall at my work, so zero forever is unreasonable.