? about resident throwing self OOB

[Sensoria17]

At my LTC facility, there is a rather challenging drug-seeking resident I have to deal with when floating to another wing. On at least one occasion, after having consumed his maximum daily dosage of prescribed narcotics, he has somehow managed to throw himself OOB (he's a paraplegic) in order to be sent to the hospital to get more pain meds. How do I deal with him should I start to notice he may getting to that point again? I suppose I can put his bed in the lowest position though I suspect he doesn't not like this at all as his bed is never in a low position. Any advice would be appreciated.

[Poi Dog]

Can you use side rails or are you a restraint free facility?

[focusedvalpn]

document behaviors, psych consult, notify MD, low bed, and floor mats. i had a resident like this and i told the um and don and they had to just tell him that a fall is any UNINTENTIONAL change of position so if you put your self out of bed they dont have to send you out to the hospital for no injuries and if you continue to do so we will make safe accommodations if that is where you would like to be. now of course we sent him out but it did work for a long while then we just reiterated when he starts up and comes back to the facility on the same meds. also send him to the same hospital after a while they will recognize him and catch on that always helps and call in report to them. my resident would crawl feet first onto the floor mats and lay there or crawl out in the hallway. and then say im grown i can do what i want to do then cuss us out to pic him up off the floor.

[1bigmedicRN]

I know in most facilities it is policy to have the bed in the lowest position so I would check and if that is the case put the bed in the lowest position. I would then explain to the patient that it is the policy and if he doesn't like it than he could talk with the administrator. Because Medicare/Medicaid does not pay any more for preventable injuries (falls, pneumonia, and etc.) and if he falls he or his family would be expected to meet the financial obligations of going to the hospital. I would also document his actions and what is said. If you catch him more than once and it is documented then the facility could opt to put mats around the bed so he is not injured (I have seen this done at a few facilities because of the same reasons.).

Just my 2 cents, good luck.

[CoffeeRTC, BSN, RN]

All of the above. Document and remember to care plan. Try to prevent injuries from a fall just as you would an little old confused residnet. Get family or involved if appropriate and don't forget your ombudsman. It would stink if this person tried to get the facility in trouble. You can call them and even ask for input and head this person off.

[casi, ASN, RN]

We will occasionally use mattresses with raised sides like this

http://www.1stseniorcare.com/glissandotmglidingmattresswithraisedsides.aspx

this might make his attempts to get out of bed a bit more challenging.

I would also look into assessing this man's pain. As we all know people with chronic pain tend to have a higher threshold for narcotics. Maybe some medication changes are in order.

[Sensoria17]

I appreciate all your help and comments. I will print these out to keep in mind for the next time I work that wing.

[nerdtonurse?, BSN, RN]

We had one of those we got from a NH every time he threw a temper tantrum because the nursing home wasn't letting him smoke dope in his room (I'm talking crack, not a medical THC). They put a camera in his room since they were concerned about it being suicidal in nature and to try to see how he was getting the dope, caught him crawling over the rails deliberately and then screaming he'd fallen. The NH told him they'd deduct the cost of the ER visit from his "spending money"left over after the facility rec'd his check. Guess what? No more "falls."

[SuesquatchRN, BSN, RN]

Document, document, document.

[ZippyGBR, BSN, RN]

document behaviors, psych consult, notify MD, low bed, and floor mats. i had a resident like this and i told the um and don and they had to just tell him that a fall is any UNINTENTIONAL change of position so if you put your self out of bed they dont have to send you out to the hospital for no injuries and if you continue to do so we will make safe accommodations if that is where you would like to be. now of course we sent him out but it did work for a long while then we just reiterated when he starts up and comes back to the facility on the same meds. also send him to the same hospital after a while they will recognize him and catch on that always helps and call in report to them. my resident would crawl feet first onto the floor mats and lay there or crawl out in the hallway. and then say im grown i can do what i want to do then cuss us out to pic him up off the floor.

exactly...

if the patient is putting themselves out of the bed and you've good evidence that thisis what they are doing then there is no need to send them to the hospital .

this needs a multidisciplinary approach

[tyvin, BSN, RN]

I've actually had the bed put on the floor. It works great but since he's a para he may scream about it or it could prove to be good exercises for him transferring up to his chair. Does he independently transfer? Also is his pain controlled ... seriously.

With paras we tend to look at them as drug seekers if they are young and constantly want medicine but you should check to see when he was last evaluated for pain management, when his dose was increased, does he have break thru meds for when the extended release tabs he's on fail ... or is he on a patch?

With paras there are many types of pain and I can see all the nursing staff deciding for him that he doesn't need anymore ... hmmmm, also what other types of meds is he on for pain management like antidepressants, muscle realizers, etc... Don't assume he's not in pain; it sounds like he's crying out for help.

[One Flew Over]

it sounds like he's crying out for help.

I agree! I also agree with keeping him safe from injury but some investigation has to be done to determine what exactly is going on with him. Definitely need to look into the cause of his pain and if possible attempt to find him some relief. I mean, if he is so desperate that he is throwing himself out of bed something is seriously wrong! Either physically or perhaps mentally.. Have they gotten psych involved? I always try to imagine myself in the situation when caring for a paraplegic/hemiplegic resident, especially when they are younger.. the loss of control must truly be profound, I honestly don't know how I would handle it myself, if heaven-forbid I were ever in that situation.. Major depression is definitely something worth looking into, it can amplify any existing chronic pain issues and make them difficult for him to deal with.