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Fall Prevention

Falls are a major cause of injury among elderly patients, with one in four adults over 65 falling each year. Risk factors for falls include medication use, physical disability, and impaired senses. Hospitals should assess patients' risk of falling using a standardized tool and implement prevention measures. Prevention includes identifying high-risk patients, reducing environmental hazards, monitoring patients, assisting with mobility, and reviewing medications that could increase fall risk. Patients and families should be educated on fall prevention strategies for home.

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178 views

Fall Prevention

Falls are a major cause of injury among elderly patients, with one in four adults over 65 falling each year. Risk factors for falls include medication use, physical disability, and impaired senses. Hospitals should assess patients' risk of falling using a standardized tool and implement prevention measures. Prevention includes identifying high-risk patients, reducing environmental hazards, monitoring patients, assisting with mobility, and reviewing medications that could increase fall risk. Patients and families should be educated on fall prevention strategies for home.

Uploaded by

vhon
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Fall prevention

Introduction
• Falls are a major cause of injury and death among elderly people. Each year, one in four adults
age 65 and older falls. For hospitalized patients, falls are the most common safety incident, with
rates of 1.7 to 25 falls per 1,000 patient days and 30% to 51% of falls in hospitals resulting in
injury. One-third of these falls are preventable.
• Factors that contribute to falls among elderly patients include lengthy convalescent periods,
incomplete recovery, medication use, increasing physical disability, and impaired vision, hearing,
or mental status. For example, if an elderly person's equilibrium becomes impaired, it's likely to
take longer to return to normal than it would for a younger adult. The risk of falling also
increases during this time. In addition to causing physical injury, falls can trigger psychological
issues, such as a loss of self-confidence, which hastens dependence and makes the need to
move to a long-term care facility more likely.
• Extrinsic (or environmental) factors that increase the risk of falling include poor lighting, throw
rugs, highly waxed floors, unfamiliar surroundings, and misused or improperly maintained
assistive devices. Intrinsic (or physiologic) factors include impairments in strength, balance, gait,
vision, and cognition and the use of multiple medications.
• All admitted patients should undergo a risk assessment for falls using a standardized, facility-
approved assessment tool, such as the Hendrich II Tool, Morse Fall Scale, Johns Hopkins Tool, or
STRATIFY tool.
• In a health care facility, an accidental fall can change a short stay for a minor problem into a
prolonged stay for serious—and possibly life-threatening—problems. The risk of falling is
highest during the first week of a stay in an acute care or a long-term care facility.

WHO'S AT RISK FOR A FALL?


Fall prevention begins with identifying the patients at greatest risk. Consider a patient with one or
more of the following characteristics to be at greatest risk for falls:
• age 80 or older
• lower extremity weakness
• female gender
• history of a recent fall
• functional or cognitive impairment
• dizziness
• gait or balance impairment
• depression
• low body mass index
• urinary incontinence
• sensory deficits, particularly vision deficits
• orthostatic hypotension
• use of more than four prescription medications
• use of psychotropic medications
• habitation in an environment that contains fall hazards. 3
Fall prevention

How to Do It?
• Perform hand hygiene.
• Confirm the patient's identity.
• Institute universal fall precautions and orient the patient to the room and call light.
• Ask a patient who is age 65 or older or a patient who demonstrates unsteadiness or difficulty
walking whether a fall has occurred in the past 12 months. If so, ask about the circumstances,
assess the frequency of falls, and evaluate for gait and balance deficits.
• Assess for proper use of assistive devices, if used.
• Assess the patient's risk of falling using a standardized, validated, fall risk assessment tool on
admission and after a change in the patient's condition, transfer from another unit, or a fall, or
at a frequency determined by your facility.
• Be sure to check the patient for potential dangers hourly during the daytime and evening and
every 2 hours overnight. Correct potential dangers in the room.
• Instruct the patient to rise slowly from a supine position.
• Advise the patient to wear well-fitting nonskid footwear.
• Promptly respond to the call light.
• Alert other caregivers to the patient's risk of falling.
• Assess the need for one-on-one monitoring and arrange for it, as needed.
• Have a gait belt readily available, if needed.
• Use a chair or bed alarm, if needed.
• Encourage the patient to perform active range-of-motion exercises.
• Assist the patient with early and regular ambulation if the patient's condition allows. Encourage
the use of an assistive device for ambulation, as recommended.
• If needed, regularly schedule assistance with toileting.
• Review the patient's medical record for medications that may contribute to a fall.
• Perform hand hygiene.
• Document the procedure.
Fall prevention

