Fall Precautions lesson 2

This is a nice summary video of fall prevention strategies in acute care settings courtesy of Swedish Covenant Hospital.

 

Fall Interventions

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The Nurse Assistants should follow these generally acceptable practices that are effective towards fall prevention in the hospitals and facilities.

• Maintain a safe physical environment making sure spills are cleaned up quickly and walkways are kept free of obstruction and clutter.
• Avoid use of restraints. Though restraints are often employed to prevent falls, they have not proved effective in medical trials. It has been demonstrated that their use increases the injury associated with falls, and several restraint-reduction projects have demonstrated that restraints can be removed without a significant increase in falls or injuries.
• Get the patient to a chair with assistive devices nearby. This includes canes, braces, walkers, orthopedic shoes, glasses, and hearing aids.
• Request the nurse to minimize IVs, catheters, and drains or to assist in monitoring invasive lines while patient is ambulating. Those invasive lines that cannot be removed can be taped to minimize their interference with ambulation.
• Encourage sleep hygiene. Daytime activities can be maximized only when preceded by a restful night’s sleep. Limiting caffeinated beverages, restricting television time, and encouraging relaxing evening activities like reading may be necessary to ensure adequate sleep. Well-rested patients are better equipped to challenge themselves physically during the day and are less at risk for the side effects associated with sleeping medications.
• Give early referral to physical and occupational therapies. Even if the patient can barely tolerate sitting in a chair, a passive range of motion exercises for all joints should be undertaken daily. Additionally, active resistance exercises may be feasible for even debilitated patients if they receive daily assistance and continual encouragement. With persistence, skeletal muscles and the cardiovascular and pulmonary systems will show more endurance.
• Watch patients closely. High risk patients should be positioned by the nursing station so that their visibility to the staff is maximized.
• Provide a safe environment that encourages independent patient activity and minimizes risk for falls (e.g., sufficient room to navigate using assistive devices, handrails, enhanced lighting, nonshiny floors, bed in lowest position, call light within reach, appropriate side rails use, raised toilet seats, need for adaptive equipment/assistive devices, minimize risk of entanglement in lines and catheters.
• Alert other staff to the patient’s risk of falling (eg, by placement of a yellow armband on the patient’s arm, placement of a falling star fall prevention sign above the patient’s bed and on the door).
• Reinforce fall prevention teaching with the patient and their family. Encourage patient to call for help before getting out of bed.
• Implement a toileting schedule and/or safety rounds (every 1 hours during the day and every 2 hours at night).
• Anticipate toileting needs and offer to assist the patient to use the bathroom every two hours
• Make sure call lights are within reach and patient is educated on how to use the call light to call for help.
• Activate bed alarm system for those patients at risk for falls
• Ensure at least 2 siderails are up and bed is the lowest position and there is adequate lighting
• Place confused patients in a room nearest the nursing station and alert all staff to keep an eye on the patient.
• Instruct all patients to wear non-skid footwear.
• Ensure that the pathway to the restroom is free of obstacles and properly lighted.
• Place assistive devices such as walkers and canes within a patient’s or resident’s reach
• Do not leave “at risk” patients or residents unattended in the bathroom
• Intentionally think about fall prevention each time you enter the patient’s room anticipating toileting needs, educating the family, etc.
• Get involved with patient’s plan of care and communicate with licensed nurse to know if patient is taking high risks medications that is placing them at risk for falls.
• Use Safety belt/gait belt for ambulation and transfer as tolerated

 

How Visitors can help prevent falls:

 

Please educate visitors about fall prevention for their family member. In order to prevent falls, it is important for visitors to be alert to the needs and capabilities of the person they are visiting. They should;

• Notify a nurse if the patient seems confused or if you notice a change in the patient’s condition.

• Ask a nurse or staff member to help you move the patient or assist the patient to walk.

• Let the nurse know if the patient cannot reach or use the call button.

• Move bedside items, such as the telephone or water pitcher so they are in easy reach of the patient.

•  If a patient needs constant supervision, alert the nurse if you are leaving the room.

 

How Communication can prevent falls:

 

Good communication between family members, visitors, patients and the nursing staff is the key to fall prevention. Family members should tell nurses about the patient’s condition and;

• When and how often they use the restroom.

• When they sleep.

• Whether they use a cane or walk on their own.

• If they have started taking new medications.

• If they are vision or hearing impaired

• If they have fallen before (When, where, how many times?)

 

If the hospitalized patient does not speak English, it is important for the visitors to help nurses by;

• Telling the nurse about the patient’s language.

• Provide nurses with a list of common words that will assist staff.

• When possible, provide a family member or friend who speaks the same language to help with translation.

 

Patient Rounding Guide

Hourly rounds by Nurse Aide to assess the following: (the 5 Ps)

i. Pain

a. Check the patient’s pain level.  Notify the Nurse if patient is in pain and medicine is needed.

ii. Personal Needs

a. Offer help using the toilet; offer hydration, offer nutrition, empty commodes/urinals.

iii. Position

a. Help the patient get in a comfortable position or turn immobile patients to maintain skin integrity.

iv. Placement

a. Make sure patient’s essential needs (call light, phone, reading material, toileting equipment, etc.) are within easy reach.

v. Prevent Falls

a. Ask patient/family to put on call light if patient needs to get out of bed.

 

 

 

 

                                                     References

Ang, E., Mordiffi , S. Z., & Wong, H. B. (2011). Evaluating the use of a targeted multiple intervention strategy in reducing patient falls in an acute care hospital: a SAFETY OF THE PATIENT – ADULT FALL PREVENTION Nur-HS-G1004

Boushon B, Nielsen G, Quigley P, Rutherford P, Taylor J, Shannon D. Transforming Care at the Bedside How-to Guide: Reducing Patient Injuries From Falls. Cambridge, MA: Institute for Healthcare Improvement; 2008. Available at: http://www.IHI.org.

Carroll, D.L, Dykes, P.C, & Hurley A.C.(2010). Patients’ perspectives of falling while in an acute care hospital and suggestions for prevention. Applied Nursing Research 23(4):238-41. Epub 2009 Jan 15. 

Eldridge, C. (2007). Evidence-based falls prevention: A study guide for nurses (2nd ed.). HCPro, Inc., Marblehead, MA.

Gordon, B., Wnek, T.F., Glorius, N., Hasdorff, C., Shiverski, J. & Ginn, J. (2010). Post-fall decision tree development and implementation. Journal of Nursing Care Quality 25(4): 358-365.

Johnson, M, George, A, & Tran, D.T. (2011). Analysis of falls incidents: Nurse and patient preventive behaviours. International Journal of Nursing Practice 17(1):60-6. doi: 10.1111/j.1440-172X.2010.01907.x.

Make a Move. (n.d.). Retrieved October 23, 2014, from http://www.the-hospitalist.org/details/article/187763/Make_a_Move.html

Meade, C. M.,., Bursell, A. L., & Ketelsen, L., (2006). Effects of nursing rounds on patients’ call light use, satisfaction, and safety. American Journal of Nursing 106 (9): 58-70.

Morse, J. M. (2009). Preventing patient falls: Establishing a fall intervention program (2nd ed.). New York: Springer Publishing.