Careplan Intervention Help

CapeCodMermaid, RN · May 22, 2011

The whole purpose of a care plan is to have an INDIVIDUALIZED plan for each resident. Using the same interventions for everyone will not work. For an alert, oriented person it might work to tell him to use his call bell before getting up, but for a demented resident, reminding them about the call bell is useless.

You have to think about what made that particular resident fall at that time. Was he wearing shoes? If not, that could be an intervention...socks are slippery. Did he have a walker and use it? Had he recently received a medication which would cause dizziness or a drop in blood pressure?

I can't see what diet has to do with a fall unless the person in diabetic and had really low or really high blood sugar, but that's a stretch.

We had a resident fall because she liked to carry her 'babies' in the front of her walker basket. It was top heavy and over she went. Our intervention was to teach her to use her wheelchair like a stroller. She was stable and the 'babies' were safe.

Canned responses for each care planned issue won't work and the DPH doesn't like them.

debRN0417 · May 23, 2011

CCM is right "can plans" ( as I call them) are not individualized. You have to put interventions in place for each resident that is specific for them. You can have some basic templates, like call bell in reach, non-slip shoes/socks, items within reach...but be careful about the "educating part" because if your resident is demented and cannot remember, then education is not a intervention that will work for them.

Long Term Care Columnist / Guide · May 23, 2011

Agree with the above. With a frequent faller, you have to look beyond the standard interventions and get creative, using the resident's mental/physical capabilities, habits, and personality to determine the interventions (and get them into the care plan!).

For example: I have a resident in my ALF whom we couldn't keep off the floor for love nor money. He's a lovable old guy, but his short-term memory is nonexistent and he still has an independent streak in him that pushes him to try to do what his body no longer can manage. We tried 2-hour checks, reminders to use his call-button, toileting, low bed, body pillows and so on. Finally, the administrator and I sat down with all his incident reports and found that nearly all his falls happened at night, when he was tired and needing more assistance to get ready for bed than he did in the morning when his energy level was higher. So we put on the care plan to have staff come in and actually get him ready for bed, help him change into pajamas, plug in his power scooter to charge during the night, etc........and voila! he hasn't fallen in the three weeks since we implemented the care plan.

You cannot, of course, prevent ALL such incidents, and the State doesn't expect that. But you do have to show that you have individualized interventions in place, and that you are reviewing them regularly to ensure that they are still appropriate. :)

txdon · May 23, 2011

Thanks for the responses. This clarifies for me how to properly write a careplan. If I have a resident who has had another fall and interventions are in place is it necessary to add a new intervention if a new intervention is not identified. We often just note the fall on the careplan and state, "continue pt/ot - no new interventions noted at this time." Is that sufficient?

CompleteUnknown · May 23, 2011

Yep, there's always going to be trouble if your care plans are the same for each resident.

As already stated, look into why the falls are happening - it's going to be a bit different for each resident. Be careful of things like 'remind to use call bell' or 'remind to use walker', you just can't use these as interventions if there is dementia or other cognitive impairment as it is pointless and a waste of everybody's time. I will put something along the lines of staff must fetch walker for resident if they are mobilising without it.

As for diet.... one thing that springs to mind is perhaps the resident is getting out of bed or trying to walk unsupervised because they're hungry at times other than meal times? If so, an intervention could be to provide a midnight snack or early breakfast or whatever.

The labs thing could maybe be something like checking Vitamin D levels with interventions such as some sun exposure if they are low - you want to look at minimising the risk of fracture should a fall occur as well as trying to prevent falls. Also think about postural hypotension and the effects of medications in general, sometimes a change in administration times can help to minimise the problems if the medication can't be ceased.

Improving strength and balance is another intervention that you can use for some residents. Is there an exercise class or anything like that at your facility? Even if not, PT will probably be able to asses the resident and suggest some things that can be done while staff are providing care eg, 'staff to ask and then supervise resident to stand for 60 seconds four times a day' or whatever.

Interventions like the one CapeCod mentioned with using the wheelchair like a stroller are exactly what you want - individualised and effective.

CompleteUnknown · May 23, 2011

Thanks for the responses. This clarifies for me how to properly write a careplan. If I have a resident who has had another fall and interventions are in place is it necessary to add a new intervention if a new intervention is not identified. We often just note the fall on the careplan and state, "continue pt/ot - no new interventions noted at this time." Is that sufficient?

I suppose you can't add a new intervention if no new interventions are identified but you really need to make sure you can show you've properly reviewed the existing interventions and that there isn't anything left to do. Sometimes that's the way it is but often there actually is something else you can try. Make sure you can show that everyone including the doctor and the family and the staff have had input into the problem and it's a good idea to get the doctor to document that he or she is aware of the falls, happy with the interventions in place and acknowledges that everything possible is being done.

debRN0417 · May 25, 2011

If you have interventions in place and the resident falls, were they injured? If they were, then you need to revise your interventions. If they were not then your interventions worked to keep them from hurting themself. Fall mats are a great example. You can have a resident who is on the floor 20 times, on their mat,with no injury. The intervention worked! They fell onto the mat and didn't get hurt. You will never keep residents from falling but you can try your best to keep them from getting injured when they do. Look at the fall specifically. Where was it. If it was in the bathroom, then you need an intervention to keep then safe in the bathroom. The next time it may be from the chair. You will need to put interventions in place for safety in the chair. and so on. Each time a fall occurs, you need to look at what you had in place and determine what went wrong, or not. As the above poster said, you have to show that you reviewed and revised and that everyone had input.