resident falls in a long term care facility

Heather27 · Feb 15, 1999

Hi.

Falls are always a reasonably traumatic thing for the residents/patients, families, and staff included! We always think, "Could I have done something more to prevent this?" Even if a person doesn't get injured from the fall, it would be wonderful if it never happened at all!!

Of course physical and chemical restraint is ONE way of preventing falls, but the facilities that practice that are, in my opinion, not worth their funding....

We find that certain residents seem to fall in "patterns" if you will...For example...some when they have missed their afternoon "nap"...some when their grandchildren have just visited (? because they are excited/overtired)...some with the classic "sundowning".

The key is to know your residents. I often hear from my staff, "Mrs. X is a fall waiting to happen!" We then take extra care to always know where she is, and try our best to keep things out of her way...make sure she doesn't get agitated...anticipate needs...toilet regularly..make sure she has glasses/dentures/shoes/ "safe" clothing..

I don't think there is any "magic" way of preventing falls completely. Be observant, be careful, and be relaxed. There is nothing like tense staff to rile up residents!!

Good luck!!

Heather

Moonstone Mist · Feb 20, 1999

Hi...I know a fall can be deadly for the elderly It is heartbreaking when a fall occurs and we, as nurses, are left wondering if we could have prevented it.

I was curious about a few things when I was reading your note...how many of your residents are on benzodiazepams? This is the number one reason for falls, according to the reading I have done. I firmly believe that there another ways of dealing with behaviour problems other then physical or chemical restraints.

I also wondered about your environment, lighting, contrasting, floor coverings etc. Could that be a reason for falls?

Do you do a fall risk indicator either on admission or with quarterly reviews? You may find that this is helpful in identifying those residents at risk as well as the cause of the risk.

Good luck...Cynthia

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BethanyJ · Feb 22, 1999

Little bit,

It does sound like you and your staff are doing quite a bit to prevent the falls in your facility. I have to agree with Cynthia on the fall risk assessments..these are great tools for identifying those at risk for falls. In my opinion, I think the best prevention is observation AND communication. Your staff needs to be inserviced on how to recognize those residents at risk and then follow through by effectively communicating this to not only the nurse, or direct caregiver, but to everyone on the unit. You mentioned you have a fall committee and the nurse brings an incident report to this meeting. What is included on this report? In the facility where I am employed, we are urged to not only report the fall and an injuries sustained, but also include outlying factors such as: what type of footwear the resident was wearing, was incontinence a factor, was the floor wet/dry, when was resident toileted last, the lighting, was fatigue a factor....etc. We also include the assigned caregivers name for that time frame. Once physician and family are notified, the report goes directly to a safety committee member who can then investigate whether this was an isolated event or there is a pattern occurring. THis makes it easier to decide how to avoid furhter falls with this particular resident. If incont. a factor we check for a UTI. If fatigue...then it means more rest periods need to be included in the residents planned activities. If falls ar due to climbing out of bed and it is a pattern we get a low bed for that resident. Once the safety team can see a pattern occurring, they discuss measures with the hands on staff who can usually come up with a quick solution to the problem. Hope this helps! Good luck!

daisey15 · Feb 22, 1999

in order to help with the prevention of falls, our geropsych facility took stats with every fall incident. client's age, sex, time of day, actual day ie sat, sun ect., dx, type of injury that occured, environmental factors, physiological factors,recommendations for prevention and any extenuating circumstances . we also did a review of all meds at time of incident and check for orthostatic hypotension along with a medical and psych eval with every fall. I found our best prevention was q 5 min rounds, and a dedicated staff that knew their clients very well and would investigate every noise, and assist clients with ambulation, especially at night.

Penrod · Feb 28, 1999

The environment may hold some clues as to why falls occur in elder care facilities. You didn't mention where most of the falls occur. May I assume they occur most often in the bathrooms and resident rooms? If not, I would be interested in knowing where most residents tend to fall.

I know that disorientation is common among dementia residents. As a former ombudsman, I've witnessed many residents maneuver around floor patterns and other design elements that are inappropriate for environments that house people with cognitive and physical disabilities. My background is not medical, but psych, sociology and design, so I can't speak from a medical background - although certain medications may have a large impact on one's level of mobility.