MEDICATIONS ASSOCIATED WITH FALLS


This table highlights some drug classes and their possible adverse effects that may
increase a patient's risk of falling.
Drug class Adverse effects
Diuretics Hypovolemia, orthostatic hypotension, electrolyte imbalances,
urinary incontinence
Antihypertensives Hypotension, syncope
Beta-adrenergic Hypotension, syncope
blockers
Nitrates Hypotension, syncope
Vasodilators Hypotension, syncope
Tricyclic Orthostatic hypotension
antidepressants
Antipsychotics Orthostatic hypotension, muscle rigidity, sedation
Benzodiazepines Excessive sedation, confusion, paradoxical agitation, loss of
balance
Antihistamines Excessive sedation, confusion, paradoxical agitation, loss of
balance
Opioids Hypotension, sedation, motor incoordination, agitation
Hypnotics Excessive sedation, ataxia, poor balance, confusion, paradoxical
agitation
Antidiabetic drugs Acute hypoglycemia
Alcohol Intoxication, motor incoordination, agitation, sedation, confusion
Patient Teaching
If the patient uses a walker or wheelchair, demonstrate how to recover from a fall. Instruct the patient
to survey the room for a low, sturdy, supportive piece of furniture, such as a coffee table. Then review
the proper procedure for lifting oneself off the floor and standing up with the walker or getting into the
wheelchair. Also review how to call for help if the patient can't get up.

Before discharge, teach the patient and family how to prevent accidental falls at home by correcting
common household hazards. Encourage them to take steps to ensure safety.

Use the teach-back method for all teaching related to fall prevention. For example, ask the patient to
perform a task you have taught or ask the patient a question to demonstrate understanding of the
information you taught.
Fall prevention

PROMOTING SAFETY IN THE HOME


Before a patient leaves the health care facility, provide the patient and family with a list of the
following tips to help ensure a safe home environment:
• Secure all carpets to the floor.
• Remove clutter, small furniture, pet gear, electrical cords, throw rugs, and anything else that
may cause someone to trip.
• Arrange or remove furniture to allow plenty of room for walking.
• Immediately wipe up spills.
• Make sure that outdoor areas are well lit and that walkways are smooth and free from ice.
• Use nonslip adhesive strips on stairs.
• Install railings on both sides of stairs.
• Provide adequate lighting in every room and stairway.
• Place nightlights in the kitchen, bathroom, and stairway.
• Install grab bars in the tub, shower, and near the toilet. Use nonskid mats and appliques in the
bath and shower.
• Walk carefully if you have a pet, such as a dog or a cat, to avoid tripping.
• Secure wires from electrical appliances to walls or moldings.
• Store frequently used clothing and other items in places where you can reach them without
standing on a stool or chair.
• Select well-fitting shoes with nonskid soles.
• Don't wear long robes.
• Wear eyeglasses, if needed.
• Sit on the edge of a bed or chair for a few minutes before rising, especially if you take a
medication that can make you feel dizzy when you stand up.
• Use a walking stick, cane, or walker whenever you feel unsteady—but always inspect the
condition of the assistive device before using it.
Documentation

Document your assessment findings and any interventions performed. If applicable, note the patient's
ability to correctly use any assistive devices. Record any measures you took to help prevent a fall,
including teaching provided to the patient and family (if applicable), their understanding of that
teaching, and any need for follow-up teaching.

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