resident falls in a long term care facility

NURSE FOR LIFE · Nov 15, 1999

little bit

I hope i can help you. I have worked in a long term care facility in Indiana for seven years and I now practice in Ohio. In Indiana I worked in a 140 bed facility with Alzheimer's and Dementia patients. Alot of the things that have already have been posted are correct. Medications are a big factor in falls and also toileting residents is a main factor. We had devices there which were called Close Call Monitors. They are designed for our patients with high risk for falls. They are basically a small black device that is attached to a residents wheelchair or headboard while in bed. The device is attached to the w/c or headboard by Velcro and on the top of the box is more velcro which a strap is attached to. On the end of the strap is a metal clip which is attached to the residents shirt or gown. What is does is that when the resident tries to get up the Velcro comes loose from the box which causes an alarm to go off and the staff are able to get to the resident prior to the fall, the alarm is loud enough that you are able to find the resident quickly regardless of location. They are not considered restraints because they do not prevent the residents from moving in any way. Sometimes residents will remove the clips from their clothes themselves. In those cases you can clip it to an undershirt where they cannot see it. It has helped our facility to drastically reduce the number of falls without restraining our residents. I hope this information has been helpful and I wish you luck.

NH nurse · Jan 1, 2000

I work in a 160 bed long term care facility. Our facility is in the process of going restaint free. We also use the merry-walkers, and the alarm previously described in the residents wheelchairs, beds, and a personal chair in their room if necessary. We have also started using lap buddies and velcro seat belts which most of the residents are able to release on command. We have had much success with these alternatives. We also bring our high rick fallers to the lobby where they can be better observed. We have had few incident since we started these programs. Most of our falls lately have been the mentally alert, who "forgot to lock their wheelchair", or "just lost their balance". I hope your programs will be successful. God Bless

theleader · Jan 15, 2000

Originally posted by little bit:
I am a DNS in a 90 bed long term care facility in Vermont. I am looking for unique ideas as to how to prevent falls. We have tried everything in the book I believe and still have too many falls in my opinion. Some of the things we have tried are tab alarms, checking glasses of the residents who fall, checking their footwear, screening by PT , some residents are then put into a program for strenghtening, those are just a few. We also have a weekly falls team meeting to discuss falls that have happened during the week. Staff attending the meeting are myself, the nurse from the unit comes with the incident report and reads it to the team, other members are PT, Act director, LNA 's . Any new ideas to prevent falls, would be greatly appreciated. I also should mention that our facility has 90 beds, 50 are a combination of short term rehab.. long term care and Palliative, the other unit is 40 beds which is a Dementia Unit where the largest portion of our falls occur.

Thank-you in advance!

theleader · Jan 15, 2000

We had a high percentage pf falls in the LTC where i work over a year ago, but have gradually reduced it to less than 5% now. Our greatest people at risk for falls were those on the med Remeron. Our consulting pharmacist helped me convince our docs that we should try getting the residents of the drug to see what would happen. We kept behavior sheets on those residents for a month to monitor their behavior and also kept track of their falls. Once they were off the Remeron, the falls stopped. Also noticed through risk management, that most of the falls were occuring on the 2-10 shift at approximately 8 pm. And staffing was a contributing factor. So I started staffing a half shift( worked great for high school CNA's) and my falls were reduced from 25 (Over 50%) to less than 5% in one month. Now our fall rate is arounf 2% with minimal injuries. Good luck!!!!

EJD-LPN · Jan 23, 2000

i agree i have worked in a restraint free facility and the merry walker,lap buddies and velcro belts is what we used.we still had r falls but they were far and few between.i do thing that you have to know your resident and thier routine and thier needs.

Originally posted by NH nurse:
I work in a 160 bed long term care facility. Our facility is in the process of going restaint free. We also use the merry-walkers, and the alarm previously described in the residents wheelchairs, beds, and a personal chair in their room if necessary. We have also started using lap buddies and velcro seat belts which most of the residents are able to release on command. We have had much success with these alternatives. We also bring our high rick fallers to the lobby where they can be better observed. We have had few incident since we started these programs. Most of our falls lately have been the mentally alert, who "forgot to lock their wheelchair", or "just lost their balance". I hope your programs will be successful. God Bless

[This message has been edited by EJD-LPN (edited January 23, 2000).]

reeree · Jan 31, 2000

Unfortunately falls happen. I found it quite effective to make frequent checks on my "At Risk Patients" I know that there is alot to do but it only takes a minute. This is the best way for me to know why they are trying to get up anyway. Restraints aren't the answer. These devices only give you a reason not to check them. If a patient is on a new drug for behavior watch them. The body alarms help some but if you are on another hall in a closed room, chances are you wont hear it. Don't depend on that alone. Train your staff, your aides (which are your back bone). "While you do your adl book take it outside Mr. Patients room and do it. I'll be

in so-in-sos' room if you need me." You can never prevent all falls. But "keeping an eye" helps.

