Admission assessment should include a fall risk assessment so that appropriate safety measures can be implemented from the moment of admission. In addition, certain events such as stroke alerts, cardiac events, deterioration in health condition, and environmental changes such as transfers to other units require a new fall risk assessment because such events cause the patient to have a new baseline and require more safety interventions.
Previous conditions increase the risk for falls. Being aware of these risk factors right away helps initiate appropriate fall risk measures from the start.
Medications that affect mental status and blood pressure can significantly increase the risk for falls. Also, patients using multiple pharmacies and doctors are at a higher risk for falls due to the risk of drug interactions and increased dosing. Medications associated with falls are anticonvulsants, antidepressants, antipsychotics, benzodiazepines, sedatives, hypnotics, opioids, anticholinergics, antihistamines, muscle relaxers, antihypertensives, and diuretics.
Some patients’ ability to walk, stand, and sit might be so compromised that it is safer to use mobility aids such as machines to lift and transfer patients. Using appropriate methods to mobilize patients decreases the risk for falls and injury.
The Morse Fall Score addresses the history of falls, a secondary diagnosis, the use of ambulatory aids, the presence of IVs, the ability to walk and transfer, and the patient’s mental status. Each factor is assigned a numeric score, which accumulates to a score total that determines if the patient is a low, medium, or high fall risk.
Medical equipment, furniture, lighting, unfamiliarity with a new environment, and clutter in the pathway can all increase a patient’s fall risk.
The patient is less likely to fall with assistance. In addition, medical personnel can help assist with safe transfers and ambulation by keeping eyes on medical equipment attached to the patient and being familiar with the room set up.
Signs in prominent colors, if possible, can serve as a constant reminder to wait for assistance before getting up and help reinforce instructions from staff.
Having the patient close provides for increased observation and a better ability to respond more quickly if necessary.
Waiting times for assistance in urgent situations (bathroom, repositioning, pain) can become distorted and seem longer, causing the patient to act before help is available. These situations can significantly increase the risk for falls.
Even with frequent instruction and reminders about waiting for assistance, patients often act alone without waiting. Alarm systems can help with alerting staff that an attempt was made to get up from the chair or bed.
A fall risk armband informs all facility personnel that the patient is at a high risk of falling even when away from the room. For example, If the patient is transported to other areas of the facility, such as procedural areas, the staff of that area will be aware of the patient’s fall risk status.
Patients might still climb out of bed despite all fall precautions being implemented. Therefore, these measures might not prevent falls; however, they might reduce the risk for injury.
Having furniture move while sitting down may cause patients to lose their balance.
Trying to reach items on the table or items placed somewhere else in the room may cause the patient to lose balance and cause him or her to fall.
The patient is less likely to hit or trip over furniture the more familiar he or she is with the room set up.
Frequent exercises and gait training with PT and OT may help improve muscle strength and balance, decreasing the risk for falls. Furthermore, using canes, walkers, and wheelchairs, if necessary, will add more stability during ambulation and transfers.
In urgent situations, patients are likely not to wait for assistance. Frequent toileting reduces these situations.
These devices help the patient be more aware of his or her surroundings reducing the risk for falls.
Flip-flops, sandals, or socks can have slippery soles that can make the patient fall. Solid shoes provide more stability and help with uneven surfaces.
Sitters are with the patient at all times where needs can be addressed immediately.
Knowledge about the appropriate use of the devices keeps the patient and family members safer. Ill-fitted and defective mobility devices can increase fall risk.
Keep walkways free from boxes, electrical cords, and phone cords.
Use tape to secure rugs and remove loose rugs altogether.
Store food, clothes, and toiletries within easy reach.
Adopt the habit to clean up spills right away.
Use non-slip mats in bathtubs and showers.
Use night lights in all rooms and hallways.
Install glow-in-the-dark light switches or motion-sensitive lighting.
Turn on the lights before moving up and down the stairs.
Consider installing these assistive devices:
Handrails for stairs on both sides from top to bottom
Raised toilet seat
Grab bars for showers and bathtubs
A bathtub or shower with a seating area
Removing fall hazards, keeping the home brightly lit, and using assistive devices help reduce the risk for falls.
Community resources can offer financial assistance to make home modifications to enhance safety.
Continued exercise can help improve balance, gait, and muscle strength, reducing the risk for falls.
Emergency response systems will dispatch providers to the scene to assist a person who has fallen and cannot get up independently.
