resident falls in a long term care facility

[Buffy]

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!

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[nursejanedough]

km rn, are you serious? Blaming the falls on meds or orthostatic hypotension? Tell us the truth, have you actually worked in LTC as a floor nurse for the last 6 months for at least 8 hours a day? Old, confused, wobbly, "unrestrained" people do fall. And get broken hips. No fault of anyone, but family and medical staff don't want to tie down everyone. Don't you think Ronald Reagan had the very best care? He fell and broke a hip. I wonder if Nancy Reagan is going to sue someone.

[AndreaMichael]

Hi "LittleBit"

I manage a small rehab facility with an average LOS of 20 days and the vast majority of these are over 65's. Cannot say we have any innovative new ways to preventing falls -- that's a really complex question. However from reading your message I detect a unique way of review and I wonder if I could obtain a copy of your protocol for your weekly review of falls. I think this initiative is to be lauded. My email is [email protected]

[km rn]

JaneDough I am no longer a staff nurse - however, that does not negate what 17 years of nursing has taught me. Please try to see the bigger picture.

Yes some falls are caused by staffing, some are not. It is very easy to blame everything on staffing yet you yourself acknowledge that gait, balance etc. are common problems with our residents. What kinds of things does your facility do to help residents with gait, and balance issues.

Was Ronald Reagan wearing gerihips? Did he have a low bed and fall mat at bedside? Yes - falls and fractures happen...sometimes a spontaneous pathologic fracture causes the fall.

Bottom line - meds need to be checked. On multiple occasions, residents have had significant orthostatic b/p issues - but a check of their meds revealed diuretics, and 2 anti-hypertensives. Please look at the studies that identify adverse drug reactions when residents are one 4 or more medications.

I remember what it is like to work in the trenches - we can't beat ourselves up because a resident fell or a resident sustained a fracture. Control charts help prevent management from over-reacting to fall numbers and making knee-jerk reactions based on one month's high fall rates.

If a fall/fracture goes to court, you can bet that the expert witness hired by the family's lawyer will be looking at medications, orthostatic blood pressures, strenghening programs, injury prevention devices, etc.