The Alzheimer's Digest: How to Reduce Falls in Acute Care Settings

Sunday, May 19, 2013

How to Reduce Falls in Acute Care Settings

According to the CDC, falls are the leading cause of injury deaths in older adults. Fall related deaths in older adults increased significantly from 1996 to 2006. Of fatal falls, 46 percent were caused by traumatic brain injury. Joint Commission, the voluntary accreditation body for health care facilities, names fall prevention as one of its patient safety goals. Acute care facilities can prevent falls by implementing a fall prevention program.

Written guidelines for a fall prevention program
Fall-risk alert bracelets and signage for patients
Written certification of annual fall prevention education of employees, or as required by facility

Instructions

Upon admission, assess patient for potential high fall risk. Most acute care facilites use a tool, based on a point system, of assessing fall risk. The higher the number, the greater the patient's risk. Patients deemed to be at high risk are placed on fall precautions, which is documented under patient safety in the patient's chart.
Have a nurse assess the patient's risk factors. Advanced age, confusion or dementia and a history of recent falls are among the most important. Certain medications such as pain medicines may increase fall risk due to dizziness or other side effects. Patients who have foley catheters for urine collection are also considered at risk. Any physical limitations such as visual or hearing problems, limb weakness, or use of assistive devices such as walkers should be evaluated.
If the patient is deemed a fall risk, inform the patient and the family that the patient is a fall risk, and why. Let the family and patient know what safety measures will be used to keep their loved one safe. Be sure appropriate signage and a wristband indicating the fall risk are in place. Preventing falls in acute care facilities is everyone's responsibility, not just nurses.
Patients who may climb out of bed without calling for assistance should have bed alarms turned on. These alarms sound if the patient approaches a rising position in bed before they stand up on the floor. When possible, those at high risk for falls should be in rooms nearest the nurse's station. It may be necessary for a family member to stay with the patient when possible.
Show the patient how to use a call light to ask for assistance. Remind them not to get up by themselves. Some patients may need this reinforced frequently. Hourly rounding on these patients helps to prevent falls by addressing needs such as toileting.
Be sure that walking areas are clear of clutter. Trashcans, patient belongings, furniture, and items accidentally dropped on the floor may cause a fall. For patients who can walk to the bathroom, remind them to use rails by the toilet and in the shower to steady themselves.

Also be sure there is enough lighting in the room to see, and that patients have glasses on if needed. Nonskid footies or shoes should be worn when the patient is getting up. Use caution while walking with IV poles or oxygen tubing as it can easily tangle around the feet.
If a patient should fall, a physical assessment should be done immediately. Notify a health care provider for any orders such as X-rays or CT scans to assess injury. Notify a supervisor, and fill out necessary incident report forms per facility protocol. Note any contributing factors to the fall that could have been prevented.