The importance of nurses’ role in fall prevention is undeniable. Nurses receive training to implement safety measures during patient care. Fall prevention remains a challenge across the United States. The Joint Commission identifies a fall prevention program as one of the National Patient Safety Goals – NPSG. Fall is a patient safety concern across the United States.
There are many underlying health conditions associated with Falls. Those conditions often contribute to patient safety events in and outside healthcare settings. The average hospital falls rates among adults patients per 1000 bed days are 2.55.
Most people will conclude that this is a small percentage. However, falls should be a never event because it is not an expected outcome. In addition, injuries related to falls cost an average of $14, 00.00 per patient for a prolonged stay. (The Joint Commission)
Definition of Fall
There are evidence-based measures that will reduce the risk of falls when implemented correctly. According to John Hopkins – a leader in fall prevention, a fall is an unintentional descent to the floor. The fall can be assisted and unassisted. For example, if the patient does not reach the floor, it is not a fall. Thus, when a staff member assists a patient in a chair or bed to prevent a fall is not a fall.
Patients may also lower themselves to a chair or bed to avoid a fall. According to the definition, behavioral and developmental falls are not considered actual falls. For example, a patient decides to get on the floor to seek attention. Moreover, it is often anticipated that infants and toddlers might fall during physical activities.
Risk Factors Associated With Falls
History of falls: Some patients had a fall or more in the past.
Physical limitation: Patients with physical limitations often exhibit difficulty ambulating which increases their fall risk.
Cognitive impairment and advanced age: Some patients demonstrate some memory deficiency which impacts their ability to think well. Thus, patients are unable to make appropriate safety decisions.
Chronic illnesses: Some chronic illnesses i.e diabetes, renal failure, pulmonary diseases, heart failure, and others affect patient activity tolerance. Thus, patients might experience difficulty walking a long distance without supervision.
Polypharmacy: This is the collection of multiple drug prescriptions from different doctors or additional over the counter medicines from the same classification. The behavior can have a negative impact on patients’ physical ability. For instance, multiple laxatives can cause excessive loose stools which can lead to electrolyte imbalance and muscle weakness.
The Role of Nurses In Falls Classification
Most nurses have difficulty identifying falls with harm versus no harm. According to the Institute for Healthcare Improvement – IHI, there is patient harm if the outcome prevents patients from functioning as they used to. For instance, a patient falls and sustains an acute fracture is considered a harmful event. However, a patient who falls but did not sustain any adverse impact will be classified as fall without harm.
Identify Patients At Risk for Falls
Nurses should receive training about the fall assessment tool in order to classify patients appropriately. For instance, John Hopkins’ fall assessment tool – JHFRAT is very common across the United States’ healthcare system. Furthermore, there is a series of questions that assign a scoring number to patients based on clinician’s selection.
It is very important for nurses to remain objective when completing this assessment in order to identify the patients’ exact risk levels. The appropriate assessment enables nursing staff to implement individualized measures to prevent falls.
Implement Falls Prevention Measures
Nurses should activate Nurse Initiated Orders – NIO in accordance with their hospital’s protocol. Patients and health care partners should receive education about fall prevention measures. For example, Nurses should consider all factors that can contribute to falls during hospitalization.
Lastly, nurses should educate patients about fall prevention measures to follow at home to promote positive outcomes. It is also important to communicate with the rehabilitation department and discuss patients’ physical limitations. Nurses should also comply with clinical documentation to validate nursing interventions.
Role of Nurses in Falls Prevention Bundle
Screen all patients for fall risk
Move patients near the nursing station
Place call bell and valuables within the patient’s reach
Implement 1:1 safety or virtual sitter
Conduct safety rounds
Implement hourly rounding
Reorient patients with acute delirium
Implement a toileting schedule
Activate bed alarm or portable alarm
Display hospital or facility fall prevention signage per protocol
Complete medication review
Apply hospital safety band, gown, and or socks
Inspect the floor for wetness and uneven surface
Ensure assisted devices are available ( eyeglasses, hearing aids, walkers, cane ect.. )
Initiate nursing orders and fall prevention care plan per protocol.
Educate patients and encourage compliance
Despite the ongoing challenge, healthcare organizations continue to strive for improvement by developing a fall prevention program. A successful program should include members from different disciplines in order to develop a comprehensive care plan. Moreover, Leadership engagement and staff accountability can influence cultural change.
Mobility training is important to obtain as a nurse because the training usually includes safe patient handling and body mechanics. Proper training in combination with the fall prevention bundle will enable nurses to assist patients with activities safely. Nurses should verify doctors’ orders for activities before engaging patients in physical activity. For instance, non-weight-bearing versus weight-bearing.
Nurse Sophie has been a registered nurse for over a decade. I have a Master's degree in nursing, and my clinical experiences include staff nurse, clinical nurse supervisor, and manager, and most recently, nurse consultant in Patient Safety and legal nursing. I was always passionate about system operations and practice standards.
I have completed over 2000 hours of medical chart reviews. I am an expert in clinical investigations, and I also develop event timelines. I can assist the legal team with the Discovery process: Deposition, Interrogatories questionnaire, event timelines, locate expert witnesses, and more. I provide and formulate clinical opinions based on the investigative summary.
Nurse Sophie, MSN, RN, LNC
Legal Nurse Consultant
Patient Safety Specialist
Email: [email protected]