Not all falls are preventable if we are going to honor patient’s independence which of course we should. Not all falls result in injury thankfully, but sometimes they do and sometimes injuries are serious or even fatal. In April 2014, I wrote about the concept of a A Patient’s Right to Fall and Our Duty to Minimize -Another Plea for Staffing and want to follow up with this piece.
I believe that staffing of nurses, nurse assistants, physical and occupational therapists, and other support staff are absolutely essential to safe care, I also know that determining whether or not staffing contributed to a patient’s fall after the fact may be tricky to determine. Here are some things to ask about when determining whether staffing was involved in the root cause of a fall.
- What was the staffing of the unit at the time of the fall? Was anyone on break?
- Which staff were familiar with this unit and this patient?
- How do staff cover other staff when on meal and rest break?
- How is the unit typically staffed? Make sure that you know how the facility documents sick calls and look for any discrepancies between who is listed on the schedule to come to work and who actually did. And get a pattern over time. Staff who work in chronically understaffed units may have to develop bad habits in order to survive. (I’m not justifying this btw, but it is a disturbing reality. See articles re: time it takes to reposition patients and normalization of deviance.)
- If a care plan indicates that your loved one is supposed to be taken to the bathroom or turned or medicated every two hours or some such regularly planned intervention, get the care plans from other patients. Create a real picture of needs of all patients on the unit and do some math! Include estimations of time re: who needs two people, how much it might take given a patients’ needs, break and meal time for staff, and the same for all patients being cared for.
Does anyone have other items to add to this list? If we can make these invisible things more visible, I think we’ll have a better chance of staffing appropriately in all types of facilities.