Writing lots of incident reports each night, is this normal for you in LTC?

msnursekim · Sep 14, 2006

you say, all of a sudden , you have more combative residents racking up tears and bruises? my first instinct as a 28 year veteran lpn is that you have a new employee that is agitating or abusing these residents. think about your nursing environment...what has changed from when you first started there compared to now? think cause and effect...something has triggered these residents to become combative now, which we all know leads to tears and bruises. :idea:

suebird3 · Sep 14, 2006

Is there any change of routine, or meds?

Suebird :)

**Elektra6, ASN, BSN, RN** · Sep 15, 2006

It is a mixed dementia/non dementia ward. Two of my residents seem to be deteriorating mentally (dementia) and have become combative lately. Ruled out physical problems, but working on the psych ones, try this, try that. I was really wondering do other LTCs have this many incidents? Do you have 10+ a week? I'm starting to feel rotten about this. I have even been assisting with PM care with the combative ones trying to prevent any problems. Our nurse's aides are great and have been working there for many years so I don't feel it's them. They feel horrible when something happens to their residents.

msnursekim · Sep 15, 2006

Unfortunately, in LTC it seems we have cycles or runs of falls, deaths, incident reports, etc. I think it just goes along with LTC...but 10 incident reports a week does seem like a lot but it also depends on how many residents you have declining at one time. As you said, you do have several in this process so seems like it would be logical to expect more incidents. Hang in there...as the old saying goes,"...this too shall pass." Thank goodness you have caring CNA's. Treasure them because they are hard to come by in this day and age. Have you asked the aides what they think could be causing the problem? Many nurses overlook the aides as an input but they are really a goldmine for information on residents.

suebird3 · Sep 15, 2006

Don't discount the Full Moon....I mean it! I swear our 'pleasantly confused' patients go gung-ho about then. And yes, some Full Moons are worse than others.

The aides are good resources. Good idea!

marjoriemac, LPN · Sep 18, 2006

I have seen periods when fals occur regualrly and skin tears. Sometimes staff education helps as they may be unintentionally too rough when dressing people etc. However I do believe there are times when risk is a part of a residents life which they are entitled to. We cannot wrap them up in cotton wool and can only ensure that we have done our duty in educating them, removing any physical dangers and documenting everything. Unfortunately sometimes people do partake in risky behaviour because they crave attention however and it is a sad state that people who are deprived of human contact will do anything to gain some. Keep a close eye on your reports and if they point to one carers involvement, or one scenario or one area - act on it. If they are all different, it may just be a natural part lifes risks!

Patti 2nd gen RN · Sep 18, 2006

Yes to msnursekim!!! Our aides are invaluable, and have an understanding of patients that often gets overlooked--validate them by asking for their input whenever you can!!!They have a huge, and dirty job for little more than McDonald's money--the reason the good ones stay is mostly that they care. But--as to 'runs' of incident reports--don't get too nuts about it--we get 'runs' of trach admissions, 'runs' of dementia patients, 'runs' of GT's--and right now we are getting renovated--the change in scheduele in getting some of the patients quite restless. Remeber, health care facilities are not motels--stuff happens.

hptogram · Sep 18, 2006

I'll go weeks without anyone falling on my shift, then all of a sudden I'll find three people on the floor. I think it does run in cycles.

Dixiecup · Sep 18, 2006

I do the monthly report for our incidents. On average we have between 20 and 40 per month.

ksmothers · Sep 18, 2006

We have a 2 partner Geriatric Practice and that is about the average per facility we receive via fax/phone.

ktwlpn, LPN · Sep 18, 2006

All of a sudden I have been writing up loads of incident reports for bruises, skin tears and falls. Is this what goes on in LTC? Or shouldn't I have this many? I have been working here for 9 months and all of a sudden some residents have become more combative and are racking up the injuries! Would like some feedback about your experiences with incidents.
Thanks!

`I'll tell you what worked for me-when the first incident occurs grab 3 incident reports from the file and lay them on the desk.You won't need the other 2....Honestly-this works for me-it's like voo-doo........Seriously now-you have ruled out UTI's etc? (we have a frequent fall protocol that really picks up alot of UTI's and other problems.2 falls within a certain time period (I'm brain farting and can't remember the exact policy) and we do a u/a,cbc and tsh.....Do you see any patterns with the tears? We use skin sleeves and leggings for protection with pretty good results.Also encourage lots of lubing-we use tons of lotion du jour....On a unit like yours if a resident is combative during care can't they be left until later? We have often changed showers and baths from shift to shift to better accomodate a residents "happy" time.I've worked in dementia units-our philosophy is "if not now then later is ok" Unless the resident has b.m. rolling out of their pant leg-then you have to get creative.I also often find that too many staff assisting the combative resident exacerbates the situation.Maybe go away and re-approach while offering a snack and a drink and go from there? I often give tylenol on the first med pass whenever I work over.It's such a long day for those folks and you know something must hurt....We also use ALOT of depakote on these residents.