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Helping to prevent patient falls is absolutely crucial, as one simple fall can cause so many problems—everything from broken hips to traumatic brain injury.

Michele L. Kimball, RN, BSN, Senior Director of Nursing at Bethesda Dilworth, knows why it’s so important to keep patients from falling and assessing their risks. She took time to give us information about what nurses can do.

What are the most important things that nurses need to know when working with patients in health care facilities?

The most important thing for a nurse to remember when assessing for fall risk and developing a fall prevention plan is that the first step is “getting to know your patient.” But without knowing what places them at risk and knowing their routine, your plan will fail. Patients come to health care facilities for so many different reasons. Staff should consider in the beginning that getting acclimated to the routine of a facility is stressful and, depending on the patient, can be confusing.  Restoring as much of their daily routine as possible can lead to success.

What can nurses do when they have stubborn patients who may insist on getting out of bed without assistance?

Allowing them to make as many decisions that they can and restoring as much of their daily routine as possible can minimize risk. 

Involve family and educate, educate, educate.

For patients who are in their own homes—in the case of home health care nursing—what tips can nurses give to these folks to prevent them from falling?

The key is beginning the discharge process prior to them going home on home health through home evaluations and assessment of daily routines. Knowing where and how the patient would need to navigate inside their home is key. Educating them on needed adjustments to their home and warm hand offs to the home health nurse on outcomes of the assessments and recommendations is vital.

The patient’s willingness and ability to take in this education as well as support systems should be considered when developing a plan. 

What kind of health issues can lead to more falls? What information can nurses give to patients so that they can prevent these health problems?

A lot of fall prevention is learning what places them at risk in the first place.

Patients with high blood pressure need to routinely take their medications as prescribed and continue to monitor their blood pressures. These medications can cause dizziness and at times orthostatic hypotension.

Patients with heart failure should continue to take their medications as prescribed and monitor their heart rate, blood pressure, and fluid status. They should contact their doctor if they become short of breath, seem tired more than usual, or notice swelling in extremities. These symptoms can develop quickly and lead to a major health set back, but most importantly lead to weakness, dizziness, and unsteady gait all key contributors to falls.

Patients with diabetes should ensure that they are controlling their blood sugars and taking their medications as prescribed. Low blood sugars could lead to dizziness and fainting, placing them at a risk for falls. Glucose is food for the brain, and if your blood sugar is low and your brain isn’t getting fed, it leads to being tired and increases risk for poor decisions, lack of concentration, and black outs — again contributing to the risk of falls.

Tell patients not to take their health conditions lightly, to notify their doctors when symptoms occur, and if they feel “funny” or something “doesn’t feel right” err on the caution side and ask their physicians. Falls are dangerous, and for the elderly population they can lead to major injuries such as fractures and even death. There is almost always some functional decline after a major fall, and this decline can be the difference of a patient being able to stay in their home or have to seek out a long-term care facility.

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Michele Wojciechowski

Michele Wojciechowski is an award-winning writer and author of the humor book Next Time I Move, They’ll Carry Me Out in a Box.

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