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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.
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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Your fellow nurse,
Frank Trujillo
I work on an ortho floor and we have a pretty good policy in place and our falls numbers are pretty low (don't remember last figure) We use bed alarms, but pretty much for the ones that forget they have had surgery. One thing that we have no control over are those that vagal when they get up. Hip replacements seem to have a propensity for that the first time they get up with PT. We work as a team, but sometimes you just can't predict it.
The only sure-fire way to prevent *all* falls is to get rid of gravity.Since anti-gravity remains in the realm of undiscovered physics and engineering - and since the ISS doesn't have any open beds - no, the goal of No Falls is unattainable on a sustained basis.
Rats- I was about to respond with something witty, and that's funnier than what I thought of.
OP- no, of course not.
Humor me please, as I rail against one of the worst misconceptions in health care...
Most likely, the correct number of falls on a unit (NICU, etc, aside) is not 0. The correct number of CAUTIs or CLABSIs in the ICU where I work is again, most likely, not 0. Heck, probably the correct number of HAPUs is not even 0. Zero falls, zero CLABSIs, zero CAUTIs - this would almost certainly represent an over-correction. It's like saying even a single drunk driving death in the US is unacceptable - it sounds like a great slogan until you consider what we'd have to do to actually accomplish this (ban all vehicles?) and realize that the solution is even more damaging than the problem it fixes.
The truth of the matter is that a nursing unit has a finite number of resources, and those resources should be allocated intelligently to deal with the many demands and risks of medicine. I'm all for coming up with new solutions that might reduce some risk or another to zero or something very close to it. I'm all for increased staffing. But given some finite number of staff, throwing more and more resources at a single target trying to eliminate it entirely just means that you're diverting resources from some other area.
I can't even achieve a fall rate of zero on myself ;p
I used to get pulled to psych a lot and they had patients 1:1 fall all the time. I myself saw a big guy tear up a steel bedframe, shred 4-point leather restraints, escape 5 aides, and fall on the floor. I don't think zero can be achieved.
Someone can easily fall even on 1:1 if they suddenly feel weak and have to be lowered. We're not allowed to catch them.
Bed alarms are useless in LTC when the resident decides to roll out of bed. You can be within feet of a room and by the time you hear the alarm sound, they are on the floor. This happened to me as I was standing right outside a room.
What good are alarms for confused dementia patients who cant remember that they cant walk? The second they try to stand, they fall. Or they wiggle their way out of bed starting with their legs.
At my facility, some "falls" have become "behaviors" because they have become so ridiculous. There is a lady who throws herself from her bed to her floor mattress at night for attention only when staff are watching. Then there is this man who is too weak to walk so he crawls around on the floor in his room. He gets aggressive when we try to help so he just sits on his floor much of the time.
Propofol, lorazepam, paralysis to zero twitches, vent, PLUS four-extremities restrains and 1:1. For everyone, from admission to discharge
Seriously, falls are not good to happen, that's true. But allocating all (finite) resources to fight falls with goal of zero, for whatever it takes, will most probably not achieve that goal and bring more problems than it solves. Just like relentless fight with Foleys may reduce incidence of CAUTI but not necesserily one of UTI in general.
The biggest reason no falls is impossible at my facility is that we don't have bed alarms, chair alarms, restraints, *anything*. It's the policy there. And staffing is sometimes iffy. So although we do watch the frequent fallers very often, we still can't be there every minute & prevent every fall.
Wrench Party
823 Posts
Fine, then give me adequate staffing, totally remote monitoring (no cords whatsoever), no lines/drains/or airways, and healthy patients that don't have cardiac or neuro issues that can cause syncope, vagal responses, sundowning, weakness related to immobility, the works.
Pretty much all my patients on a CT surgical floor are on cardiac meds, vasoactive drips, hardwired to telemetry and have LDAs (chest tubes, temporary pacemakers, JP drains, Woundvacs, Foleys, IVs, et.) and' standing' and walking laps are major projects.