so many falls!

nutella, MSN, RN · Jan 6, 2016

I think that on LTC units with patients who suffer from dementia and parkinson's the fall risk is higher due to the nature of those illnesses. Prevention is important but you have to have enough staff for that. I know that alarms are frowned upon in a lot of facilities and some have a policy that does not allow them. Even with a chair alarm it can be hard to prevent falls as some residents who are forgetful can also be very quick when it comes to getting up without assistance. Most places in my area do not allow residents to stay inside their room during the day and they are in activities or in a common area with somebody watching them and running when somebody tries to get up without assist - in some facilities there is a lot of "running".

Med pass is a time when you need to focus on your task to avoid mistakes and monitoring a resident at the same time is difficult and probably not recommended as it adds to distraction.

If your work environment is not sufficient and you feel that you can not succeed in there why not look around for a different place to work.

jadelpn, LPN, EMT-B · Jan 6, 2016

This needs to be addressed with a number of different things. If the goal is no falls, then you need to talk about how that could be feasible. Sundowners may need to be medicated earlier in the evening? There are family (myself included as the HCP for my demented grandmother) that wants you to use a seatbelt on a wheelchair, or a geri chair at the nurse's station. Or a volunteer or family member that comes and has supper with auntie. And the family needs to be aware of the challenges, and what they think could work.

The activity director can also help. Ear buds with classical music or books on tape. The shopping channels have a mesmerizing effect. There are some activity driven things that could occur around that time.

The DON needs to be more involved in solutions that are feasible, do-able and clear. Not just some rigamarole about "blah, blah too many fall blah blah"....so what are they going to do about it?

ponymom · Jan 6, 2016

Yes you definitely need to start notifying the families about being so poorly staffed on a routine basis that it not possible to watch over the residents in a safe manner. Get that family member the names and numbers of the DON, ADON, CEO, COO, Janitor, etc.

If you get crap from the suits (and being ltc, you will), ask them what they want you to do about it.

"No, really, what do *You* really want me to do about it, how do *You* think I could manage all this with just two aides (when they're both here)". Make eye contact. Stand there and wait for an answer.

You damn well know that if something major happens and crap goes down, that hole of a nh will hang you out to dry.

Good luck.

Falls are not preventable unless there is enough staff to do the preventing.

TriciaJ, RN · Jan 6, 2016

Falls are not preventable unless there is enough staff to do the preventing.

This is priceless. It should be hanging on the office wall of every nurse manager.

qcnursingstudent · Jan 6, 2016

Thanks everyone! Yes I'm going to be putting in applications. We've talked to our manager many times about adding at least one more aid in our shift but it doesn't seem like that's happening. Last night I had a fall and also a resident with Parkinson's who kept getting up and being combative with the staff. Myself and a CNA had to stay with him for about 2 hours. Supervisor was unable to come assist. It was a ****show.

Neural · Jan 7, 2016

Yes you definitely need to start notifying the families about being so poorly staffed on a routine basis that it not possible to watch over the residents in a safe manner. Get that family member the names and numbers of the DON, ADON, CEO, COO, Janitor, etc.

Make sure you have another job lined up if you choose to do this. You're gonna need it.

Nurse Leigh · Jan 7, 2016

Falls are not preventable unless there is enough staff to do the preventing.

Even with improved staffing not all falls can be prevented - I swear it seems like some people are bound and determined to get up and then fall. It's not like we can tackle them to the bed!

If facilities are reluctant (or refusing) to use restraints where they may be appropriate, they (and patients/residents and their loved ones) should understand falls will be more likely.

I hate it when staff (nurses and aides) get blamed for someone down the hall falling when staff are busy with other people or tasks - for the places who use bed alarms, they go off once the person is actively getting up, and unless a facility hires superheroes, in most cases a fall may have already occurred by the time staff can get to the room.

CelticGoddess, BSN, RN · Jan 7, 2016

So I've been beating myself up like I always do. I work in LTC and my residents mainly have dementia and Parkinson's. I have a lot of fall risk residents on my side. I am the primary nurse from the 3 to 11 shift. Right before supper, most of my residents are sundowning and this is when most of them become agitated and want to get out of their wheelchairs or out of their beds. Its really frustrating esp since it's me and only two CNAs taking care of 25 residents. Our facility doesn't use bed alarms or chair alarms which I think is ridiculous. Our DON doesn't believe in them but she always asks us why we always have so many falls. For our residents who are fall risk we usually put them by the nurses station. However at 3 to 11 we don't have anyone there usually which is ridiculous. We do 15 minute checks on them but that can get really difficult since I have other residents to tend to too and if someone needs assistance in the bathroom, I need to be with them.
I just feel like I'm an inadequate nurse due to all these falls I've been having lately. Yes falls are preventable but sometimes I feel like the only way for me to ensure they don't fall is by bringing them All along with me with my med passes and stuff.

I worked LTC for 2 years so I can understand your frustration. You are NOT the reason you can't keep your residents from falling. You are working an impossible job with no resources. The facility I worked at got rid of EVERYTHING that could be thought of as a restraint. That mean bed alarms (how in the world is a bed alarm a restraint). Falls are preventable when you have the right equipment and adequate staff. You are not working with adequate staff and they are giving you NOTHING to help prevent the falls. Keep reminding yourself, it is NOT your fault.

It takes a resident 10 seconds to fall. And you can be watching them and they will get up and fall. This happened to me. I was sitting next to my resident and my trainee was standing near him. I got up to answer the phone and in that short time, he fell, hit his head and lost consciousness. It happens. I felt bad about it. But I did everything I could.

You are doing what you can in a near impossible situation. Don't beat yourself up over it.

Lev, MSN, RN, NP · Jan 7, 2016

Has your DON ever worked on the floor? Bed and chair alarms are so so important in preventing falls.

Ruger8mm · Jan 7, 2016

Do you work in the same facility I do? These residents are driving my crazy. They are constantly standing up and running around looking for a Flying Spaghetti Monster or god knows what else they think they are seeing. Lots of falls here to. It's irritating. I'm glad tomorrow is my last day.

On a side note it is funny to watch how all the crazies start to time their verbalizations and sync with those around them. It's almost like a twisted chorus.

Don't beat yourself up. Your employer set you up for failure. Just do your best, shoot for exceptionally detailed charting and enjoy your shift.

qcnursingstudent · Jan 7, 2016

She said she hasn't been a working RN in a longtime. I doubt shes worked there and shes definitely never worked there from 3 to 11 with the residents I have now.