Nurses can play a part in preventing patient falls

20170320100000, Azzida Dzaher
With a high incidence of falls being reported, nurses at every level are responsible in fall preventions.
Falls are the top safety concern among hospitalised patients. Implementing effective fall prevention is crucially needed in all care settings since patients’ falls are normally allied with increased length of stay at the hospital and high medical costs.

Preventing patients’ falls is becoming a pivotal role of nurses, as patient falls and associated injuries are the leading cause of deaths in patients aged 85 and older. As a nurse, who spends the most time with the patients as compared to other healthcare providers, fall prevention remains as a significant part of patient care and is a high priority in patient safety. Since the fall risk of each patient varies, these safety practices require a multidisciplinary approach that tailors to every patient.

Fall risk assessment

Fall risk assessments are accredited to all hospitals to identify falls risk among hospitalised patients. In that way, prevention measures can be implemented into the patient care plan.

You can begin the assessment by collecting patients’ fall-risk form and medical records; these will help you to identify patient’s risk factors for falling, history of falling, as well as patients’ cognitive and physical function.

Prior to the end of screening, appropriately ask them if they have any additional concerns on falling, which you may not have taken note of when assessing them. Additionally, you need to ensure that the patient understands his fall risk, the interventions that will be performed and why it is important.

The patient’s medical condition is a factor that will affect his fall risk. You have to plan the care interventions specifically to the risk found. For instance, a frail patient aged 70 years old must be provided vigilant bedside observation, or be accompanied by his/her caregiver. Additionally, ambulatory devices such as a wheel chair should be provided as it is useful when a patient needs to ambulate.

To implement this fall prevention will also require participation from patient’s families and caregivers so that they can comprehend and correlate the interventions done with patient’s various fall risks, resulting in less misunderstanding and better patient-family cooperation.

Proper footwear

Non-skid hospital socks or anti-slip grip socks are recommended for patients to use when they want to stand as they prevent their feet from sliding, which consequently reduces their risks of falling. Compared to going barefoot or wearing standard socks, experts have found that non-skid socks are effective in preventing falls. However, this care practice would not be recommended for patients who have shuffling gait and foot drop, as wearing these socks may enhance the risk of falls for such individuals.

Hourly rounding

Ward rounding should be strictly followed by every nurse. Through rounding visits, nurses are able to anticipate the patient’s needs when it comes to movement, changing positions and accessing personal items.

When you regularly ask about their needs, this indirectly gives them an opportunity to express their concerns without thinking that they are disrupting the nurse's work. Hourly rounding has been shown to effectively reduce falls among hospitalised patients, and seems to be more effective than using other measures such as the call light system and pressure injuries.

While call light systems are designed for patient safety, it seems to be irrelevant for dementia patients who may not understand the purpose of light; other patients may also be reluctant to press the call light because they worry about disturbing nurses. Therefore, with the close surveillance that comes with hourly rounding, patients will feel less apprehensive and safer.

Bed alarms

For dementia, Alzheimer diagnosed and psychotic patients, using bed or chair alarms would be the best recommendation in place of the call light system. This alarm will help alert nurses when patients try to get out from the bed or chair without assistance. When the alarm detects this, it will distract patients so that they will stop and wait for nurses to assist them. On top of that, nurses and other care providers must acknowledge the use of alarms, so that they can differentiate between false alarms, alarm fatigue and placing alarms on appropriate patients. Also, patient and their families should be familiar with the alarm’s sound, and how it is triggered to avoid it from agitating the patient.

With high incidence of falls reported, nurses at every level are responsible in fall preventions. This requires nurses to optimize the use of their expertise, knowledge, skills and technologies to protect patients from falls and minimise injuries caused by falls. MIMS

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Sources:
Chari, S., Haines, T., Varghese, P., & Economidis, A. (2009). Are non-slip socks really ‘non-slip’? An analysis of slip resistance. BMC Geriatr.
Healey, F., & Darowski, A. (2012). Older patients and falls in hospital. Clin Risk. 18(5):170–176
Quigley, P. (2015). Tailoring falls-prevention interventions to each patient. Retrieved from https://www.americannursetoday.com/tailoring-falls-prevention-interventions/
Saleh, B.S., Nusair, H., Al Zubadi, N., Al Shloul, S., & Saleh, U. (2011). The nursing rounds system: effect of patient's call light use, bed sores, fall and satisfaction level. Int J Nurs Pract. 17(3):299–303. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21605271
The Joint Commission. (2013). The joint commission comprehensive accreditation and certification manual. Retrieved from www.jointcommission.org/standards_information/edition.aspx