12 Tricks to Preventing Patient Falls in Hospitals

10/26/2018

prevent patient falls in hospitals

By Brook Jillings, Contributor

Patient falls occur at a rate of around 700,000 to 1,000,000 incidents each year in the United States. Patients are at risk for significant injury from falls, including lacerations, internal bleeding and fractures, and medical facilities can open themselves up to legal troubles if a fall is deemed preventable. 

Hospitals must also consider the extra burden of care needed for injuries stemming from a fall. Fortunately, there are steps you can take to prevent patient falls, leading to a reduced number of on-site injuries and better medical outcomes.

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12 tips to prevent patient falls in hospitals

1. Know your patient's medications

Judi Kuric, ACNP-BC, ACNPC, FNP-BC, CNRN, SCRN and Academic Program Coordinator for Walden University, stresses the importance of knowing the side effects of any medications your patient is prescribed. "Blood pressure and anti-arrhythmic medications can cause orthostatic changes. Medications that cause sedation (pain medication) can create confusion or impaired balance. Benzodiazepines, anti-depressants and anti-psychotics are high on the list of medications that contribute to falls. Reviewing the patient's medication list and new orders can be key in identifying increased fall risks."

2. Recognize common indicators

"Nurses can also screen patients for key indicators that raise their risk of falling," states Kuric. "These can include any patient that has fallen within the past three months, utilizes a cane or walker and/or experiences delirium, dementia or confusion." Advanced age, often the catalyst behind risk indicators for patient falls, should also be considered.

Lauren McGrath, bCRE of the Hearing Health Foundation, adds, "One of the most prudent actions nurses can take is to know how to detect hearing loss in a patient and ensure the patient receives treatment (e.g. hearing aids) if needed." She points out the connection between untreated hearing loss and balance, explaining that it can double the risk for patient falls.

3. Assess patient strength before mobilization

"Ask them to put their feet flat on the bed and lift their behind off the bed," suggests Matt Thomson, RN and creator of TheRNMentor.com website. "This should indicate if they have the strength to stand."

4. Use a standardized rating system

Thomson and Kuric both agree that a standardized rating system is crucial for preventing patient falls in hospitals. Kuric recommends the Morse Falls Scale or the STRATIFY to assess fall risk, saying, "These are the two most studied, but there are certainly others available. The point is to assess the patient and employ additional interventions to prevent falls."

5. Overestimate your patient's need for mobility assistance

Once you've assessed a patient's mobility needs, overestimate the amount of assistance required rather than your own ability to assist alone. Some patient falls can be prevented by simply having an extra nurse available to help. "Always have more help than you think necessary for the first attempt," recommends Thomson. "An assistant can leave if they're not needed."

6. Accompany patients in the bathroom

To help prevent patient falls, Thomson stresses that nurses should never leave patients alone in the bathroom. "If they have a problem with your presence, step outside the room with the door slightly ajar so you can always see them," he says. "Step in as soon as they look like they are finished."

7. Keep the environment safe

A simple tip for patient falls prevention is to do a quick environment check. "Many falls occur when they reach for the phones, purses, glasses, etc," states Thomson. "Always have the patient's belongings within reach."

"Nurses can keep the call light and a patient's personal possessions within easy reach," adds Kuric. "When focusing on the room, it's important to keep the floors dry and clutter free and use night lights to assist patients in visualizing hazards."

8. Use bed and safety measures

Bed safety measures are installed for a reason, so nurses can help prevent patient falls by taking advantage of them. Kuric suggests nurses maintain the bed in a low position with the rails up. Thomson champions bed alarms. "Always use a bed alarm, and only disengage it when the patient shows they can safely ambulate long distances without assistance."

9. Engage brakes

A simple tip for patient falls prevention comes from Kuric, who suggests "keeping the bed and wheelchair brakes locked." This ensures any unexpected movement from the patient won't destabilize the chair or bed while getting in or out of it.

10. Get a "bedside report" when changing shifts

Chris Caulfield, RN, NP-C, MSN of IntelyCare, touts bedside reports during shift changes as the best intervention for decreasing patient falls in hospitals. "The last med pass or CNA visit could be 2-3 hours prior to your arrival," he explains. "It’s usually about that time when the frailest patient decides to walk to the bathroom on their own."

11. Give patients non-slip footwear

This easy prevention trick helps prevent falls for mobile patients. "Ensure the patient utilizes nonslip foot wear when ambulating," says Kuric. This can keep patients from slipping on smooth hospital floors.

12. Encourage early patient participation in mobility programs

Finally, Kuric suggests encouraging hospital mobility programs to help prevent patient falls. "Early mobility programs for all patients help prevent deconditioning and decrease falling risks," she points out. "Patient care teams that include PT and OT to facilitate early and frequent ambulation, movement and exercise can decrease the risk of falls. This can be started in the MICU as an early intervention and prevention program."

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