Whether you’re working in a hospital, a rehab facility, an assisted living care facility, or doing home health care, chances are that, at some point, you will come across patients who are at a high risk for falling.
According to the Centers for Disease Control and Prevention (CDC), more than 700,000 patients each year are hospitalized because of a fall injury—and most often, this is because of either concussions or hip fractures. In addition, one out of every five falls tends to result in a serious injury such as broken bones or a head injury of some sort. Annually, the medical costs for these fall-related injuries are approximately $34 billion, with two-thirds of that being hospital costs.
These types of patients aren’t the only ones at risk for falls, though. Other diseases, medical conditions, and various medications can also put patients at risk for falling. The key for nurses is to help patients prevent falls as much as possible.
Even if you’ve received training to deal with this patient type, there are always more actions steps you can take and tips to keep in mind. Especially with fall-risk patients, you can never be too careful.
Evaluate and Assess
“In the hospital, the first thing that should be done is an evaluation of the fall risk. Your patient assessment will clue you in on how much of a fall risk your patient is,” says Sherae Durham, BSN, RN, TCRN, the trauma coordinator for education, injury prevention, and outreach at Osceola Regional Medical Center in Kissimmee, Florida. “Different facilities approach this differently, but in the end, your interventions will be based on the individual’s fall risk.”
Durham stresses that you must remember that patients’ risk levels can change throughout their time with you. She gives the example of a low-risk patient becoming a high-risk one after a procedure or receiving certain medication.
“Our go-to strategies include hourly rounding, which ensures, among other things, that each patient has the assistance they need, such as moving from the bed to the chair, to the bathroom, or to change positions,” explains Suzanne Tercyak, RN-BC, MSN, the assistant chief nursing officer at Largo Medical Center in Largo, Florida. “We also screen each patient for risk for falls using the Morse Falls Scale, and based on the screening results, we add additional safety measures.”
Tercyak says that some of these measures include identifying patients who are at-risk for falls by having them wear non-skid yellow socks and a yellow falls-risk bracelet on them. “This strategy is important and works well as all staff can identify a [fall-risk] patient once they are off their assigned unit,” she says. For example, if the patient needs to go to the imaging department, the staff there will immediately know that the patient needs assistance. “In addition, we oftentimes move the at-risk patient into view of the staff; ask a family member to stay with the patient, and/or utilize a bed alarm for quick notification that the patient is moving off the bed,” Tercyak says.
Another go-to strategy for patients is to provide standby assistance if someone is a fall risk—no matter if that risk is low or high, says Daisy Cruz, RN, director of nursing for BrightStar Care of Stamford, Connecticut.
“A main go-to strategy is to listen and/or observe the client to determine the motivation or cause for the fall. This will always work,” says Michelle Davis, PT, DPT, the program director of rehabilitation at Harrogate CCRC, in Lakewood, New Jersey. “Look for a pattern to the falls relative to timing of the day, actions being performed prior to the fall, etc.”
Education is Key
For fall-risk patients, providing them with education is absolutely crucial. “Education is always key to prevention because the more you know, the better you are,” says Cruz. “Making recommendations about their house like taking out a loose rug or adding a nonslip mat or shower chair in the bathtub can go a long way.”
“Being in the hospital increases everybody’s risk for falling, and people do not always realize this,” says Durham. “It is always easier to get cooperation when people know what is going what is going on and understand the situation.”
Before informing family members or friends, though, “make sure you are operating in accordance with HIPAA guidelines,” says Davis.
Tips to Reduce Falls
While a patient is in the hospital or a facility, use alarms to alert the staff members’ attention if the patient tries to get out of bed, says Julianna Harmer, RN, charge nurse at the Harrogate Health Care Center in Lakewood, New Jersey. “Keep bells within reach [of the patient],” she says, so that they can get help if and when they need it.
Sometimes preventing falls can be as simple as “Keeping a confused patient oriented to their surroundings, and keeping the bed low, paths cleared, and things within reach,” says Durham. “For others, it can require constant supervision, and that person may need a hired sitter or a family member to be with them at all times.”
When discharging a patient or if working with patients at their homes, be sure to give them tips that can help them keep from falling. “I suggest preventing falls by minimizing clutter in the home and ensuring there is a clear path for walking. Using rug pads to secure throw rugs on the floor, providing proper lighting on stairs and common rooms, and using night lights or stick-on lights for darker areas also decreases the chance of slipping,” explains Alicia Schwartz, RN MSN, PCC, CMM, RN, a registered nurse for VNSNY CHOICE Health Plans in New York, New York. “Make sure hand rails and bathroom grab bars are installs and are secure. Proper shoes are also important—avoid heeled shoes, slippers, and sandals without straps.”
Exercise is also important for fall prevention, says Schwartz. “Exercises can be performed while sitting, standing, and/or lying down. Mobilizing our joints helps to increase overall body function, which will directly reduce the risk of falls,” she says.
Some other tips Schwartz suggests are to clearly mark edges of steps and use non-slip treads on wooden ones. In addition, store food, dishes, and cooking equipment at the waist or counter level. If patients have to reach up or down too far, they may be more prone to fall.
Remember to give this kind of information to patients, families, and caregivers during discharge. “The fall risk doesn’t necessarily end once the patient leaves the hospital,” says Durham. “Patients may go home with alterations in motor function, on medication that alters their mentation and balance, and sometimes with unfamiliar, special equipment. We need to make sure that patients and caregivers are able to be safe in their homes after discharge as well.”