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Improving Resident Safety In Long-term Care Facilities -- Part Two If you’re an RN thinking about working in a long-term facility, or are an RN concerned about the residents in the facility where you work, read on for a checklist of mechanisms that should be or could be implemented to ensure the highest level of resident safety: Falling: -- Keep a “Fall list” at the nurse’s station. This is a list of residents who have a history of, or are prone to, falling. Put these residents, as well as those that are confused or demented, in rooms closest to the nurse’s station. -- Have low beds for those residents who fall or climb out of them. Have proper lifting equipment, and make sure it‘s used correctly. -- Use slip-resistant floors, or put slip-resistant adhesive strips and slip-resistant paint on floor and walls. Provide grab bars, raised toilet seats, handrails in corridors. Provide hip pads to reduce risk of hip fractures. -- Provide adequate lighting and reduce clutter, provide proper fit and maintenance of wheelchairs. (Source: OSHA). Wanderers: -- Clip “shirt alarms” and put “alarm bracelets/watches” on the residents who tend to wander. Transmitting devices can also alert staff that a resident has removed covers, stepped on a mat next to their bed, opens a door, or leaves a chair. This not only alerts staff to wanderers, but gives wanderers more freedom of movement and raises quality of life. -- Put padded or Velcro barriers or bars across the doorways of residents who are at risk for wandering. -- Have a “walking space” or “walking room” for wanderers, so that they will have a place to walk when they so desire. These can be indoors and out. -- Provide a lot of activities for the residents. They will be too occupied to get into idle conflicts with one another. Activities will keep wanderers more interested in their present surroundings. -- Meet the needs that often drive wanderers--Physical needs such as hunger, thirst, toileting, temperature and noise, exercise and movement--Emotional needs such as interaction with staff, family, friends, and fellow residents. -- Train staff in the warning signs of wandering--restlessness, excessive movement, an expressed desire to “go home”. Make sure all staff members are trained in the handling of wanderers and elopers. -- Use transmitting devices that alert staff when a resident has entered an unsafe area or exit. -- Use doors that can only be opened by key, code, or card. Use door alarms, and consider putting them on windows and loading docks. Some devices sound an alarm and lock the door at the same time. The alarms are disabled in the event of fire or other emergency General: -- Exercise extra care while dispensing medicine. -- Organize community volunteers to help with feeding at mealtimes, to decrease incidents of malnutrition or dehydration. -- Make sure all staff members are trained in the recognition and reporting of abuse, neglect, and sexual abuse. Offerings from an Ombudsman: “Under the federal Older Americans Act, every state is required to have an ombudsman program that addresses complaints and advocates for improvements in the long-term care system. The top three complaints investigated by the Kentucky Long-Term Care Ombudsman program in 2002, involved issues surrounding dignity, respect and staff attitudes toward residents; staff being unresponsive or unavailable; and staff training or lack of screening of staff. Ombudsmen and other advocates believe that hands-on, direct care, provided by a well-supervised nursing staff is the key to providing quality care of residents. Stated another way, advocates believe that poor staffing will most likely lead to neglectful care. Also, in light of the recent fires in nursing homes: Suggested questions include -- Check to make sure that there is an evacuation plan in place and that staff have practiced it regularly. -- Are there safety systems such as alternative exits, smoke detectors and sprinklers? -- Check on the staff to resident ratio, especially nights, weekends and holidays. And, NFPA has a fact sheet regarding fire safety in nursing homes. The fact sheet can be accessed at: www.nfpa.org/Research/NFPAFactSheets/NursingHome.asp-- John M. Sammons, MSW ++ Safety devices can be expensive. Alarm bracelets can range from $30-$220. Locking systems and alarms can start at $800. Transmitting systems can be as high as $10,000. No one can guarantee 0 injuries. They will happen, under the best of circumstances. But providing the best safety measures possible will give staff and family peace of mind, and the residents the security they deserve. Is the price really too high? ©Copyright 2006 Medi-Smart.com. No part of this article may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.
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