I recently spoke at length with an administrator for a geri/psych unit about a plan of an ADA upgrade involving most of the patients' bathrooms. Falls by the patients and staff members were a critical issue. Unfortunately, the ADA guidelines for patient bathrooms often results in water being splashed all over the floor when a roll-in shower (30"x60" min.)is included. She told me that two of her staff members were knocked down by a patient. The floor was too slick for them to remain standing when the patient struggled with them. Matte flooring may help the situation. Additional grab bars may help in a geriatric environment, but are not appropriate in psych environments. We included little trench drains (with 'safe' covers) between the floor and the shower unit to help ease the excess water problem. It may prove to be a maintenance problem, but they were willing to try anything.

Also check carpet/flooring conditions. Direct sunlight and glare may be a problem. One key may be a clearer understanding of a residents' perception of the environment. Hearing loss, diminishing eyesight, sundowning, etc. may play a role in one's changing environmental perceptions. Medication also changes one's perceptions. Even feelings of vulnerability may increase the tendency to trip and/or fall. From my own experience, I tend to trip in unfamiliar places or when I feel self-conscious about something. Others have told me the same thing.

laura · Apr 7, 1999

At my facility the Residents at high risk for fall have red name tags on their doors instead of black that way every one knows who the fall risk are. I work the 3-11 when alot of our falls occur and we have found that bringing the ones that are climbing out of bed up to the nurses desk until they tire works well. We takes turns watching them as we chart and can get to them before they fall if they attempt to get up without assistance.

bj54 · Jun 7, 1999

I work in a 105 bed LTC facility. We have

relatively few falls. One of the "patterns"

we noted was toileting. So, the majority of our residents are on a toileting program and are assisted to the BR or taken to the BR q2h. Another thing that helps is the Merry Walker. Residents who tire easily can use this equipment for mobility and have a seat to sit down when they become tired. They also have the stability of the PVC wraparound to give them more security. It provides a resting place for their arms and hands when they are tired. It is not considered a restraint. We have only three (3) restraints in the entire facility. Hope this helps.

Betty

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bj

MQ Edna · Jun 23, 1999

I'll bet you a hundred bucks you don't have enough aides. You may THINK you do but I worked on an alzheimers unit with 3 aides and 1 nurse to 12 patients. Now that was good staffing and the aides were not over-whelmed so they could potty and watch these residents correctly. Sometimes people in administration forget how hard it is to take care of old or sick people!!!

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jen622

Nanaimo · Jun 23, 1999

I was curious what people actually thought of the push for 'no restraints'. I work as a geriatric nursing consultant in private practise, but also work casual in a long term care facility. One shift, there were six falls resulting in one broken hip, one fractured humerous and some broken ribs...not to mention numerous cuts and bruises.

Though there is much lip service paid to 'environmental interventions' such as regular toiletting, I agree with Jen who states that there are frankly not enough staff around.

If those of us in the healthcare profession truly believe in 'no restraints', then it is clearly unacceptable to simply remove these restraints without implementing REALISTIC replacement interventions.

FYI:

The mortality rate for a hip fracture is over 50% in the first year!

Regards,

Jackie

lorraine · Jul 26, 1999

I am a restorative nurse in a 50 bed dual diagnosed long term care center. I am also known as the "device queen" and fall risk coordinator. I have the worst scenario and I'm sure everyone has seen this. A very frail lady, extreme balance problem, unsteady gait (needs contact guard assist to ambulate) and she has alzheimers and has forgotten that she can't walk safely. After several months and several falls we finally have success. All of her meds and labs were evaluated, as were her sleeping patterns, toileting needs, and intake. She was taken off of all psychotropics and is now taking effexor for depression, remeron for depression and appetite stimulant,and megace for appetite stimulant. She has a pressure bed alarm with an adaptor for the call light system and a pressure chair alarm for her w/c. We use a very lightweight self releasing waist restraint and find that pulling her blouse over it keeps her from noticing it. The bulky waist restraints are annoying for most residents. The audiologist found excess cerumen and diagnosed her with vertigo. After a good regiment of wax removal we noticed an improvement in balance. New glasses with a strap to hold them in place also helped. Her appitite improved and she started gaining weight and is no longer wead d/t lack of nutrients. We also use a biocore mattress (defined perimeter). This allows her to get out of bed, but slows her down. So when the alarm sounds it gives us a few added seconds to respond. Hope this helps. And knock on wood she hasn't fell in 4 months...quite a record.

Deb Roush · Nov 8, 1999

While doing research for a newsletter article on the changing standards in restraint use, I found a great website for alternatives to restraints called "Untie the Elderly" www.ute.kendal.org

One thing many people discussed was the floor- they have a good brief article on good floor care related to fall prevention. Also good info on how to gradually reduce restraint use, and be successful. It's worth checking out.