A resident of the Manorcare of Palos Heights West nursing home fell on her face while being transferred to her wheelchair. The incident resulted in serious injuries to the woman’s face and was most likely caused by a failure to properly train nursing home staff.
The resident’s plan of care includes the use of a gait belt to protect her from nursing home falls. A gait belt is a thick cloth strap with handles that goes around a nursing home resident’s waist. The handles on the belt allow a single staff member to offer complete support to a resident who is able to stand and walk, but is unsteady on his or her feet.
The Palos Heights West staff member took her hands out of the gait belt handles and left the resident standing unattended while she adjusted the locks on the woman’s wheelchair. As she adjusted the wheelchair, the resident toppled forward directly onto her face.
When a resident is unable to support their own weight, two or more staff members use one of several different types of mechanical lifts to facilitate the transfer from a chair to a bed or vice versa. Falls usually take place when a single staff member attempts to utilize the complicated machine.
Using a gait belt is an intervention for a single staff member, but it requires detailed training. Not only is it important that staff know how to use the belt to prevent falls, they also need to learn how to properly plan to manage a resident with a gait belt.
The cardinal rule, one that this staff member clearly forgot, is to never, never, leave a resident who requires a gait belt standing by him or herself. If a staff member needs to adjust the wheelchair, he or she needs to transfer the resident to a bed or a stationary chair, then adjust the wheelchair, then move the resident from the chair to the wheelchair.