Reduce the Risk of Patient Harm

Resulting from Falls

Objectives By the end of this presentation the participant will be able to:

Define the patient fall List the factor contributing towards

fall Discuss the importance of patient’s

assessment and assessment criteria. Implement the specific nursing

intervention for fall prevention Manage patient after falls Aware about the patient fall

prevention program

Fall “A fall is considered an unintentional event that results in a

person coming to rest on the ground or other lower level.” (www.UTHCPCProcedures - Fall Prevention and Management

Program.mht) “Fall: loss of upright position that results in landing on the floor,

ground or an object or furniture or a sudden, uncontrolled, unintentional, non purposeful, downward displacement of the body to the floor/ground or hitting another object like a chair or stair.”

Fall Prevention: “strategy using specific interventions to avoid risks of falling.”

(Briggs National Quality Improvement/Hospitalization Reduction Study)

Factor Contributing To Patient’s Falls

History:History: Previous fall history.

Physical Status:Physical Status: Fatigue/weakness Dizziness/balance problem Impaired mobility Sensory impairment Seizures disorder Alteration in elimination

Mental Status:Mental Status:

Confused (illogical thinking) Impaired memory/judgment Disoriented to time place or person Lack of familiar with immediate

surrounding Inability to understand/follow instructions

Factor Contributing To Patient’s Falls cont...

Medications:Medications: Drugs that have diuretic effects Drugs that alter thought process

and or create hypotensive effects (narcotics and sedatives, psychotropic, hypnotic, tranquilizers, antihypertensive)

Drugs that increase GI motility (laxative, enemas, cathartics)

Factor Contributing To Patient’s Falls cont...

Other factorsOther factors Wet floor No orientation to unit Slippery floor Area under construction Less light/darkness Obstacles e.g. cords/wires in the way Transferring of patients from bed to

Stretcher/wheel chair Faulty equipments such as Mobility aids

Factor Contributing To Patient’s Falls cont...

Nurses Assessment

Nursing Specific Intervention Strict implementation of nursing initial falls

assessment and daily reassessment. Patients should be screened by assessing

intrinsic and extrinsic fall-related risk factors Orientation to unit Calling bell beside patient and in

the bath room Patient and family education

regarding medication effects and side effects Teach patient use of grab bars Bed side and trolley's rails up Beds at low level

Nursing Specific Intervention

Lock all equipment while transferring patients

Continues dryness of wet floor and putting warning signs during cleaning

Isolate the construction area Presence and maintenance of

emergency lights every where.

Post Fall Nursing ActionPost Fall Nursing Action Immediate call for help Assess for injuries Obtain and record

sitting/standing vital signs Assess for change in range of

motion Alert physician Follow organizational policies

for patient monitoring Assess intrinsic and extrinsic

factors for fall

But we need to share the learning fromour mistakes to try and stop them

happening again …..

So...So...

Document the circumstances in medical record

Complete incident report (HERF(health care event reporting form), Patient Safety Event Report: Fall)

International Patient Safety GoalsGoal 6 - Fall Risk Assessment

There is a policy regarding fall risk assessment and reassessment for all patients in the hospital, however the policy did not emphasized monitoring the unintended related consequences of the fall reduction measures.

Unintended Consequences Monitor patient for unintended related consequences

of the fall reduction measures i.e. limiting water intake, restraint related injuries and patients jumping over the bed side rail.

References References

http://www.ftmc.com/content.aspx?PID=231

http://www.nursingcenter.com/prodev/cearticleprint.asp?

www.ncvhs.hhs.gov/070619p8.pdf http://www.kevinmd.com/blog/2009/07/the-

unintended-consequences-of-preventing-patient-falls.html

THANKSSTAY BLESSED