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Clinical Corner: Patient Falls

By Lalah Landers BSN, RN Clinical Nurse Manager at Medical Solutions

Did you know: Falls are the most frequently reported incidents in adult inpatient units? Actually, 30-50% of falls result in some injury, varying from bruises to severe wounds or fractures.

Patients at Risk for Fall (and a few tips to help address the risk):

Patients with Altered Mental Status – This includes patients with delirium or at-risk for delirium (patients with hip fractures, advanced age, baseline dementia, medication).

Patients With Impaired Gait or Mobility – Such as patients who entered the hospital and already use an assistive device like a cane or walker (make sure they are in good repair or obtain one from the hospital), patients who have new fractures, DVTs, hip replacements, knee replacements, recent stroke, spinal stenosis, or osteoporosis. For these patients you may consider bedside commode use.

Patients With Frequent Toileting Needs – For example, patients with incompetent bladder/bowel and patients on diuretics. These patients should be taken to the toilet on a regular basis or pre-set schedule and may consider bedside commode use.

Visual Impairment – For these patients it helps to have corrective lenses within reach, assistance up to use the restroom, or bedside commode.

Patients High Risk Medications – For example, psychotropic medications may cause orthostatic hypotension; new anti-hypertensives may cause hypotension or dizziness.

Patients with a History of Frequent/Recent Falls – For these patients put side rails up and bed alarms on.  The only caveat here is that you MUST respond to bed alarms; they can’t be ignored. Notify your nursing aides and co-workers around you that you have a patient at risk for falls.  Ask them to please respond if you aren’t available.  Remember:  YOU ARE ULTIMATELY RESPONSIBLE FOR YOUR PATIENT’S SAFETY!!

How Can You Prevent Patient Falls?

  • Use your facilities Fall Risk Scale (MORSE, Stratify, etc.)
  • Use Falling Star Door Markers or your facilities method of alert
  • Ensure your patient has a yellow arm band, yellow socks, etc., to alert staff of their risk of fall
  • Make sure you communicate fall risk during your shift to shift report and ensure it is noted on the patients chart
  • Use bed alarms
  • Make hourly rounds on patients
  • Have family sit with patient if possible
  • If possible, move fall risk patients closer to nurses’ station
  • Ensure bed is in low position
  • Document and follow up on any patient status changes that may increase their risk of fall
  • Instruct patient and family to call nurse/staff for assistance when ambulating
  • Do not leave patient alone in bathroom
  • Make sure your patient has non-skid slippers or their own shoes.
  • Lock bed wheels, wheelchairs, stretchers and commodes
  • Keep water, personal items within reach
  • Physician intervention for sitter or  restraints as required ( refer to facility restraint policy)

References:

http://www.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/CurrieL_FIP.pdf

http://www.ncbi.nlm.nih.gov/pubmed/21939135

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About the Author

My name is Jeannie Holmes. I’m the Social Media and Brand Cultivator at Medical Solutions, one of the leading traveling nurse companies. I'm so happy to work at Medical Solutions and think it is an awesome company that has a lot to offer nurses interested in a travel career. I have never been a nurse and am not a recruiter. Have a great day!