Assessing Fall Risks Accurately

The last hospital I worked at had this huge emphasis on preventing falls, with a "NO Falls" tolerance. We had a safety officer walking up and down the hall at all times making sure call lights were within reach, bed wheels were locked, patients were toileted, etc. It still didn't prevent falls from happening. The tool we used to evaluate people didn't make sense. People that weren't fall risks could be a high fall risk according to the assessment. Now I'm at a hospital with a more exhaustive and accurate tool called the John Hopkin's Fall Risk Assessment. Here it is:

Complete the following and calculate fall risk score. If no box is checked, score for category is 0.

Points

Age (single-select)
o 60 – 69 years (1 point)
o 70 – 79 years (2 points)
o ³ 80 years (3 points)

Fall History (single-select)
o One fall within 6 months before admission (5 points)

Elimination, bowel and urine (single-select)
o Incontinence (2 points)
o Urgency or frequency (2 points)
o Urgency/frequency and incontinence (4 points)

Medications: includes pca/opiates, anti-convulsants, anti-hypertensives, diuretics, hypnotics, laxatives, sedatives, and psychotropics (single-select)
o On 1 high fall risk drug (3 point)
o On 2 or more high fall risk drugs (5 points)
o Sedated procedure within past 24 hours (7 points)

Patient care equipment: Any equipment that tethers patient, e.g., IV infusion, chest tube, indwelling catheters, SCDs, etc) (single-select)
o One present (1 point)
o Two present (2 points)
o 3 or more present (3 points)

Mobility (multi-select, choose all that apply and add points together)
o Requires assistance or supervision for mobility, transfer, or ambulation (2 points)
o Unsteady gait (2 points)
o Visual or auditory impairment affecting mobility (2 points)

Cognition (multi-select, choose all that apply and add points together)
o Altered awareness of immediate physical environment (1 point)
o Impulsive (2 points)
o Lack of understanding of one’s physical and cognitive limitations (4 points)



*Moderate risk = 6-13 Total Points, High risk > 13 Total Points Total Points

Plum A IV Pump by Abbott

I have found information on the cassette style IV pumps that I have been using at Baylor. Here are the step by step instructions to priming the lines:

1. Spike the bag

2. Pull out white knob on infusion cassette. This allows the chamber to fill up.

3. Hold the cassette upside down and fill up the chamber.

4. Flip it upright at the first drops of the bubble/circle chamber filling.

Here is a website with a video on how to set up these pumps: http://www.wonderhowto.com/how-to-plum-iv-infusion-pump-nursing-259932/

I have yet to figure out an easy way to clear the pumps, but I did find an instruction manual to these pumps. It can be found here: http://www.ardusmedical.com/manuals/Abbott-Plum-A+-Op-Manual.pdf

I hope if you are a traveler or a RN that ever has to use these pumps and needs more info then this will help.

Equipment and Eclipsys

Most of the frustration of working in this new hospital is learning how to use all of the equipment and apparatus. Everytime I go to do something on my own I have realized I need help, because it's different.

I went to spike my first IV fluids only to realize the plug to pull out of the bag was different. I had to go ask questions. I was afraid that if I pulled out that plug and it was the wrong plug then there would be a liter of fluid all over the floor. Priming the tubing was whole another challenge. The tubing is different and requires fliping a button half way down, flipping a chamber upside down, letting the chamber fill, then flipping the chamber back over. Nothing seems to be common sense.

While the nurse that I was following was busy doing another task I offered to help her in starting new IVs. Then while I was trying to start the IV noticed there wasn't a needle retracter. I blew the patient's vein once, then was able to start it the next time. I attempted to start another IV on another patient and blew the veins twice more in the process. This will take some practice getting used to the needles.

Even the oxygen tops are different than I have ever seen before. I've worked with eons of oxygen cannisters in multiple settings and have never seen them like these.

Above all of these technical issues of equipment was the 2 nights of paper charting I did. There was paper after paper. I have never seen so much charting, checking the charting for the past 24 hours, then checking it for the whole shift, then checking it again with report. This weekend the hospital will finally go to computer charting called Eclipsys. We spent 3 long days in front of computers learning to use this system. I took detailed notes and typed up a cheat sheet for all in my class to use. We'll see how it goes tomorrow night. It'll be frustrating taking the time to figure out everything until I can flip from screen to screen knowing where everything is.

Redlining!

Red lining is a term nurses use to describe checking off orders, but that's not the redlining I am talking about. One thing I have noticed here in Dallas is all of the red lines on the pavement in the parking lots designating fire lanes. Red lines are all over this city. I will include the pictures.

Southern Hospitality

More than just a coined phrase we use in the North. It actually exists!

Last week I was getting ready to cross the street. There were no cars around, until I decided I was going to cross the street. I was waiting on the side until a truck passed by then I was safe to cross. But instead the truck stopped to let me cross first.

The other day I got off at my bus stop and asked the girl sitting at the stop where the other bus stopped at. She took the time, walked me down a path, to show me where the stop was.

I had the rental car place take me home after dropping off the car and the guy got the door for me like they do when you are on a date.

At the end of my first shift the nurse manager on the unit that I am working took me all the way out to the bus stop, because she wanted to make sure I found it and got there in time. Wow!

Whenever I am walking there are countless number of people that stop to ask me if I want a ride. I thought it was strange until one of the bus drivers in his 50s or 60s told me that when he was young they always stopped to ask a lady if she needed a ride. In the Midwest we get suspicious about this, but here it's the norm.

I'm sure there have been and will be many more of these stories to share as I remember and encounter them.

DART bus journey!

Today I took the DART bus for the first time. Not quite like Chicago with buses every 7-10 minutes. They come once an hour in places, so my trip has to be coordinated perfectly with the train. The buses also don't let you know what your next stop is like the buses in Chicago, making it extremely difficult to know where to get off. I let the bus driver know, but it wasn't his usual route. He didn't know where my stop was either. My goal was to go to the Galleria, but because I didn't want to find myself walking and walking forever once I got off the bus I went to the mall instead.

My bus driver happened to be the bus driver that picked me up to take me back to the train station. We talked on both trips. He was probably in his late 50s or 60s from San Antonio. He told me that back in the day he also always asked the girls if they needed rides. So it definately is a Texas thing to ask girls if they want rides.

Hotel Tour

This is the video of the Extended Stay Hotel in Dallas that I am staying in for 5 weeks during my first travel assignment.

Pros: Close to train and bus lines, weekly housekeeping, close to several restaurants, walking distance to Wal-Mart Supercenter.

Cons: Bus system not reliable, hall traffic noisy, no swimming pool, men with fake gold grills inviting you to hang out at their crib.