Assessing and Preventing Patient Falls

Healthcare Training Resource
May 13, 2013 — 887 views  
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Patient fall prevention is a priority for hospital nurses, and it requires a multifaceted approach. Many hospitals complete a fall risk assessment on older patients when they are admitted to the hospital or nursing home. Falls are the leading cause of nonfatal injuries in all types of healthcare institutions. The risk of falling increases exponentially with age.

A thorough risk assessment includes several pertinent factors.

  • Older adults, particularly over 75 years of age
  • Any history of a recent fall
  • Functional disability, especially when an assistive device is necessary
  • Unsteady gait or balance, visual impairment
  • Certain morbidities, such as dementia, hip fractures, Type II diabetes, Parkinson's disease, arthritis and depression
  • Alterations in the level of consciousness or a cognitive impairment
  • Taking high risk medications
  • Urge urinary incontinence or frequent toileting
  • Postural hypotension
  • Use of physical restraints
  • Inappropriate footwear or being barefoot
  • Anticoagulants - Plavix, Coumadin or aspirin increase the risk of injury with a fall

There are multiple components to develop a plan to reduce the risk of patient falls. Education is an important aspect of any patient fall prevention program. The patient and their family should be educated in every aspect of the program.

The patient should always be instructed prior to initiating any new activity or when learning to use an assistive device. They should be taught to use grab bars. Patients are also instructed about their medications, so they understand what the medicines are for, when they are due, any possible side effects and possible interactions with foods and other medicines.

There are some specific direct patient care issues that will help prevent patient falls. If the status of the patient changes during their stay in the hospital, then the risk assessment may also change. A patient with weakness on one side needs to be in a bed that allows them to exit toward their strong side.

Nurses should assess the patient's coordination and balance before assisting them with transfers. Some patients also need to have bowel and bladder programs to assist them with incontinence and to help decrease urgency. Treaded socks should always be used if the patient has no other covering for their feet.

In addition, there are extrinsic factors to consider.

  • Clutter in the room
  • Appropriate lighting
  • Loose electrical cords
  • Hazardous activities
  • Time of day
  • Keeping patient care items within easy reach

The bed and chair height must be at the appropriate level. Side rails should be raised for at risk patients, and many beds have alarms that let the staff know if the patient tries to get out of bed.

Physical therapy that includes exercises to increase the lower body strength; plus, balance exercises, are very good ways to prevent patient falls. Studies have proven that participating in Tai Chi also helps reduce falls. There are also hip pads available that can be effective in preventing hip fractures for an individual with an unsteady gait.

Osteoporosis is a major problem in senior adults. There are medications available to increase bone mass. Calcium and vitamin D is critical to maintain healthy bones also.

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