NMB22 · Mar 15, 2000

I work in a 30 bed facility. Fall prone residents are watched closely during the day. I've noticed that most of the falls are at night, or between 3-11. We have recently increased our staffing for 2nd shift, which has helped out. During the night we use sensor alarms near the bedside. Every time they move around in bed we can hear them. We also have catch mattresses on the floors of the residents prone to falling. . Some of the restless residents have protective wedges on the sides of their beds so they won't roll out. Frequent rounds, and toileting helps out a great deal. Another good thing with our facility is that during the day most of the residents stay in the day room, right outside the nursing office, and have activities and tv to keep them occupied. This gives u a better chance to keep an eye on everyone.

nurse2beee · Mar 24, 2000

Hi. I am currently a Certified Nursing Assistant and in nursing school. I used to work at a local nursing home for my summer job. We had a lot of residents who had been diagnosed with alheimer's disease. So needless of say we had a lot of people falling. It really had nothing to do with the CNA'S on duty, just that the patients were suseptible to falling. We found that if we kept a close eye on our assigned patients for the entire 8 hours that we were there, we found that there was a decrease in the falls. I believe that it had a lot to do with attention. They no longer were "intentally" falling because they felt like they could get attention and love by just being themselves. Of course this does not help with everyone, but it can be a very effective and inexpensive form of preventing falls for some residents. I know that it sounds very trival but believe me even though it is just a small thing, it works.

I hope this helps.

Originally posted by little bit:
I am a DNS in a 90 bed long term care facility in Vermont. I am looking for unique ideas as to how to prevent falls. We have tried everything in the book I believe and still have too many falls in my opinion. Some of the things we have tried are tab alarms, checking glasses of the residents who fall, checking their footwear, screening by PT , some residents are then put into a program for strenghtening, those are just a few. We also have a weekly falls team meeting to discuss falls that have happened during the week. Staff attending the meeting are myself, the nurse from the unit comes with the incident report and reads it to the team, other members are PT, Act director, LNA 's . Any new ideas to prevent falls, would be greatly appreciated. I also should mention that our facility has 90 beds, 50 are a combination of short term rehab.. long term care and Palliative, the other unit is 40 beds which is a Dementia Unit where the largest portion of our falls occur.

Thank-you in advance!

Dayannight · Mar 27, 2000

Like some of the above responses already pointed out, I'll bet staffing is an important contributing factor to these falls. While you'll never be able to eliminate falls entirely, I'll bet you'd notice a significant improvement over the next three months if your staffing of aides were to increase particularly during the hours when most of the falls are occurring. Let's face it, most long-term care facilities are notoriously understaffed....

pfoley · Mar 28, 2000

Originally posted by Dayannight:
Like some of the above responses already pointed out, I'll bet staffing is an important contributing factor to these falls. While you'll never be able to eliminate falls entirely, I'll bet you'd notice a significant improvement over the next three months if your staffing of aides were to increase particularly during the hours when most of the falls are occurring. Let's face it, most long-term care facilities are notoriously understaffed....

I have read the postings with great interest and sense that falls are of particular consideration in your organizations, as of course they should be to us all who work in long term care facilities. In Nova Scotia, Canada and generally right across this country, falls in geriatric clients are important challenges we face on a regular and consistent basis and we too search to find means to reduce the numbers and severity of them. There is an acceptance, however, of the right of the client to "risk", and the accompanying question of benefit and burden in deciding on approaches which might be employed in a particular client's case. We not only look at what the options list is in terms of safety measures to "prevent" or "eliminate" falls, we also place great weight on the impact the alternative measure potentially will have on the client's quality of life. There are clients then for whom alternative measures reduce quality of life experience; these clients will not have measures imposed. With congnitively intact clients, discussion has been held with them to outline the potential risk so that they have understanding of the consequences. With cognitively impaired clients, about all we really can provide is more frequent monitoring by the entire care team, and an altering of environmental factors which may be increasing risk potential. Of course family is directly involved.

It is my understanding that legal liability issues are a main consideration and motive in deciding care approaches in America. My question is how far do these very real considerations move the focus away from the client and more toward the meeting of regulations and legal liability concerns?

Katele · May 6, 2000

I am on a fall prevention team at my facility and I agree with some of the others about looking at what type of drugs they are on especially antianxiety drugs and tranquilizers....if you can work together with a pharmacy consultant you can probably assess and possibly eliminate that certain drug with something else like an antidepressant. Or instead of having that type of drug as a routine med. maybe PRN would even do it. This approach has decreased falls in our facility and also we have to get together with our assistants in order to determine the causes for these falls, if you get to understand the behaviors of the pt. you will likely be able to find the most appropriate intervention because no pt. is the same.

Originally posted by little bit:
I am a DNS in a 90 bed long term care facility in Vermont. I am looking for unique ideas as to how to prevent falls. We have tried everything in the book I believe and still have too many falls in my opinion. Some of the things we have tried are tab alarms, checking glasses of the residents who fall, checking their footwear, screening by PT , some residents are then put into a program for strenghtening, those are just a few. We also have a weekly falls team meeting to discuss falls that have happened during the week. Staff attending the meeting are myself, the nurse from the unit comes with the incident report and reads it to the team, other members are PT, Act director, LNA 's . Any new ideas to prevent falls, would be greatly appreciated. I also should mention that our facility has 90 beds, 50 are a combination of short term rehab.. long term care and Palliative, the other unit is 40 beds which is a Dementia Unit where the largest portion of our falls occur.

Thank-you in advance!

monica f · May 7, 2000

We use fall risk assessments. Those patients that are considered "high risk" are put in rooms closest to the nurses station sometimes. Other times we use bed alarms. These are placed in either the bed or chair that they are sitting in. This has prevented people from sneaking out of their chairs and beds.