A fall is defined as any unplanned descent to the floor or other lower surface with or without injury to the patient.
Definitions of fall injuries:
• None – no injuries
• Minor – injury level requiring use of a dressing, ice, cleaning of a wound, limb elevation or topical medication
• Moderate – injury level requiring suturing, use of steristrips/skin glue or splinting
• Major – injury level requiring surgery, casting, traction or consultation for neurological or internal injury
• Death – injury resulting in death
Fall rates are based on staff reported incidents and calculated in a number of ways. Fall injury rates are calculated in two different ways. All rates are based in some manner on the number of patients in the unit and/or how long patients have been in the unit.
Fall risk assessment is an important part of helping prevent falls. The purpose of fall risk assessment is to identify a patient’s risk for falling in order to correct problems and prevent falls. Fall risk assessment can be a simple screening of all older adults admitted to a healthcare facility or performed at your doctor’s office. A more involved fall risk test is appropriate for those at high risk for falls or who have recently fallen.
Fall risk assessments should use the following risk factors:
• Advancing age, especially if older than 75
• History of a recent fall
• Presence of other problems: dementia, hip fracture, Type II diabetes, Parkinson’s disease, arthritis and depression
• Use of assistive device
• Mental problems
• Gait, balance or vision problems
• Use of high-risk medications
• Urinary problems
• Physical restraint use
• Bare feet or inappropriate footwear
Commonly used risk assessment tools include:
• Hendrich II Fall Risk Model
• Morse Fall Scale
• St. Thomas’ Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY)
4-P rounding is a technique used in some hospitals to help reduce the possibility of falls, as well as other problems. Nurses do an hourly check on all patients for Bathroom/Personal Care, Positioning, Possessions/Proximity and Pain. Nurses check patients for the following:
• Do they need to go to the bathroom?
• Do they need to be turned? Get up in the chair? Get back to bed?
• Do they have their tissues, water, glasses, phone, call bell close at hand?
• Is their pain under control?
Checking each patient every hour and making sure all “P” needs are met help patients feel attended to and helps prevent problems associated with falls.
Fall prevention helps reduce accidental falls suffered by older people. This typically involves changes to the older adult’s surroundings. The home can present many hazards. Common places for falls are the bathtub and steps. Changes in the home can reduce hazards and aid a person in his or her daily activities. Changes could include limiting clutter, installing grab bars in the shower or tub or near the toilet and installing non-slip decals on slippery surfaces. Other changes might include handrails on both sides of stairs, better lighting and adding color contrast on steps.
Various symbols and colors are used to warn about patient fall risk. A falling leaf, falling star, triangle, waterfall, banana peel and tree with falling apple are examples of symbols used by NICHE healthcare facilities to alert staff to patients at high risk for falls.
These reminders help healthcare staff take steps to reduce the risk of falls. They can also remind patients about falls and prompt them to ask for help when getting out of bed, etc.
Adult walkers are used to stop physical weakening, pressure ulcers, loss of mobility, loss of muscle tone and falls. By helping provide stability, adult walkers promote safety and walking, and add to an older adult’s independence.
Older adults should be assessed for need and correct fit by a physical or occupational therapist before using a walker. Persons with mental problems may not be candidates for a walker, as they may not understand use instructions or may need reminders to use the walker.
The Merry Walker® is both a walker and wheelchair. This device has been used in healthcare facilities and home care. Individual assessment is needed to determine eligibility for use of the Merry Walker.
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