Fall Assessment and Prevention: A Nursing Responsibility

March 15th, 2012

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By , BSN, RN

For about a week now I’ve been harping on areas of concern to nurses and other healthcare professionals. Medical mistakes, hospital acquired infections, and pressure ulcers are all big news as healthcare is being reorganized. Medicare and Medicaid have established they will no longer pay for the results of provider errors—whether that provider is the hospital, the physician, or the nurse. The bottom line is, as health care professionals it is our duty to be more careful—for the patient, for ourselves and for our employers if we want to have jobs.

The top three most common nursing areas affecting patient safety are medications errors, infections, and falls. According to studies, up to 12 percent of hospitalized patients fall at least one time during a stay in the hospital. The Joint Commission ranks falls as on the top 10 sentinel events, with rates between four and 14 falls per 1000 patient days. Falls are one of the categories the Centers of Medicare and Medicaid (CMS) will no longer reimburse for is the patient falls during hospitalization.

Add to those numbers that 50 percent of hospitalized patients are simply at risk for falls and almost half of those clients who do fall will suffer an injury. The average hospital stay for patients who fall is 12.3 days longer, and injuries from falls lead to a 61% increase in patient-care costs.

Assessing Clients

Assessment of a patient’s fall risk factors is essential in determining specific needs and developing targeted interventions to prevent falls from occurring. The nurse is usually the healthcare provider in charge of such assessments and whether in a hospital or clinic setting or as a home health nurse, it’s all about asking the right questions.

There are several good fall assessment tools, all of which can help the nurse assess and prevent before accidents and injuries result. A client’s risk of falling increases dramatically as the number of risk factors increase. In many cases family members are important resources in assessing a client’s fall risk. They are often better at reporting a patient’s level of confusion or ability to ambulate.

Falls are of particular concern to older adults. They often lead to fear of additional falls, withdrawal from usual activities, and loss of independence. Falls in the elderly often result in placement in a nursing home for rehabilitation or even long-term placement may be required. As the daughter of an orthopaedic surgeon I often heard, “old people fall down, break their hips and die.” This is something just about everybody in healthcare acknowledges. It’s not the broken hip that kills people, it’s the inactivity, and often the resulting pulmonary issues, like pneumonia, that end in loss of life.

Risk Factors

The risk factors leading to falls are a combination of health-related issues and environmental hazards. Health related issues can include: cardiovascular conditions like postural hypotension; mobility afflictions like arthritis, muscle weakness, and foot problems; cognitive impairment, and adverse medication reactions. Environmental hazards include things like poor lighting, stairs, slippery floors, and even shoes, with both slippery and sticky bottoms being hazardous.

Part of the job of floor nurses in hospitals is orienting their patients to their rooms, their equipment, and their floor. Here are some guidelines for every nurse for preventing falls in hospitals:

  • Orient client on admission to their surroundings and explain the call system.
  • Carefully assess the client’s ability to ambulate and transfer; provide walking aids and assistance as required.
  • Closely supervise clients at risk for falls during the first few days, especially at night.
  • Encourage the client to use the call bell to request assistance; ensure the bell is within easy reach.
  • Place bedside tables and overbed tables near the bed or chair so that patients do not overreach and then lose their balance.
  • Always keep hospital beds in the low position when not providing care so that patients can move in and out of bed easily.
  • Encourage clients to use grab bars mounted in the toilet and bathing areas and railings along hospital corridors.
  • Make sure nonskid bath mats are available in tubs and showers.
  • Encourage the client to wear nonskid footwear.
  • Keep the environment tidy; particularly keep light cords from underfoot and furniture out of the way.
  • Reduce poor lighting and glare, which causes clients to squint.
  • Attach side rails to the beds of confused, sedated, restless or unconscious patients and keep the rails in place when the patient is unattended.

Healthy People 2020

The Healthy People program is a program of nationwide health promotion and disease prevention goals set by the United State Department of Health and Human Services. Healthy People provides science-based, 10-year national objective for improving the health of all Americans. New, to Healthy People 2020 guidelines is an entire section focused on older adults. You guessed it…fall prevention is a major component of their Healthy People goals.

Older adults are among the fastest growing age groups, and the first “baby boomers” (adults born between 1946 and 1964) turned 65 in 2011. More than 37 million people are in this group (60 percent) and they will manage more than one chronic condition by 2030.

What this means to us, as nurses, is we will be plenty busy. I know some of the guidelines I listed above seem obvious, particularly to experienced nurses. But, the reality is our patient population is getting older, as healthcare providers we are getting busier, and it just can’t hurt to be reminded about the basics. And, as new nurses join our ranks, they too need to focus on not only the medical side of healthcare, but also the safety side that goes with taking care of others. It is our number one priority.

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