Explainers

Managing and Preventing Falls


Nurses hold an important role in preventing falls. We need to be able to recognise our patients’ risk, treat patients who have fallen, and implement successful falls prevention programs.

What is a Fall?

In healthcare, we often discuss patient falls. But what is a fall? The Victorian Quality Council defines a fall as a sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, the ground or other surfaces.

This definition means a fall can occur in many ways including someone slipping, tripping over, being lowered to the ground, their legs giving way, or simply losing their balance. No wonder we get confused as to what constitutes a fall!

Why do People Fall?

There are a number of predictors when it comes to falls. These include:

  • patients who have a history of falls
  • neurological conditions like Parkinson’s disease
  • cognitive problems including delirium or dementia
  • lower limb arthritis
  • depression
  • acute infections
  • visual impairment
  • hematological or oncology conditions.

Falls can also be attributed to environmental risk factors such as hazards in the patient’s room, corridors, or common areas. Falls occur most when a patient is moving, transferring, or performing activities of daily living. Therefore, our prevention strategies need to be aimed at these times, in addition to decreasing their environmental and personal risk.

It is best if interventions are targeted for the individual and directly relate to their specific risk factors. For example, if Mr Smith is at risk of falling due to Parkinson’s disease then interventions may include Mr Smith using his frame when walking, in addition to supervision from nursing staff.

Scenario: Your Patient has had a Fall, Now What?

Conducting a falls risk assessment.Your patient has arrived on the ward. You have completed their falls screening and found they are at a high risk of falling. This has led you to complete a falls risk assessment and put interventions in place to decrease their risk of falling. But, despite this, they have a fall. What do you do?

Once we have determined that the patient is stable, we then take baseline measurements of the patients’ vital signs including their blood glucose levels and neurological observations if indicated. We also assess the patient for any injuries and monitor them for any changes in level of consciousness, the presence of headaches, amnesia, or vomiting.

If it is safe to do so, we can move the patient. This should be done with consideration to the patients’ conditions and the hospital’s guidelines on lifting – which Australia-wide is a No-Lift policy. Therefore, this may mean making use of an appropriate lifting device.

The patient must then be monitored. Special consideration must be given to patients on anticoagulation or antiplatelet therapies who are at an increased risk of bleeding.

All falls must be reported to the medical officer and documented. Documentation should include a risk incident report in addition to documentation within the patient’s history. The patient’s family must also be notified.

It should be noted after a fall the patient is automatically at a higher risk of falling again. Analysis of the fall should occur to prevent the individual from additional falls.

Preventing Falls

Preventing falls.The main prevention lies in screening our patients. We need to rapidly identify patients who are at risk of falling and develop specific interventions to minimise their risk. Education needs to be provided not only to the patient, but also to their family. The patient’s family can be your biggest ally in helping to reinforce fall prevention strategies with the individual.

It is also important to make use of allied health professionals including physiotherapists, podiatrists, and pharmacists, depending on the individual’s risk factors, to assist in decreasing the risk of repeated falls.

As nurses, we need to remain diligent in screening patients for their risk of falling and ensure that high-risk patients have appropriate, targeted treatment goals in place to decrease their risk.

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References

  • ACSQHC
    http://www.safetyandquality.gov.au/our-work/falls-prevention/falls-prevention-resources/
  • ACSQHC nurse info sheet
    http://www.safetyandquality.gov.au/wp-content/uploads/2009/01/30466-Nurses.pdf
  • VIC Gov
    http://www.health.vic.gov.au/qualitycouncil/downloads/falls/research.pdf
  • JB best practice
    http://connect.jbiconnectplus.org/ViewSourceFile.aspx?0=5394
  • ACSQHC fall guidelines
    http://www.safetyandquality.gov.au/wp-content/uploads/2009/01/Guidelines-HOSP.pdf

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