Chapter 13 Preventing Falls Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Preventing Falls The risk of falling increases with age. A history of falls increases the risk of falling again. Falls are the most common accidents in nursing centers. Persons older than 65 years are at risk. According to the CDC: Falls are the main cause of injury-related deaths in older adults. In the United States, over one third of adults 65 years old and older fall each year. About 1,800 nursing center residents die each year from falls. Falls can cause serious injury-including fractures. Falls result in disability, decline in function, and reduced quality of life. Fear of falling can cause further loss of function, depression, feelings of helplessness, and social isolation. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Causes and Risk Factors Most falls occur in patient and resident rooms and in bathrooms. Causes include: Poor lighting, cluttered floors, throw rugs, and out-of-place furniture Wet and slippery floors, bathtubs, and showers Needing to use the bathroom, usually to urinate, is a major cause of falling. Most falls occur between 1600 and 2000. They also are more likely to occur during shift changes. Review the accident risk factors listed in Chapter 12 in the Textbook. Review the contents of Box 13-1 on p. 185 in the Textbook. Review the Teamwork and Time Management: Causes and Risk Factors for Falls box on p. 185 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Fall Prevention Programs Agencies have fall prevention programs. Common sense and simple safety measures can prevent many falls. The health team works with the person and family to reduce the risk of falls. The goal is to prevent falls without decreasing the person’s quality of life. The care plan also lists measures for the person’s specific risk factors. Review the measures listed in Box 13-2 on pp. 186-187 in the Textbook. Review the Focus on Communication: Fall Prevention Programs Box on p. 188 in the Textbook. Review the Promoting Safety and Comfort: Fall Prevention Programs Box on p. 188 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Fall Prevention Programs (cont’d) Bed rails Bed rails are raised and lowered. Bed rails lock in place with levers, latches, or buttons. They are half, three-quarters, or the full length of the bed. The nurse and care plan tell you when to raise bed rails. Bed rails are needed by: Persons who are unconscious or sedated with drugs Some confused or disoriented people If a person needs bed rails, keep them up at all times except when giving bedside nursing care. A bed rail (side rail) is a device that serves as a guard or a barrier along the side of the bed. When half-length rails are used, each side may have two rails. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Fall Prevention Programs (cont’d) Bed rails present hazards. Entrapment is a risk. Bed rails are considered restraints if the person cannot: Get out of bed Lower them without help. Accrediting agency standards and federal and state laws affect bed rail use. If a person uses bed rails: Check the person often. Report to the nurse that you checked the person. Record your observations when you check on the person, if you are allowed to chart. When bed rails are used, the person can fall when trying to climb over them. The person cannot get out of bed or use the bathroom. Bed rails cannot be used unless needed to treat a person’s medical symptoms. The person or a legal representative must give consent for raised bed rails. The need for bed rails is carefully noted in the person’s medical record and care plan. Use of bed rails must be in the person’s best interests. Review the Focus on Children and Older Persons: Bed Rails Box on p. 189 in the Textbook. Review the Promoting Safety and Comfort: Bed Rails Box on p. 189 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Fall Prevention Programs (cont’d) Hand rails and grab bars Hand rails are in hallways and stairways. They give support to persons who are weak or unsteady when walking. Grab bars are in bathrooms and in shower/tub rooms. They provide support for sitting down or getting up from a toilet. They are used for getting in and out of the shower or tub. Bed wheels are locked at all times except when moving the bed. Wheelchair and stretcher wheels also are locked during transfers. Bed legs have wheels that let the bed move easily. Each wheel has a lock to prevent the bed from moving. Make sure wheels are locked when you: Are giving bedside care Transfer a person to and from the bed Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Transfer/Gait Belt A transfer belt (gait belt) is a device used to support a person who is unsteady or disabled. It helps prevent falls and injuries. A transfer/gait belt is always applied over clothing. The belt buckle is never positioned over the person’s spine. The belt goes around the person’s waist. Grasp under the belt to support the person. Review the Promoting Safety and Comfort: Transfer/Gait Belts Box on p. 191 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

The Falling Person Falling may be caused by: Weakness, light-headedness, or dizziness Fainting Slipping or sliding on spills, waxed floors, throw rugs, or improper shoes Do not try to prevent the fall. If a person starts to fall, ease him or her to the floor. Do not let the person move or get up before the nurse checks for injuries. An incident report is completed after all falls. A person may start to fall when standing or walking. Review the causes and risk factors for falls on p. 184 in the Textbook. If you try to prevent the fall, you could injure yourself and the person. Easing the person to the floor lets you control the direction of the fall. You also can protect the person’s head. If you find a person on the floor, do not move the person. Stay with the person and call for the nurse. Review the Focus on Children and Older Persons: The Falling Person Box on p. 193 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.