Patient falls: What works to prevent them?

[UPSBossman]

I've been trying to solve the problem of falls since I started in healthcare a year ago. I quickly decided to approach the problem differently from the rest of my health system, assuming that falls can not be eliminated, so we should try to lessen the ill effects when they do happen. I came up with a proposal that would install a reactive, minimally deflective floor in the patient's room. In English, a floor that absorbs the impact of a fall (instead of the patient) but does not distort when you walk on it or roll a bed over it (not a tripping hazard nor does it make it hard to roll anything on it.) The floor did not absorb fluids, and was anti-microbial. The brass decided it was too expensive, and the project died on the table.

Unable to leave it alone, I'm again trying to figure out a solution. I want my new proposal to include fall prevention tactics as well. Online searches have been very generic: "Education and family involvement" is apparently the solution, but this doesn't work for my purposes.

I'm curious if any of you would be willing to share with me fall prevention tactics that work. Is there anything you've seen done that actually had a positive impact on the patient? Strategies or a technique that have reduced the severity or frequency of patient falls in your experience?

Thanks in advance for any help you can give me on this!

[Double-Helix, BSN, RN]

Research wise, there have not been any interventions that have been proven effective to prevent falls during controlled studies. However, check out a Bringham Young research study (Massachussetts) about a new fall prevention interventions. I'm not sure where to get the results of the study, but they might have some information on their website, or call the research department. I heard a presentation about it at a conference.

[sweetnurse63, BSN, RN]

Realistically, falls are unpreventable. However; the best prevention tactic that i use is rounding every two hrs and more frequently with high risk patients. I have caught several patients trying to get oob and i was able to prevent their falls while rounding; another helpful tactic was the use of bed alarms and they do work!!! but some facilities are discontinuing them for some odd reason, we also use floor mats to help cushion falls. UPSbossman, you had a great idea though:smokin:

[UPSBossman]

Look at SmartCell mats. They absorb more impact than foam, do not absorb fluid, and have minimal deflection under weight. Its very similar to the flooring I pitched a year ago.

As for rounding, our system rounds every hour (in theory) although I don't think that happens. We have a lot of things in place, and I think most of them are pointless. A sign on the door marking a PT as a fall risk isnt going to stop a A&O X 0 patient from getting up

[leslie :-D]

A sign on the door marking a PT as a fall risk isnt going to stop a A&O X 0 patient from getting up

are you sure about that?

it has been my experience that a&o are trustworthy...

it's the demented pts that can't comply.

usually, these folks who are at risk, are usually seeking something.

it's up to us to help them express their needs.

toileting schedule has worked with some.

reviewing meds, r/o constipation, r/o uti, uri.

how about a plain, old gym mat at bedside...

that is IF they're going to fall upon getting oob.

good luck on your project.

leslie:)

[RoyalPrince]

We implemented a Sitter-select system connected to our call bell system, basically a big sensor pad is placed under patient's top sheet and connected to call bell - only on patients at risk for falls - will beep and alert station of patient movement to the extremes of the sensor = 0 falls since

[systoly]

As Leslie said, meet their needs, basic as well as others. Walking, exercising and visiting with a restless patient may help.

[AgentBeast, MSN, RN]

Tying the patients down works. However, there are some legal ramifications that come along with this.

[jerenemarie]

Here a few preventative tips I used with care planning: 1. Making sure they have their glasses on & that they are clean, this goes with hearing aides too! 2. No throw rugs in rooms. 3. Follow toileting schedule. 4. Having a program in place for pain control. 5. Review meds monthly for any medication that may contribute to falls & reassess the need for them or possible alternative. 6. Keep bathroom light on at night;have nightlights on at all times. 7. Look for patterns of falls for individual residents; time of day, blood sugar high or low (always check sugar on diabetics at time of fall), did they need to use bathroom, etc. 8. Look back at any labs...maybe someone who has falls & is on lanoxin needs their dig. level checked? Maybe they need a Hgb check for anemia, thyroid test, etc. 9. Check their ears for wax build up...we had a lady who was having frequent falls & it was discovered both ears were impacted...made her dizzy of course! After her ears were cleaned out she had no more falls!

Hope these help!

Thanks,

Jerenemarie

[melsch]

As Leslie said make sure their basic needs are met -toileting, exercise etc. We have extra low beds that we use and keep them at the lowest level. We also have crash mats that we put on the floor - but in my experience they are just another trip hazard for both the patient and the nurse - yes I can be a klutz too. Make sure walkers, canes, wheelchairs etc and within reach, especially if the patient is used to using them as at least they will have something to hold on to if they are unsteady. We use bed monitors (tabs pinned to the patient, sensors under the mattress, and floor pads so when their feet hit the floor we are alerted -my favorite and seems to work best). We sometimes put our most confused and prone to getting up and falling patients in gerichairs at the nursing station so we can keep and eye on them and prevent them from getting up.

You will never prevent all falls even with restraints and it seems that we are supposed to allow people to live and risk, and I even heard one manager say that if they keep landing on the floor they must want to be there. I don't agree with that attitude and think we are doing our very confused patients a disservice to allow them to hurt themselves, but I don't have any other answers either.

[taalyn_1, CNA]

The floor mat alarms work real well, IF someone actually goes in to check the pt when it goes off. Doing your rounds/bedchecks, toileting regularly helps. Ive noticed a lot of the pts that tend to get up @ night and fall are just trying to get to the bathroom or are looking for something to drink/eat. I have heard people at work say, "the pt has the right to fall if they so choose" this is true but we are there to try and prevent it if at all possible. Keeping your eyes on the risky pts is a must, its tough though when you have a million other things going on too.

[Wise Woman RN]

Having enough staff helps, too.