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7 Tips For Nurses On Patient Fall Prevention

The Agency for Healthcare Research and Quality (AHRQ) estimates that between 700,000 and 1,000,000 patient falls occur each year, with more than a third of these incidents resulting in injury. With potential injuries such as lacerations, fractures, head trauma or internal bleeding, fall prevention is a crucial nursing responsibility. To help you protect your patients from further impairment and complications in care, here are seven ways to prevent patient falls.

Patient Fall Prevention

1. Identify potential risk factors

Some patients are at greater risk of falling than others, so it's important for nurses to screen their charges for risk factors to identify who needs extra care. "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," says Dr. Judi Kuric, DNP, ACNP-BC, ACNPC, FNP-BC, CNRN, SCRN, the academic program coordinator for the Walden University MSN Adult/Gerontology Acute Care Nurse Practitioner program. "Other key indicators can include a patient with new onset of a neurologic diagnosis (stroke, head injury, etc.) or who may have frequent toileting needs (think about patients that receive medications for constipation)."

"Get a podiatric consult to see if there is peripheral neuropathy in the lower extremities," suggests Edgard Nau, DPM or Manhattan Home Podiatric. "Impaired proprioception is a big factor in falls."

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2. Utilize the standard risk scale preferred by your facility

Dr. Kuric also recommends using a standard risk scale, such as the Morse Falls Scale (history of falls, secondary diagnosis, ambulatory aid, IV/heparin lock, gait and mental status) or the STRATIFY scale (transfer/mobility, history of falls, vision, agitation and toileting). "These are the two most studied, but there are certainly others available," she says. "The point is to assess the patient and employ additional interventions to prevent falls."

3. Check medications

Becoming familiar with the medications your patients take can also help with fall prevention. "Blood pressure and anti-arrhythmic medications can cause orthostatic changes," cautions Dr. Kuric. "Medications that cause sedation can create confusion or impaired balance. Benzodiazepines, antidepressants and antipsychotics are high on the list of medications that contribute to falls."

4. Get your patients moving

Keeping your patients mobile to maintain muscle tone can help ensure they have the strength and coordination to stay upright as well. "Patient care teams that include PT and OT to facilitate early and frequent ambulation, movement and exercise can decrease the risk of falls," Dr. Kuric suggests. "This can be started in the MICU as an early intervention/prevention program."

5. Anticipate ambulatory complications

Although having your patients’ ambulatory is beneficial, take care to ensure they can do so safely. Dr. Kuric recommends using nonslip footwear for mobile patients and making yourself available to patients who struggle with mobility. "From a care perspective," she says, "nurses can schedule rounds to meet the patient's needs and decrease the chance they move unsafely to meet their own needs."

6. Take precautions for patients in beds and wheelchairs

Although many patient falls happen while the person is standing or moving about, it's important to recognize the risk to patients while they're sitting in a wheelchair or lying in their bed. Dr. Kuric offers tips, such as "Maintaining the bed in the low position with side rails up, keeping the bed and wheelchair brakes locked and utilizing bed monitors for at-risk patients."

7. Maintain a safe environment

One of the most critical solutions to fall prevention is making an effort to keep the patient's environment safe. This includes anticipating the patient's needs and generally keeping the room free of obstacles. "Nurses can keep the call light and a patient's possessions within easy reach," says Dr. 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."

The patients you see already have established symptoms, illnesses or injuries that need to be addressed. Fall prevention ensures their condition is not exacerbated by additional injury,possibly leading to greater suffering and more complexity in treatment. While caring for your patients, remember that it sometimes means protecting them from themselves. By following these seven tips, you can greatly reduce the number of patient falls under your care.

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