Patient fell 5 times in 7 days

[Nurse Beth, MSN]

Dear Nurse Beth,

Good morning. I have reached out before in fact last month. Your advice helped and we were not disciplined for a med error..

My issue now is there is a resident who keeps falling out of bed. I work on a dementia unit, locked down. He has fallen out of bed 5 times in 7 days when he returned from the hospital. He cannot ambulate, he is end stage CHF and acute kidney failure. We have put many interventions in place but he ends up on the mat before we can get there. He is the closest room to nurses station. Interventions are bariatric bed, chair alarm, recliner, mats on side of bed, bed alarm 1/2 side rails up, toileting schedule. He is out of bed from 7am-7pm.. Cna to sit at his bedside on 11-7 when they are not in another residents room. They are not 1:1.

The family is not on board with hospice they are very much in denial and in turmoil so they cannot help him. His anxiety is through the roof and he has no anxiety medication they just d/c his zyprexa as we are in the window for state survey. Now they want to d/c his bed alarm for the same reason (too many restraints). I was told we will get slammed by the state which as a nurse I am my patient advocate and believe it is not safe to take his bed alarm away. I feel it is our only shot to possibly keep him off the floor. My question is this correct about too many restraints and wouldn't the side rails or chair alarm be better to remove if we have to takes something away.

Thank you

Dear Window for State Survey,

I would make a comfortable bed on the floor at ground level. The mats can go on either side.

He has fallen 5 times in 7 days and he is going to keep falling out of bed. I'm surprised that a 1:1 sitter is not assigned at all times. A sitter who can only be there when they are not in another resident's room is not going to prevent his next fall.

D/C ing the bed alarm, even though bed alarms are questionably helpful in preventing falls, is not going to help your facility do better on survey. A bed alarm is not a restraint. Side rails can harm patients even when only 2 or 3 out of 4 are up, and they don't prevent falls.

Best wishes, my friend

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!