When asked to address falls management in the LTC setting, I often think “what can I say or contribute that already hasn’t been said?” Throughout my career in this business (or this adventure, as I prefer to call it), I have been told that I do not conform or that I tend to go outside the box. That might be true, but I do it for the right reasons—the dedicated people who work in long-term care and those they care for. So here’s what I can share with you, and maybe you’ll look at falls management a little differently.
How does your staff respond to a resident fall? What do they assess? What are they required to do? Do you as a team discuss the fall and try to establish new goals or do you find yourself repeating the same mistakes? Focusing on previous falls will never reduce fall rates alone but it will offer insight into the intrinsic and environmental factors that cause them.
We have a responsibility to complete the required paperwork, which should include at a minimum the Nursing Admission Evaluation, which gives staff insight into the resident’s life patterns, habits, desires and history of falls. Our job is to create an environment that minimizes the risk of falls and/or injury from a fall. When a fall occurs, complete an incident report including any witness statements. The report should include an assessment of not only the resident (the first priority) but an environmental assessment. A pain evaluation, occurrence investigations and neuro checks should be completed as required, as well as an assessment of all fall management devices (i.e., alarms, belts, mattresses). Check all devices that indicate a resident’s behavior could lead to a fall. These devices do not prevent falls unless all staff respond quickly to the alarms. Even then it could be too late and a fall might have occurred. What will your staff do? Put the alarm back on? Your team should re-evaluate the situation to determine what led to the incident.
A DIFFERENT APPROACH
Why was the resident acting in a way that increased the potential for a fall or caused one? Let’s go back to the resident’s admission. What do you know about the person you are responsible for? Conduct a background investigation that sheds light on what this resident liked to do before coming to your facility. What was the resident’s occupation? Interests? We must re-create the resident’s preferences within the walls of our facility because not everyone likes to play bingo and watch movies.
KNOW YOUR RESIDENT
More facilities are becoming acute rehab facilities, caring for those with physical needs. Usually residents receive therapy once or twice a day, but what about the rest of the day? We must meet their medical needs, especially pain control, but we must meet their emotional needs too. Is the man in Room 100 lonely because his wife cannot visit him? Does the lady in Room 300 miss her dog or cat? If so, make sure that she is involved during animal therapy. Can the family bring the pet in? Are there photos of loved ones and/or pets in each resident’s room? Knowing your residents helps to meet their personalized emotional needs.
What about long-term residents? Again, try to re-create their reality. Think about another lady: She is slightly confused and your admission assessment indicates that although she was independent at home, she could be unsteady on her feet. You have followed instructions by completing a physical therapy evaluation, initiated falls prevention devices and alarms and staff has been instructed to check on her often. However, she is found in the hall visibly shaken because of the “other lady in her room.” A staff member leads her back to her room and reassures her that no one else is there. The resident is asked to sit down in her chair.
At the next check, she is found getting up. Again, a staff member asks her to sit down, offers to get her a drink, turns on the TV or gets her something to look at. They do not hear her say: “I do not know the other lady in that room.” At last, the housekeeper approaches the resident and asks her about the other lady. In response, the resident points to her own reflection in a mirror. She didn’t recognize herself and was frightened. The mirror was removed and she no longer was afraid to be with “that other lady.”
LESSON TO LEARN
Find out why a resident’s actions might lead to unsafe behavior and help him or her be successful. Why do we always try to return a resident to the chair or bed instead of determining the reason for getting up in the first place? It takes all staff members to make falls management successful. It takes listening to the resident not only with our ears but with our hearts. Your staff must feel it is just as important to learn about the resident as it is to provide hands-on care.
In this adventure, I have found that most staff do try unless their suggestions or observations are met with resistance or if they see no one is taking their contributions to heart. Then they stop sharing. Welcome all discussion without criticism. Open the box and climb out to see that there are many interventions to falls management and some of the most successful are those created when we take the time to listen with our hearts not only to the resident, but to our staff as well.