Wednesday, December 19, 2007

Waughing the Dog

Horribly cheesy title, I know. Here are some more pearls gleaned from the 3rd and 4th hours of Ms. Waugh's most excellent discussion:
1. The rationale for using restraints is: They keep 'em SAFE, keep us from getting SUED, and we don't have enough STAFF. This rationale is a bunch of horse baloney because it's all lies.
2. There are two kinds of residents who fall from the bed: Getter uppers and roller outers.
3. Roller outers are rare; best interventions are low bed and/or a bigger bed (Queen size bed is smaller than regular bed + mat). Mats are bad -- don't use them.
4. For getter uppers, teach them how to get off the floor. Identify why they might be getting up (toilet, hungry, they heard a noise, they are finished sleeping). Make sure residents know the call system is working.
5. Notice I said call system and not call light; CMS allows any system to be used as long as it enables the resident to summon for help. Technically, residents could be taught to "holler real loud" and it would be legal. The 3rd hour describes techniques for getting residents to use bells ONLY when they're needed. People often use the call system because they're lonely.
**6. If someone is getting up and is going to fall, DON'T YELL. Call them by name in a normal tone without excitement, say "Before you go, do you have time to share with me...", and insert something they can share from their short term memory. This is the absolute best intervention and it takes advantage of the resident's very short attention span.
7. Before someone moves in to the facility, go to their home for about an hour for a preadmission evaluation. Find out 7 things: What do they like to hear, taste, smell, touch, and see? What do they like to sit in? (The most worn out chair -- have it sent to facility) Where do they sleep? (Sometimes the chair or the couch due to CHF/COPD/etc. -- that's okay and it isn't neglect on their kids part). This is where you find your falls interventions.
8. Care plan meetings should be 20/80 medical vs. social information about the resident.

No comments: