Preventing Falls

Objectives:
After you take this class, you will be able to:

  1. Detail things that make patients and residents at risk for falls.

  2. Adhere to basic safety, identification and standard precautions principles when providing personal care.

INTRODUCTION

Falls are a big problem in hospitals, nursing homes and patient homes. Falls can cause very serious injury and even death. They can lead to the need for a hospital stay or a longer than needed hospital stay, high costs to a patient, a broken hip and even death from a head injury. Nursing assistants and other healthcare workers must prevent falls and the harm that they can lead to.

WHY DO PATIENTS AND RESIDENTS FALL?

Patients can fall for a number of reasons. Some of the things that make people fall are:

  • Age. Older people fall more than young people.

  • Poor vision. People who cannot see well can trip over things they cannot see.

  • Confusion. People who are confused may not pay attention to dangers. They may try to stand up when their muscle are too weak to hold their body up; they may fall down stairs thinking that someone is calling them and they may try to walk to the bathroom in a dark room that has a lot of clutter without calling the nurse or nursing assistant for help.

  • Some medications. Many patients and residents fall because they are taking a medication that makes them sleepy or dizzy. Other patients may fall from medications that lower blood pressure when they stand.

  • Poor balance, coordination, gait and range of motion (ROM). A person will fall when they can't keep their balance. Many older patients and those that have had a stroke have poor balance and they walk in a way that is not natural, that is, they have poor gait and coordination. They will also fall when their muscles are not able to flex and extend in a normal way.

  • Weak muscles. People that have weak muscles or damaged nerves will fall if help, safety and good patient care is not given. Weak muscles are a very big problem when the legs are weak.

  • Jerky muscles. Patients and residents with shaky or jerky muscles are at risk for falls.

  • Some diseases. A person can be weak and dizzy if they have a heart problem or a head or nervous system problem, like a seizure. Also, arthritis, a disease of the bones, can make the bone joints stiff and not able to hold the body in a safe and correct position when a person walks. A person with a stroke or another disease like Parkinson's disease is at risk for falls.

  • Slow reaction time. Older people do not react or respond to dangers as fast as young people. For example, an old person may fall when they can not stop fast enough to avoid a puddle on the floor or an old person may not be able to stop their car when the light turns red and they are driving a car.

  • Poor control of the body and its functions. Patients that can not hold their urine or feces until they get to the bathroom may slip on their own urine or stool. Other patients may fall or slip as well.

  • An unsafe area. Patient rooms that have clutter, poor light or have no nurse call bell are not safe. They can make a person fall or trip. Glare also adds to falls.

  • Patient foot wear. Shoes and slippers that are not skid proof are a danger. All patients must have sturdy, skid proof shoes or slippers that fit well.

  • No answers to calls for help. Calls for help must be answered right away. A nursing assistant or nurse must go to the patient room right away when a patient calls for help and/or turns on their nurse call bell. This is VERY important if the person is at risk for falls. If that call bell is not answered and a patient falls while going to the bathroom, who is wrong? The patient or the nursing staff member?

  • Broken equipment. If a cane, walker, wheelchair or wheelchair brake is broken it can make a person fall. Do NOT use anything that is broken. Report ALL broken equipment to the nurse.

  • Past falls. Patients and residents that have had a fall in the past are at risk for future falls. Patients and residents with more than one fall in the past are at very great risk for future falls

  • Fear of falling. Patients and residents will tense and tighten their muscles and be stiff if they have a fear of falling. This fear of falling can lead to a fall and injury.

HOW CAN FALLS BE PREVENTED?

Nursing assistants and other people that work in homes, hospitals and nursing homes can prevent falls. That is good news. Preventing falls is a team effort. All people that take care of patients and residents must make sure that their patients and residents are safe. They must make sure that no patient or resident falls. EVERY patient and resident must be safe.

Nurses and other people that work in homes, hospitals and nursing homes, like the doctor and the physical therapist, must assess a resident or patient. They have to find out if the patient or resident is at risk for falls. They must find out if a new patient or resident that comes to the hospital or nursing home is at risk for falls. They ask, "Can this person fall? What things can lead to a fall? What can we do to make sure that this patient or resident does not fall? What special things can we do to make sure that this person does NOT fall?" The things that we can do to make sure that a person does not fall should be written in the person's plan of care. Nursing assistants will do many of these special care things that are in the plan of care. Nursing assistants have a very important role to prevent falls.

Nurses and other people that work in homes, hospitals and nursing homes, like the doctor and the physical therapist, must again assess a patient or resident when they or their medications have changed. For example, a person has changed when they are alert on Monday morning and they are confused on Tuesday. This patient's condition has changed. This change must be reported to the nurse so that the patient or resident can be assessed again for risk for falls. They may now be at risk for falls when they were not at risk for falls on Monday. Special care must also be done to prevent falls if the patient or resident has a condition change.

Patients and residents must also be assessed at least every three months even if their condition has not changed. This extra check is to make sure that very little patient changes do NOT add up to a risk for falls. Little changes can often add up to big danger. A person that you have taken care of for 4 years may change slowly to the point where they too are now in danger of falling.

Special measures and special nursing care must start as soon as any patient or resident is assessed as fall risk. Many hospitals and nursing homes have a Falls Risk Program. These special things must be done to save patients and residents from a fall. Nursing assistants MUST know and follow this program.

Some hospitals and nursing homes use and place a "falling star" picture on the wall over the patient or resident bed. Others may put this picture outside the room. All of these pictures should alert all that this patient or resident will fall unless YOU do special things to prevent it. These pictures tell people that they MUST pay attention to the person. They alert ALL that this patient or resident may fall unless EVERY ONE is alert. Look into the room to make sure the patient or resident is safe.

Other hospitals may make nurses and nursing assistants move the patient's bed and/or room closer to the nursing station or they make sure that all of these patients have a bed and/or chair alarm.

Other special fall risk care items that should be in the care plan for fall risk patients and residents, as needed, are:

  • Low beds

  • Changing the patient's medications, when possible, to lower the risk of dizziness, sleepiness and/or blood pressure changes. The doctor makes this decision.

  • More frequent patient monitoring and observation

  • Using protective, gym type, mats on the floor next to the bed to lower the risk and extent of injury if a patient falls in spite of all efforts

  • Balance, gait, muscle and/or range of motion exercises and training

  • Assistive devices, such as canes, walkers and Merry Walkers

  • High toilet seats

All patients and residents, even if they are not identified as high risk for falls, need very close attention to their safety needs.

All patients must have a safe room and patient care area that is:

  • Well lit and with no glare

  • Kept clean, dry and uncluttered

  • Skid proof and dry

  • Equipped with handrails and grab bars, especially in the bathrooms and in areas where patients walk, like the hallways

  • Filled with stable and sturdy chairs at a good height and with armrests to assist the patient or resident with standing

  • Free of wires, cords and other tripping hazards

  • Free of side rails and restraints

All patients must also have:

  • Their need for independence and freedom balanced with their safety needs

  • Frequent monitoring and observation to prevent falls

  • Sturdy, non skid shoes and footwear

  • A workable nurse call bell that is always within reach and that is promptly answered

  • Instruction about changing position slowly and being alert to safety risks

  • Their bed at the lowest possible level

  • Toileting, fluid and food needs anticipated for and promptly met

Many elderly patients and residents also need:

  • A bedside commode nearby so they can safely use it

  • Adequate and easy to reach assistive devices, such as walkers or canes. If the patient needs assistance with these devices, nurses and nursing assistants must give them the help they need.

  • Ramps to safely enter and leave a building without using stairs. In the home, wheelchair lifts are sometimes used if the person lives in a two-story house.

  • Properly fitting eyeglasses that are easily reached or provided to them by the nursing assistant or nurse

Summary

Most falls can be predicted and prevented. Nursing assistants play a very important role in the prevention of falls. If a patient is at risk for falls, all preventive measures must be done and documented, as required by your facility. Some of the other things that you can do to prevent falls and patient injury are listed below.

  • Keep nurse call bells within the reach of the patient at all times
  • Look for call bell lights and answer them promptly even if the patient is not assigned to you
  • As you walk down a hall turn your head back and forth viewing all patients and their rooms so you identify safety hazards and patient behaviors
  • Listen for calls of help, banging, falling objects, etc.
  • Listen for bed and chair alarms
  • Know your patients
  • Closely observe and monitor your patients
  • Know which patients on your unit are at risk for falls
  • Know about the ways that falls have been successfully prevented for each of your patients
  • Anticipate and meet your patients' needs
  • Document and report your observations and your interventions
  • Clean up small non-hazardous spills immediately or block off the area immediately if you are waiting for someone to clean up a large spill
  • Keep all bed gatches in the retracted position
  • Remove all clutter from patient rooms and care areas
  • Tell the patient and family members about safety measures to prevent falls in your facility
  • Keep minimal distance between frequent points of contact. For example, keep the distance from the bed to the commode or bathroom or the chair to the bed to the least possible.
  • Provide frequent toileting, according to the patient's bowel and bladder pattern, if identified
  • Report patient falls immediately
  • Report any changes in the patient or resident condition
  • Get help from another member of the team to transfer and lift patients, whenever necessary in order to prevent patient injury and injury to yourself.
  • Make patient safety and falls prevention your priority
  • Encourage others to make safety and falls prevention their priority
  • Be a team member. Preventing falls is everyone's responsibility.

References

Berman, Audrey, Shirlee Snyder, Barbara Kozier and Glenora Erb. (2010). Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice. 8th Edition. Pearson Prentice Hall.

Nettina, Sandra M. (2009). The Lippincott Manual of Nursing Practice. 7th Ed. Lippincott, Williams and Wilkins.

University of Iowa Gerontological Nursing Interventions Research Center. (1996). Prevention of Falls. University of Iowa.

Wold, Gloria Hoffmann. (2008). Basic Geriatric Nursing. Elsevier Mosby.

 

Copyright 2010 Alene Burke



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