Preventing falls in acute rehab center

RNMarykay · Aug 9, 2009

I work on a rehab floor. We work as a TEAM - there is no "I'm the RN, you are the Tech" attitude here...if someone needs help getting pulled up in the bed, so be it. If they are a total assist - get a gait belt and get help. Our nurse leader also creatively schedules the techs so that we have enough to get it all done in the midst of daytime/dr's/physical therapy etc...

We also have our physical therapists work with techs and new nurses on how to effectively "block" a patients knees, lift without hurting their back, etc. When the PT's assess the pt they usually put on the whiteboard in their room what kind of assist they are (min/mod/max) and why (knees buckle, confused).

It's helpful to know that some types of stroke patients are more prone to attempting to transfer themselves (I think it is the ones with left sided weakness, it affects their judgement), and put those on a bed alarm or close to the nurses station where we can keep an eye on them. We also park pts in their wheelchairs out in our view point between therapy sessions so they don't try to get out on their own.

Hope that helps!

g

cna23 · Feb 7, 2011

Personally, I dont think there's really a way to prevent them, just be very well prepared if and when they happen. Have a gait belt ready,. If the patient does go down, help them to fall flat on their buttocks. (U dont want to break a hip, after all, thats what it is cushioned for). if the pt has a weak side, always stand on that side. If the pt says that they feel that they are gonna fall, sit them down immediately, if there isnt a chair in IMMEDIATE view, get them on the floor. Its always better to be safe than sorry.

JacksonRN · Feb 11, 2011

we have the gait belts, we use the slide tech to get them to the ground if we have them and they fall. we use alarms to help us know when they are trying to get up and hopfully get to them first.

starletRN · Feb 16, 2011

Also keep everything within reach. Patients who have zero safety awareness try to walk across the room for their water cup, phone, snack etc. then they fall.

groovy jeff, RN · Feb 18, 2011

rehab is not for sissys that is for sure!! acute rehab is tough as people are starting to feel better and think that they can do more than they can. amputees forget that there leg isn't there and fall alot. here is my list as to what can be done. the number one reason people fall is that they were trying to reach their call light or something they dropped. #2 is getting up to go to the bathroom. so keep stuff in reach and offer toileting more. here is the rest of my list:

bed and chair alarms

gait belts

constant reorientation even with people that are a&ox4

q2 toileting

for those that are confused or have no deficit awareness use pelvic restraints in their chairs (better to be safe than sorry)

sitters

good luck!

Long Term Care Columnist / Guide · Feb 19, 2011

My advice as a former rehab nurse is to review meds first....many rehab patients are on multiple meds such as opiates, diuretics, and antihypertensives, all of which can contribute to falls. They also take blood thinners which put them at higher risk for internal and external bleeding.

Additionally, I checked orthostatic blood pressure readings on at least three occasions to see if their BP dropped when they rose from lying to sitting to standing, and when someone did fall I'd do a urine dip to see if they were brewing a UTI (another extremely common cause of falls) and follow up accordingly. Body pillows, tucked strategically into a resident's bed, help to prevent falls due to rolling OOB. Toileting before and after meals, and before bedtime, eliminate many falls that occur because a resident needs to use the bathroom and they've forgotten they need help with that. Frequent (Q 30-60 mins.) visual checks combined with offers of toileting, food/drink, or pain meds can also be worth the time and trouble it takes to do them.

Just a few ideas.......use them as you wish. :)

spongebob6286, BSN, RN · Apr 25, 2011

use tab alarm, lap buddy, always make rounds even at HS. make sure they can reach the stuffs they usually need like call light, eyeglass, their reading materials, even a glass of water, walker, wheelchair, bedside commodes.