Unit Design Blamed for Increase in Falls

[abundantgrace]

I work at a 175-bed hospital. I work on a med/surg unit that has been open about 6 months. This unit is different from other units because it is split into 2 separate units, one on either side of the floor. Needless to say, this is a very large unit and a lot of walking is done during every shift.

Each side has its own med, supply rooms and nursing station. There is no centralized nursing station which is the typical set up for a hospital floor with patient rooms. Each side is staffed with 2 nurses and 1 nursing tech. The unit can hold 15 patients on each side.

The unit typically gets many patients who are very confused and they often try to get out of bed. Many times it is necessary for 2 staff members to be in a room to care for a patient. This leaves 1 staff member for the other 14 patients. The problem is that we are being blamed for an increase in falls.

This is not our fault. We work very hard every shift. Our staff works well together and have a great spirit of teamwork. We don't have a "that's your patient" philosophy, but when there is a need, we all rise to the challenge.

What do you think we can do to decrease falls? Obviously we can't change the unit design.

Thanks for your suggestions.

[eatmysoxRN, ASN, RN]

Do you have/use bed alarms?

~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~

[Boog'sCRRN246, RN]

Do you have/use bed alarms?

What good is a bed alarm if there is no staff to respond to it?

[MrChicagoRN, RN]

The first thing is to ask WHY they are falling

[eatmysoxRN, ASN, RN]

What good is a bed alarm if there is no staff to respond to it?

I certainly agree but I'm sure that staffing is a non negotiable factor in the situation.

~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~

[abundantgrace]

I forgot to mention that we always use bed alarms and we occasionally use restraints if the bed alarms, meds or a family member is not available to stay with the patient.

How is everyone's unit set up?

[abundantgrace]

This is a large unit and many of the patients are confused and they try to get out of bed. We set bed alarms and occasionally use restraints. We try to place the patients with the highest fall risk in front of the nursing station. We also have A X O X 3 patients who fall - go figure.

Have you ever seen a unit set up like this?

[abundantgrace]

Yes we do. Sometimes we can't hear the alarms if we are in a negative pressure room. Each staff member wears a phone and are alerted when someone gets out of bed. But by the time we get to the room, the patient is already on the floor. It's very frustrating.

[stablesystole]

Welcome to the utter genius of decentralized modern nursing unit design. It's another one of those things thought up by the idiots who either never worked the floor at all or have forgotten what it's like.

[Altra, BSN, RN]

The problem is probably not the design itself -- it's the 1:7-8 nurse-patient ratio on a unit where a large portion of the patient population is confused.

[martymoose, BSN, RN]

The first thing is to ask WHY they are falling

seriously??? you are asking why? Do you work in a hospital?

We get so many advanced dementia/alzheimers patients that have no idea what's going on. People who haven't walked without assist/walkers for years forget that they need these things. Tell them to stay in bed? They don't remember to do this. They just get up. And Fall!We are not allowed to use any restraints at all.

It is soooo extremely frustrating to have these patients , as in reality , they need a full time babysitter!! Family never helps. Staffing doesn't allow for this.Then they fall, break a hip, get a brain bleed, etc. And who is blamed for this??? THE NURSE...

Op i am so sorry. It sucks to have this kind of liability. Makes you wonder if you should look for a new facility?

[abundantgrace]

Hey,

Thanks for your response. I'm new to this. I just saw your reply. Anyway, it's extremely frustrating, management doesn't care about acuity, just filling beds. When we do have need for a sitter, no one wants to work, because when they come to work, they are overwhelmed and burned out. Thank goodness we can use Ativan, Haldol, and as a last resort, restraints. Many patients who are self care may only see me 1 -2 times per shift because I'm so busy with the confused patients. I feel badly for them, but it can't be helped.

Part of our hospital core value statement includes the words "patient first". I don't think management cares about the patient or staff, only about the bottom line. It's very sad that healthcare has been reduced to this.