Need advice: Frequent falls of non compliant homebound pt with dementia

[autumnlea]

I'm RN supervisor for home health agency.

We have an at home 87 yr old frail, non compliant female pt with frequent falls and dementia.

Family wants to know from us how they and/or we, can keep her from falling out of wheelchair 4-6 x daily without using restraints (which we never use.)

I have spoken with the daughter several times re. state law prohibiting use of restraints.

She has a room to room monitor so she can hear her Mother.

Our 2 CNA's live on with the patient in her home. CNA's each have 12 hr shift.

Client will try to stand up or ambulate without giving any indication of her desires to get up and she has frequent daily falls up tp 6 x a day resulting in bruises and discomfort.

Any suggestions as to how without restraints this situation can be better managed?

Thanks for ANY suggestions or examples of what you have seen or done in similar situation.

[loriangel14, RN]

So she has a CNA with her at all times and she still falls?

Why can't restraints be used?

[ChristineN, BSN, RN]

So she has a CNA with her at all times and she still falls?

Why can't restraints be used?

OP mentioned state law, and I have never heard of restraints being used in home care.

[autumnlea]

GA law prohibits use of restraints.

A difficult situation especially with this type of client.

Thanks for your interest in replying/asking.

[loriangel14, RN]

How are they falling so frequently when they have a CNA in attendance?

[autumnlea]

If caregiver turns away for even a moment, or goes to put laundry up or while cooking for client, the client quietly walks away while CNA's back is turned for an instant, the client consistently falls.

Client is totally non compliant ( dementia) and does not follow simple instructions (such as to wait for a min. or ask for help.)

Also client is in wheelchair most of time and falls out of the chair constantly by slipping down in chair and then falls to floor ( slips onto floor.)

Caregiver is there 12 hr almost attached to clients side. One of our best CNA's.

Any suggestions as to a good way to manage this?

[chrisrn24]

What about something like Ativan, Seroquel or Haldol?

[autumnlea]

Thanks. That may be the best solution.

[MunoRN, RN]

Benzos should generally be avoided in patients with dementia as it typically causes increased agitation as the initial effects wear off in these patients. Antipsychotics are only considered appropriate in dementia patients to control severe agitation when other efforts have failed, and have no clinically significant effects on cognition, STML, or wandering behaviors, but should be used very sparingly since they all increase the risk of death, some more than others, haldol for instance doubles the risk of death in dementia patients.

[SaoirseRN]

Is a seatbelt considered a true restraint? Couldn't that be considered a safety device that wouldn't maybe stop the gradual slipping to the floor (ie, could still get out) but might delay things long enough for the caregiver to notice and/or prevent the sudden standing and subsequent falling

I have a feeling that might still be considered a restraint, and if so that seems like a poorly thought out state law if it won't even allow a seatbelt for safety.

[loriangel14, RN]

What about something like Ativan, Seroquel or Haldol?

Yep.Where I work we use a lot of these. Some get all three.

[0.adamantite]

How about interventions like timed toileting, or a seat alarm to alert staff when patient is getting up? I've even see seat alarms that say "Stop, don't get up" when a person tries to stand. I guess I can't see why a patient is falling so much with a 1:1 CNA. I would bring the client with me around the house as I did things and keep a very watchful eye on them.