FALL PREVENTION AND MANAGEMENT IN
HOSPITALS
ANNAPURNA SINGH QUALITY
HEAD
OBJECTIVES:-
To decrease the incidence of fall.
To reduce the risk of injury.
To determine the way of the falls occurrence.
To implement fall prevention program
To improve environment safety
Enhance staff knowledge
Improve patient and families confidence.
DEFINITIONS :-
Fall :- unexpected falling down from high position to
lower position with or without injury due to physical or
mental effect.
Near Fall: sudden loss of balance with incomplete fall
which include slips, stumbles, or strip with ability to
control .
MOST CAUSING TO FALLS
Individual Environmental
• Loss of consciousness.
• Unsafe higher position.
• Orthopedic disorders. • Beds side rails.
• Hypoglycemia. • unlocked wheel chair.
• Anemia, Vision • Water in the floor.
• Hypotension.
• Wire connections.
• Drugs action
• Steps or stairs.
. • Post operative (sedation).
• Aging and sleeping habits • Walker.
• Paralysis, TIA, CVA • Interfering Clothes
• Transfer time
PATIENT FALL INJURY LEVELS
• None: No injury.
• Minor: minor injury with abrasion or bruise treated by dressing,
limb elevation, topical medication.
• Moderate: injury lead to Suturing or limping treated by bandage,
splinting, muscle or joint strain.
• Major: which leads for casting, skin traction and surgery, may need
neurological and vascular attention.
• Death: the patient died as a result of serious injury.
• UTD: unable to determine from the documentation
• All in-patients will be assessed for the risk of fall upon admission.
• Reassessment is indicated for all of the following conditions:
- post operative.
- following procedural sedation.
- after administer medication.
- after blood transfusion.
- transferring patients between 2 units.
- after recording incident of fall. - any changing in ambulatory status or elimination status,
• Applying Risk Fall procedure for patients
- Hendrich 11 Fall risk for Adults.
- Humpty Dumpty Scale for Pediatrics .
• Standard fall precaution shall be implemented for all patients.
• Reporting and documenting any fall occurrence.
• All Falls patients should be classified according to level of Injury
Post Fall Protocol of Care
Implement the following intervention after any fall:
• First Aid.
• Ensure that patient is safe from further danger .
• ask for help.
• don’t reposition the patient until the patient is ready to do so.
• move the patient safely with attention to moving and handling.
• complete the post fall assessment Form
• Reporting.
• Patient and Family Education.
STANDARD FALL PRECAUTION FOR LOW RISK PATIENTS
• Orient the surrounding environment.
• Provide Medication Information.
• Instruct patient to call for assistance.
• Instruct to use the rubber
– soled shoes or non
– slip footwear to prevent slipping.
• Secure call bell, phone, bed table.
• Ensure the clothes are not interfere with the patient mobility.
• Maintain the bed in the lowest position and ensure bed and wheelchairs are looked.
• Put side rails
• Conduct regular environmental rounds in all areas surrounding the patients to decrease the risk of falls.
• Keep bathroom light on and the floor dry.
STANDARD FALL PRECAUTION FOR MODERATE RISK PATIENTS
Identify as falls risk on medical record and include in shift endorsement.
• Assist and supervise ambulation, Reinforce to always call for assistance.
• Conduct hourly safety checks.
• Perform regular pain assessment
• Offer assistance to the bathroom or use bedpan hourly while awake.
• Evaluate for reversible causes
- Orthostatic B.P
- Monitor Blood Sugar .
- Adequate Hydration
• Check the patients after the visitors leave always.
• Don’t lower the bed side rails if any nurse rise it up.
• Patient Education.
• Family Education.
• Apply Fall Risk Hand Band
STANDARD FALL PRECAUTION FOR HIGH RISK PATIENTS
• Apply all low and moderate interventions.
• Place a high risk for fall sticker/ label on the patient charts and patient room.
• Raise Both upper and lower side rails.
• Place mattress on floor.
• Review the medication.
• Assess the need of physical therapy consultation.
• Assess the need for 1:1 monitoring as needed.
PATIENT AND FAMILY EDUCATION
• Educate both about the risk of falling, Safety Issues, and their
Mobility Limitation.
• Teach patient to make position changes slowly.
• Emphasize how important the family to be involving tin the
patient safety.
• Emphasize on what patient can do to be healthy, active, and
independent
IN THE EVENT OF FALL
• Nurse will give support
• Immediate action
• Documentation
• Post fall counselling
• Evaluation
NURSE WILL GIVE SUPPORT
Easing him/her to the floor by
grasping the patient’s clothes .
Allow the pts to slide down bend
your legs so that you can control
the direction of the fall
Try to protect the pts’ head
Assess the patient for any injury
IMMEDIATE ACTION
When a patient fall or is found on
the floor.
The charge nurse will immediately
assess the patients injury,
DOCUMENTATION
1. Record the details of prior
of fall, fall, results of fall
and intervention.
2. Morse fall score, notify the
fall prevention nurse
3. Document in Nurses notes,
clinical audit, OVR and
incident fall assessment.
POST FALL COUNSELLING
1. Determine if the patient’s gaits confidence
was affected.
2. Assess the future fear of falls.
3. Use education to manage the expectations
and fears of the family and direct care staff.
4. Post fall counseling should take place as
soon as possible after the fall.
EVALUATION
1. All falls will be tracked and trended on a monthly basis
2. Data is to be evaluated by the fall prevention nurse.
3. Data will reviewed and signed by the Medical Director, Administrator and Nursing
Director.
4. Assessment of data will be reported to Clinical Audit team.
5. Data will be analyzed for total number of falls, patterns/repeat falls, trends and
casual factors.
6. Data will used to improve care plans
7. Data will be used to improve this fall risk management and loss
control program.
8. Set measurable goals and objectives for care in the context of
resident wishes and advanced directives.
9. Document resident’s response to interventions and alter
interventions if not successful.
