Hi folks.
My dad has a traumatic brain injury 4 weeks ago and is currently in hospital in Scotland. He's in a rehabilitation ward.
Unfortunately, he's unable to walk and is unable to retain information in short-term memory. One of the effects is that he keeps trying to get out of bed, then falling. That's now happened 7 times while he's been in hospital.
He's in a room across from the nurses station, has the bedrails up and has a pressure mat with an alarm. Unfortunately, he is still getting up through the night and falling over because he's forgotten that he cannot walk, that he shouldn't get up and that he should press the buzzer to call a nurse.
At 75 and with a traumatic brain injury already, he's at high risk of injury if he keeps falling.
I've been told that there's nothing more the nursing team or doctor can do, but I don't consider that acceptable. Does anyone have experience in this area, who could advise on any additional action to protect a patient in this condition.
I've suggested the following (hospital is still considering them) - some of which are problematic when he's still considered to have good mental capacity and capable of making decisions about his own care:
- Putting a sign at the end of his bed, that tells him he shouldn't get up - which is lit at night so he can read it
- Putting some visible indicator on his leg(s), so that he remembers he can't get up (e.g. a knee brace, etc - which might be considered a 'restraint' and therefore not permitted)
- Putting a skull cap or some other protective device on his head at night to minimise further impact on his existing brain injury (which might be uncomfortable)
- More impediments to getting out of bed e.g. full length bed rails, or something he needs to remove/move in order to stand up (might pose a higher risk if he tries to overcome obstacles, and might make it more difficult for clinicians to reach him in an emergency)
- Ensuring there is always somebody at the nursing station (which might be challenging, given other duties in the ward)
- Using a mobile monitoring device e.g camera in the room, that can be constantly viewed using a phone or mobile device regardless of where the nurses are (nurses may not have time to check this when they are tending to somebody else)
- Improved alarm system - that instead of making a noise and flashing a light in the corridor, actually sets off an alarm that the nurse carries, with an indication of which patient so that they know my dad is at risk of falling (nursing staff may not want this, they might genuinely be unable to help because of a higher priority patient, such a device may not be available, etc.)
- 1:1 nursing care (which might be challenging due to cost and staffing shortages)
- Using some sort of volunteer service so that he has somebody in the room with him 24 hours a day (may irritate him, he may not want them, and it may be difficult to arrange - or not exist at all)
- Mild sedation at night (problematic from a human rights perspective, and not 'clinically' necessary)
- Catheterisation (since he's trying to go to the toilet) - but there's a risk he gets up anyway and rips out the catheter; also the usual risk of infection, etc.
- Moving him into a higher dependency unit with a higher staff-to-patient ratio (problematic as there are likely to be people who need that service because they are clinically acute)
- Moving him to a specialist unit with experience of people with very high fall risk (if such a thing exists)
Any assistance or ideas that can limit his fall risk would be greatly appreciated and accepted.
Thanks.