PATOLOGÍAS DE LA PERSONALIDAD

The Falls Nurse Coordinator will give you an Engineer Walker In-

spection for each resident who uses a walker which needs repair. Each

resident will have her own form with name and room number at the top. There are three questions on this form. After you have in- spected the walker, answer each question yes or no. If the answer to the question is yes, follow the arrow down to the next question. If the answer to the question is no, follow the arrow across to the list of tasks. Check the box beside each task which you think applies to the resident’s walker, then make repairs as directed. Write your initials beside each task when it is done.

Reason: A walker helps the resident balance during transfer and

while walking. It must be stable with all hardware present and have clean, even rubber tips on the ends of the legs (Figure 15a). If the walker has caster wheels (Figure 15b), they should be firm, in good shape, and roll smoothly.

Supplies: Rubber tips from hardware store, screws, bolts, new caster

wheels, oil, screwdriver.

Instructions: Replace missing bolts or screws. If any are loose, tight-

en them. If a rubber tip is missing or uneven, replace it. Measure the end of the walker legs so that you purchase the right size rubber tip. If the walker has caster wheels that do not roll smoothly, lubricate them. Replace them if they are worn or cracked.

3. Make Other Changes for High-Risk Residents as

Requested by the Falls Team

The Falls Therapist and Nurse Coordinator may also ask you to make additional changes to rooms and bathrooms of residents who are at very high risk of falling. There are also changes which may need to be made to the resident’s wheelchair. You will be asked to do these tasks in addition to those on the Engineer Inspection List and equipment inspections. A list of changes which you may need to make is given in Figure 16. An explanation of each task follows.

TASK 1. Exchange high bed for low bed.

Reason: Residents’ feet must rest flat on the floor when they sit on the

edge of the bed in preparation for transfer. If a resident’s feet do not rest firmly on the floor, they are more likely to lose their balance.

Supplies: Bed that can be lowered.

Instructions: Exchange beds with another resident. Ask staff to find

a resident who is bedridden and does not need a bed which can be lowered. If you cannot exchange beds, ask the administrator about the purchase of a new one. To order a new bed, refer to sources in Appendix A.

TASK 2. Add or move handrail.

Reason: The handrail must be situated in the right place for the

resident. Some residents need support on both sides. Towel racks are not sturdy enough to support a resident during transfer and should not be used for this.

Supplies: Handrail, screwdriver, screws or bolts.

Instructions: Move the current handrail or secure a new one where

the therapist tells you to place it. The handrail should be 1 - 1¼ inches in diameter. In general, you should mount a handrail 33 - 36 inches from the floor and no more than 1½ inches from the wall. The exact height for placement depends upon the height of both the commode and the resident. To order new handrails, refer to sources in Appendix A.

TASK 3. Adjust length of chair legs.

Reason: Many residents sit in a lounge chair during the day. The chair

must be the right height for the resident to sit down and stand up safely. If the chair is too low, the resident will have difficulty getting out of the chair. If the chair is too high, the resident’s feet will not rest firmly on the floor when rising. Either could cause the resident to lose her balance.

Supplies: Wood glue, plywood or hardwood to make small boxes for

each leg or to make a long rectangle for each side of the chair, saw, screws, screwdriver, fastener bit or expandable auger.

Instructions: 1) To increase chair height. Find out from the

therapist how many inches you need to raise the chair. Measure the thickness of each chair leg. Make four boxes or cut solid squares out of wood for each chair leg of the height you need to raise the chair.

Room and Bathroom

• Exchange high bed for low bed • Add or move handrail

• Adjust length of chair legs • Check outdoor areas for safety

Wheelchair

• Label chair

• Add brake extensions

Figure 16 Engineering Tasks for Resident’s Room, Bathroom, and Wheelchair

Figure 17 Square Leg Riser

Figure 18 Round Leg Riser

Figure 19 Brace Style Riser

Figure 20 Platform riser

If the chair leg is square or rectangular, use plywood or hardwood to frame the leg with a box (Figure 17). Make sure there is a tight fit. Use glue and nails to make the box. Fasten each box onto the chair leg with a screw. If the chair leg is round, use a solid block of hardwood and drill a hole the size of the leg into the block (Figure 18). Fasten each box or block onto the leg with a screw. If the chair is large, use a brace style riser (Figure 19), for added support. Use ½–¾ inch plywood to make two open-ended rectangles which extend from the front leg to the back leg. Cut an insert to fit inside the rectangle. Cut out or drill a section at either end for chair legs. Secure the insert into the rectangle with glue and nails or screws. Fasten each leg into the rectangle with a screw. If the chair has two wooden risers instead of four separate legs, make a platform riser (Figure 20). Measure the width and length of each side. Make two open-ended rectangles out of plywood. Make an insert for each one which fits inside the rect- angle and allows chair risers to be screwed into place. 2) To lower

the chair. Find out from the therapist how many inches you need to

remove from the chair legs. If the chair cannot be adjusted, exchange it for one that is the right height.

TASK 4. Check outdoor areas for safety.

Reason: Uneven pavement, moving cars or any other unsafe condi-

tions may cause residents to fall when they go out of the building.

Instructions: Talk to the administrator and nursing staff to see what

barriers, door alarms, door locks, signs or other things can be used to keep the resident out of unsafe areas. Purchase supplies as needed.

TASK 5. Label chair.

Reason: When a wheelchair has been adapted to a resident’s special

needs, it should only be used for that resident. However it is common for staff to switch wheelchairs between residents. To make it easier for staff to use the right chair, the resident’s name should be on the wheelchair and on any of the resident’s seating items.

Supplies: Paint pen with indelible ink, felt tip marker, resident name

bracelets.

Instructions: Turn the chair over and write the resident’s name on

the bottom of the seat with the paint pen or write the resident’s name on a resident name bracelet and attach it to the chair frame. Also attach one to the armrests and legrests if they can be removed and to any seating items.

TASK 6. Add brake extensions (Figure 21).

Reason: Residents must be able to reach the brakes, grab and lo

them before transfer. If a chair moves while the resident is getting or out of it, a fall is likely.

Supplies: 16 inches of ½ inch steel electrical conduit from hardwa

store, 2 rubber tips ¾ inch each, hammer, tape measure, hacksa file, sandpaper.

Instructions: Cut an 8 inch piece of conduit. Flatten one end w

a hammer so that it fits over the brake lever. Remove the rubber from the brake lever. Slide the conduit over the brake lever about 2 inches. Ensure a tight fit. Put a rubber tip over the end of the conduit. Make sure there are no sharp edges. For purchase of break extensions, refer to sources in Appendix A.

Figure 21 Brake Extension