Presented by Dorcas Kiptepkut BSN RN Fall Prevention Presented by Dorcas Kiptepkut BSN RN

Scenario M.D is a 78 years old female, who had a fall in her house 4 days ago. She was admitted to the hospital and found to have a right hip fracture. She has a history Alzheimer's and hypertension. She underwent open reduction and internal fixation of the right hip. The doctor has prescribed Percocet for pain 2 tablets q 4hr PRN for pain and dilaudid 1mg IV for breakthrough pain. This evening while making rounds, the nurse found her on the floor.

Definition To drop accidentally to the floor or ground. Fall   To drop accidentally to the floor or ground. An accidental drop, usually caused by slipping or losing one’s balance

Fall Prevention There is no simple fall prevention strategy that will work for all patients across the spectrum or healthcare. falls appear to happen because of a complex interaction of intrinsic and extrinsic risk factors, interventions require a multi-faceted approach

Statistics  Hospital inpatient falls are common and may lead to injuries and prolonged hospitalization  According to the Centers for Disease Control and Prevention Injury Center (2007), falls are the third most common cause of unintentional injury and death across all age groups. The first leading cause among people 65 years and older.

Statistics Twenty percent to 30% of people who fall suffer moderate to severe injuries such as bruises, hip fractures, or head traumas. These injuries can make it hard to get around and limit independent living. They also can increase the risk of early death         

Statistics Falls are the most common cause of traumatic brain injuries, or TBI. In 2000, TBI accounted for 46% of fatal falls among older adults   In 2000, direct medical cost totaled $0.2 billion ($179 million) for fatal falls and $19 billion for nonfatal fall injuries

Risk factors Altered mental status The single biggest predictor of a fall is a history of falls Reduced visual acuity and hearing Vestibular dysfunction Peripheral neuropathy Musculoskeletal Disorders and Impaired mobility Altered mental status

Risk Factors Urinary/Bowel frequency, Syncope/ vertigo Visual Deficits Use of ambulatory aids Medication: tranquilizers, Narcotics, analgesics, Barbiturates, Hypnotics, Antipsychotics, antidepressants, Antihypertensive, eye drops

Fall Prevention A strong fall prevention strategy that encompasses a number of different interventions and targets multiple risk factors. The success of a program appears to be not as dependent on a specific intervention but on a comprehensive interdisciplinary program.

Fall Prevention Assessing and screening for risk factors for falls. Using triggers to implement a falls prevention protocol. Implementing protocols according to patient needs. Assessing and reassessing patient and modifying as appropriate. Reporting falls (internal and external). Measuring/monitoring fall rates. .

Fall Prevention A hospital can be a dangerous and erratic place for inpatients due to unfamiliar physical environment changes in patients' medical conditions related to physical and psychological health and sensory systems (e.g., pain).

Assessment Assess all patients for falls risk Upon point of entry. Admission to unit Transfer As needed per the patients condition

criteria Fall interventions should be initiated depending on the falls score. According to Johns Hopkins fall assessment; Low fall risk (0-5 points). Moderate risk (6-13 points) High risk (any score greater than 13

Interventions make frequent rounds on all patients with high risk for fall. answer call lights promptly. Place call light within patient’s reach. Patients should be provided with hard sole slippers. Staff to ensure a clear path to the bathroom. minimize room clustering.

Interventions Fall Precautions Make sure personal items are within patient’s reach. Clean all spills immediately. Provide an high risk for falls patient with a bedside commode. Solicit a family member to stay with a high risk for fall patient.

Interventions Assess the patients condition Assess the patients medication regimen Consult with pharmacy and physician for medication review. Move patient close to the nurses station. Consider getting a sitter/companion if else fails

Post Fall Assess patient for injury Complete a set of vital signs to include neurological checks Notify physician immediately Initiate treatment per physician order Document the event

Post Fall Reassess the patient care plan Reassess the teaching plan Make changes as needed.

The End fall prevention strategies should strongly be adhered to. Nurses should make their rounds regularly assessing patients who are mostly at risk. communicating to other co workers about patients is key. When all these steps are taken properly there will be a reduction in the number of falls and patient injuries.

conclusion Falls has been a persistent issue among hospitalized patients therefore nurses should be more vigilant during their physical assessment. Protecting patients from falls and fall-related injuries requires shared responsibility among health care providers, administrators, and risk managers.

References References Centers for Disease Control and Prevention. (2007). Preventing falls among older adults: Fall prevention Protocol. (2012). Prince Georges Hospital Center Venes, D. (2001). Taber's Cyclopedia Medical Dictionary. Philadelphia: F A Davis Company.