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This document discusses patient falls in a hospital setting. It defines a fall and near fall, and lists intrinsic and extrinsic risk factors for falls including age, mobility issues, medications, and environmental hazards. Interventions to prevent falls include multifactorial approaches, education, modifying risks, and specific measures like bed alarms, moving high-risk patients nearer to the nurses' station, and use of sitters. Hospitals should screen patients for fall risk, improve communication of risk between providers, and implement prevention strategies while preserving patient mobility.

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Адам Чанг
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41 views

Presentation 1

This document discusses patient falls in a hospital setting. It defines a fall and near fall, and lists intrinsic and extrinsic risk factors for falls including age, mobility issues, medications, and environmental hazards. Interventions to prevent falls include multifactorial approaches, education, modifying risks, and specific measures like bed alarms, moving high-risk patients nearer to the nurses' station, and use of sitters. Hospitals should screen patients for fall risk, improve communication of risk between providers, and implement prevention strategies while preserving patient mobility.

Uploaded by

Адам Чанг
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 28

PATIENT FALL

WHY????

Definitions
Fall : sudden, uncontrolled, unintentional downward displacement of the body to the ground or other object
Near Fall: sudden loss of balance that does not result in a fall or other injury

Un-witnessed Fall: a patient found on the floor or other object but no one knows how he/she got there.

STATISTIC PATIENT FALL 2010

STATISTIC PATIENT FALL 2011

WHY DID THE PATIENT FALL?

Risk Factors for Falls


Intrinsic
History of falls Mobility impairment Agitation Urinary frequency

Muscle weakness
Visual deficits Cognitive impairment

Depression
Arthritis Age>80

Postural hypotension

Anon. J Am Geriatr Soc. 2001;49:664-672; Tinetti MA, et al. NEJM. 1988;319:1701-1707. Nevitt MC, et al. JAMA. 1989;261:2663-2668; Oliver D, et al. BMJ. 1997; 315:1049-1053.

Risk Factors for Falls (cont.)


Extrinsic/Environmental
Medications Poor lighting Loose carpets Agitation Urinary frequency

Anon. J Am Geriatr Soc. 2001;49:664-672; Tinetti MA, et al. NEJM. 1988;319:1701-1707. Nevitt MC, et al. JAMA. 1989;261:2663-2668; Oliver D, et al. BMJ. 1997; 315:1049-1053.

Patient Falls out of Bed


The patient was identified as being a fall risk. The following precautions were taken:
Bed rails up Bed in lowest possible position Call light immediately accessible Patient told explicitly: Call nurse if you need

anything Patient placed in area with many nurses nearby Bed alarm activated
9

Patient Falls out of Bed


The patient stated he did not want to be restrained. The next evening, the patient attempted to climb out of bed by squeezing between his bed rails, and fell to the ground.

10

A Patient Caught in Bedrails

11

WHAT TO DO WHEN A PATIENT FALL???

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TAKUT. ,SOROK.S WEEP UNDER CARPET CEPAT.

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YOU SHOULD.
1. ATTEND TO THE PATIENT IMMEDIATELY - CONDITION OF PATIENT - VITAL SIGNS 2. INFORM THE DOCTOR STAT - CARRY OUT TREATMENT AS PLANNED 3. WRITE THE INCIDENT REPORTING WITHIN 24 HOURS - USE Incident Reporting Manual Appendix 6 Form.

Procedure

Perform falls risk assessment (Hendrich II Fall Risk Model) on all patients on admission, upon transfer from one unit to another unit, change in condition, change in medication, addition of a new diagnosis, and after a fall, near fall, or un-witnessed fall, and daily.

Evaluate the appropriateness of bed-chair monitor alert systems, low beds, bed bolster, and other safety devices, which may be appropriate. Reviewing the patients medication for potential risks associated with the regimen.( Antiepileptics, Benzodiazepines)

Hendrich II Fall Risk Model

Medications
Antiepileptics Benzodiazepines

Generic
Carbamazepine Divalproex Ethotoin Ethosuximide Felbamate Fosphenytoin Gabapentin Lamotrigine Mephenytoin Methsuximide Phenobarbital Phenytoin Primidone Topiramate Trimethadione

Brand
Tegretol Depakote Peganone Zarontin Felbatol Cerebyx Neurontin Lamictal Mesantoin Celontin Luminal Dilantin Mysoline Topamax Tridione

Generic
Alprazolam Chlordiazepoxide Clonazepam Clorazepate Diazepam Flurazepam Halazepam Lorazepam Midazolam Oxazepam Temazepam Triazolam

Brand
Xanax Librium Lklonopin Tranxene Valium Dalmane Paxipam Ativan Versed Serax Restoril Halcion

Valproic Acid

Depakene

Got Patient Safety?

Interventions for High Risk patients to prevent falls


1.

Reorienting the confused patient to time and place.

2.
3.

Checking the patient hourly


Reviewing current plan of care as to effectiveness and making adjustments as necessary. Utilizing bed alarms.

4.

Interventions for High Risk patients to prevent falls - cont


5.

Including fall prevention in patient and family education efforts.

6.

Initiating AM/PM Safety Huddles at shift change to alert staff of all patients on unit who are at risk for falls. Use low beds for those at risk for falls.

7.

The Nurse Will .


8.
9.

Evaluate the need for side rails.


Attempt to illicit from family what patients home routine is.

10. Establish a toilet routine to occur during hourly rounding for ambulating to the bathroom.

The Nurse Will .(cont)


11. Arrange furniture so that patients can use for support.
12. Ensure staff receives information about the

needs of the patient assigned to their care at shift change; when they cover for one another (such as breaks and meal times): and whenever the mobility and/or cognitive functioning of a patient changes.

Strategies for Fall Prevention


Multifactorial interventions
Education of staff Review and modification of medications Exercise and balance training Modification of environmental hazards

22

Strategies for Fall Prevention (cont.)


Specific interventions
Bed alarms Moving patient to room near RN station Sitter for agitated patient Placing patients mattress on the floor Chemical restraints Physical restraints

23

PATIENTS IDENTIFIED AS A RISK TO FALL


1.
2.

3.
4.

5.

Explain the Fall Risk Program to the patient and/or family. Place the prevention bracelet on the patients wrist (do not use in place of the ID Bracelet). Place the yellow star magnet on the doorway outside of the patients room. Place the Universal Bed sign on the wall above the patients bed. Eg : (PPJ) Fall Prevention Program pamphlet is given to either the patient or family members as appropriate.

System Improvements
Enhance communication Bracelets to identify patients at high fall risk Checklistrisk factors reviewed on sign out Maintain mobility Balance risk of falling with benefits of activity Avoid cascade of functional decline Seek financially feasible alternatives Sitterssolicit family members Reserve beds near RN station for at-risk patients

25

Take-Home Points
Falls are common in hospitalized

patients but must be avoided Patients should be screened by assessing intrinsic and extrinsic fallrelated risk factors Communication of fall risk between providers is critical to prevent falls
26

Take-Home Points (cont.)


Other fall prevention strategies include:
Medication review Relocation of patient Sitters Bed alarms Mobility preservation

Bed rails should be used with caution Physical restraints should be a last resort
27

THANK YOU
I AM SAFE..

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