Patients falling

Be_Moore · May 15, 2009

Well for me, bathroom privileges are decided with a quick assessment when I do my initial assessment. How strong are their legs? Are they confused? Do they have a fall history? Is there anything that puts them at higher risk (hypotension, narcotics, benzos, new amputations vs. old amputations)? How old are they. Depending on the answers depends on whether they get bed pan, bedside commode, or toilet privileges. Then, I lay down the rules. Unless you are 40 or under who just happens to be here for some ridiculous reason like a hangnail, you will get escorted to the bathroom per me or a tech the first time. If the patient does fine with no assistance, they get to do as they please. If they don't do so hot, I decide whether to either A) assist every time or B) Downgrade their privileges. If they are confused, they get restrained if they can't cope with the decisions made for them.

Of course, I work in an ICU and benefit from 1:2 ratios. And most of my patients don't get bathroom privileges. But this month's staff meeting actually had a section where we talked about our high fall ratios...to which my manager's suggestion was better use of restraints.

johnst10 · May 16, 2009

In the last few places I have worked (PCUs) we used the fall risk assessment. Patients and family members were told the reason for someone to accompany the pt to the BR or the need for a bsc. Signs are posted on the wall in the room explaining the different helps for high risk patients. All IV poles/lines are situated as well as possible toward the toilet so if a patient decides to get up on their own it is not a hindrance. We also only put up the top half of the rails so they can reach the controls, not the bottom. Once again, if they decide to get up, even if disoriented, the risk of injury is much less if they are not crawling out the end of the bed.

I personally have released many patients from wrist or vest restraints when I come in the morning. I find that either they have rested and are oriented, they can see in the daylight, they feel better, family is/are around, there are more ancillary staff such as housekeeping, kitchen aids, PT/OT, resp, etc, but most of my patients do not need to be restrained. We also ask the patient frequently if they need to go to the BR. This lessens accidents in the bed and the slips in urine or other "stuff".

There is a TON of lit out there about fall prevention. Good luck.

Pepper The Cat, BSN, RN · May 16, 2009

High/Low beds have been great for us.

These beds can be lowered very low - it makes it difficult for the pt to get up out of bed by themselves because when they sit at the edge of the bed, their knees are above their hips making it difficult to stand. Bed exit alarms are also very good.

Of course, all this stuff costs $$$ so we had to convince the PTB that it was worth the money to purchase this stuff.

We also leave rails down on those that we cannot get into a high low bed. If they are going to get out no matter what, its better to leave the rail down then have them go over it if you follow me.

Another option is to put a commode right next to the bed so all the pt has to do is stand and pivot. Of course - they have to have the mental ability to remember to do this - I don't know what your pt popuation is like so this may not help.

StrwbryblndRN · May 16, 2009

We have the highest falls in the hospital but at the same time it is not everynight either and we have a high percentage of elderly.

Like previous posts we assess their ability to get up. And if the pt is A/O x3 and the pt has been advised not to get up, we make sure we at least CYA with documentation. You can't force them to stay seated. It is their life.

Bedside commode and reiteration of call bell to get to bathroom are our biggest uses for A/Ox3. For confused, depending on the level, we will use whatever possible for restraints. Whether chemical or physical. I work overnight and our staff is skeletal so it is important to keep pt's in bed if a fall risk.

Of course you have the in between who can't/refused to be calmed and remain the biggest fall risk. Those we keep as close to the nursing station as possible and will have them sit in the hallway, and everyone takes responsibility for them.

Sadly we have recently had a long stent of time with 75% of the floor total care/confused. Ratio 6:1 Talk about bad nights.

As long as you do what you need to do (and document), do not sweat it. You can't stop everything from happening.

mjjlRN · May 16, 2009

We are required to do a fall risk assessment q shift, if the patient is deemed at risk for falling, they get bright yellow gripper socks, a yellow arm band, and a "falling leaves" sign on their door. We also have signs that we put in the rooms. Green sign that says you may be up ad lib, a yellow sign that says please have a family member or staff member with you before getting oob, and a red sign says stop, do NOT get oob without your Nurse/CNA present. We also are required to do hourly rounding (the nurse, CNA take turns) and assess for the "4P's" that cause most falls: PAIN, POTTY, POSITION, and POSSESSIONS.

If we have a patient who we think will not listen and will get oob without calling for help, we try to move them right in front of nursing station and leave their door open, which helps, too.

NursingStudent5548 · May 16, 2009

Our facilty was COMPLETELY RESTRAINT FREE....Most times I agreed but others we got resourceful.

For instance it was always the disoriented that fell....(once in a while someone in socks on the tile floor)

We had tabs alarms on ALL the confused pts. Those that would pull them off would get them safety pinned to the back of their shirt...

We had one man who suffered from severe dementia and was very mobile. He fell often, he liked to bang his head as well. He broke his nose a few times, split his brow...After this we put him in a bicycle helmet and knee and elbow pads. He has not fallen hardly at all since... He was aphasic so I wouldn't be suprised if it was his way of trying to be let go..

We were a long time care facilty with just under 50 patients and 1:10 ratio. We got severely suprised if there was more than 5 falls in a month...

catshowlady · May 16, 2009

I love the bed alarms. We are almost restraint-free in my ICU. I haven't used a Posey vest on anybody for almost 2 years now. It helps that all but 4 of our rooms have a direct line-of-sight to the nurses' station.

April, RN, BSN, RN · May 16, 2009

Yes, bed alarms! If the patient is found to be impulsive or "forgetful of limitations" then we put them in a room visible from the nurses station. As soon as the alarm goes off, someone can be there in seconds. We do fall risk assessments on every patient. As another poster mentioned, I tell every patient to call me when they want to get out of bed for any reason unless they are young and there for something less serious. Keeping patients at risk for falls in the bed closest to the bathroom seems to help as well.

coffee4metech · May 16, 2009

Well keep the bed in the lowest position and get a bedside commode and assist with teaching them out to use a urinal for aboslute emergencies that would eliminate some falls. Also like previous posters stated Bed ALARMS are a life saver for both patient and CNA and nurse.

cardiacmadeline, RN · May 16, 2009

We use bed alarms all the time! Just wondering, does anyone else use the Posey beds?

elthia · May 16, 2009

The problem with bed alarms is that I've noticed I always seem to hear the bed alarm going off, run in the room to hear crash, and see pt on the floor. OR the bed alarm goes off when I'm in the middle of a sterile dressing change, or am pulling a femoral cardiac sheath and holding pressure for 15 minutes. My unit is HUGE, 36 beds, all single rooms, with LONG hallways. Unfortunately we are using restraints more and more often, especially since almost all are pt's are on anticoagulants.