Skill 29
Fall Prevention in a Health Care Facility
Patient falls are the most common type of inpatient accident (Oliver, Healey, and Haines, 2010). Between 1% and 3% of these falls result in fractures. Risk factors for falls among inpatients include a history of falling, muscle weakness, agitation and confusion, urinary incontinence or frequency, postural hypotension, and use of high-risk medications (e.g., benzodiazepines, opioids, antihistamines, and sedative-hypnotics) (Chang et al., 2011; Oliver et al., 2010).
A fall-reduction program includes a fall risk assessment of every patient, which is usually conducted on admission to a hospital and then routinely (see agency policy) until the patient’s discharge.
Remember that patient situations change. Preventing falls and fall-related injuries requires diligent ongoing nursing assessment and engagement of the entire health care team in the implementation of patient-specific interventions (ICSI, 2010).
A full set of raised side rails (two to a bed or four to a bed) is a physical restraint. Raising only one of two, or three of four, side rails gives patients room to exit a bed safely and move around within the bed. It is also important to keep a bed in low position with wheels locked when stationary.
Electronic bed and chair alarms warn nursing staff when patients try to leave the bed or chair on their own. Additional devices to use at a patient’s bedside are a gait belt, a bedside commode, a nonskid floor mat, an overhead trapeze, and a ceiling lift.
Delegation Considerations
Assessment of a patient’s risk for falling cannot be delegated to nursing assistive personnel (NAP). However, the skills necessary to prevent falls can be delegated. The nurse directs NAP by:
