1. Preventing Patient Falls
Is Key to Keeping Kidney Patients Safe

2. Facts About Falls
An estimated 15,240 End Stage Renal Disease patients fall in dialysis facilities nationwide every three months.
40% of patients who fell cited dizziness as the main reason for their fall.
Tripping, slipping, loss of balance and weakness are also contributing factors.
Once patients fall, they may become more cautious and less physically active thereby becoming weaker and increasing the likelihood of future falls.
Renal Physicians Association: Health and safety survey to improve patient safety in end stage renal disease: Report of findings from the ESRD patient survey, 2007.
Desmet C et al. Falls in hemodialysis patients: prospective study of incidence, risk factors, and complications. Am J of Kidney Dis 45(1):
Brouwer B, Musselman K, Culham E. Physical function and health status among seniors with and without a fear of falling,” Gerontology 50(3):

3. Contributing Factors Impaired Cognition Degenerative Arthritis
Peripheral Neuropathy
Peripheral Vascular Disease
Lower Extremity Amputation
Living Alone

4. Contributing Factors Vision Impaired Environmental Factors Medications
Assistive Devices
Poor Physical Functioning
Prior Fall
ID Fluid Removal

5. Fall Prevention Best Practices
Patient Fall Risk Assessment
Educational Programs
Physical strengthening/therapy
Pre-Dialysis Assessment Prior to Each Treatment
Fall Reporting and Physician Notification
Dialysis Heparinization for Patients with Prior Falls

6. Patient Fall Risk Assessment
Physical Conditioning Assessment
Medication Review
Home Environment Questionnaire
Dialogue with Patient and Caregivers
Physical Conditioning/Therapy Needs Assessment

7. Focused Education Program for Patients, Caregivers and Staff
Train new staff in all fall risk assessment procedures and fall prevention policies 1
Provide additional training to staff during in-service training and as need arises 2
Reinforce fall prevention policies through newsletter articles, brochures and bulletin board postings 3
Offer patients and caregivers information and education opportunities 4

8. Physical Strengthening/Therapy
Address physical functioning/strength issues
May include referral to a physical therapist
May include recommendation for an assistive device
Individually tailored strength training to increase patient’s coordination and muscle function

9. Pre-dialysis Risk Assessment
Ask patient about falls occurring since previous dialysis-most falls occur at home during the first half of the interdialytic interval
Post dialysis and orthostatic hypotension do not safely predict falling risk
Determine need for physician notification and/or adjustment in dialysis heparinization
Enter information into patient’s medical record
The Pre-Dialysis Assessment represents a key line of defense against patient falls when conducted before every dialysis treatment.
Each patient should be asked if any falls have occurred since their last visit.
All pertinent information from the assessment is entered into the patient’s medical record for future reference.
If the patient has experienced a prior fall, adjustment of dialysis heparinization by the physician may be needed.

10. Physician Notification
When serious injury results from a fall
When falls occur in the dialysis facility
When there is any acute change in patient condition subsequent to a fall
When there is a head injury with active bleeding

11. Dialysis Heparinization
For patients who have fallen prior to dialysis treatment, anticoagulation may be adjusted
Heightened alert for patients receiving Warfarin
Prothrombin time/International Normalized Ratio before dialysis subsequent to fall or injury
Consider decreasing/withholding heparin
The importance of reporting every patient fall is critical to the adjustment of anticoagulants, as this can contribute subsequent falls.
Staff should be particularly attentive to the possible need for adjustment after a fall for patient’s receiving Warfarin.
Subsequent to a fall or injury, a Prothrombin time/International Normalized Ratio should be conducted before dialysis.
Finally, decreasing or withholding heparin may be necessary for patients who have fallen.

13. Which of the following is NOT a contributing factor to patient falls?
Poor physical functioning
No record of prior falls
Living Alone
Impaired Cognition
ID Fluid Removal
Which of the following is NOT a contributing factor to patient falls?
Poor physical functioning.
No record of prior falls.
Living Alone.
Impaired Cognition.
ID Fluid Removal.

14. Which of the following is NOT a contributing factor to patient falls?
Poor physical functioning
No record of prior falls
Living Alone
Impaired Cognition
ID Fluid Removal

15. Which of the following IS part of an effective patient falls risk assessment?
A. Knowledge of patient’s likes and dislikes
B. Review of patient punctuality
C. Number and age of close family members
D. Home environment questionnaire
E. Level of interaction with other patients

16. Which of the following IS part of an effective patient falls risk assessment?
A. Knowledge of patient’s likes and dislikes
B. Review of patient punctuality
C. Number and age of close family members
D. Home environment questionnaire
E. Level of interaction with other patients

17. TRUE OR FALSE?
Recommending the use of assistive devices to patients is inappropriate in dialysis centers.

18. TRUE OR FALSE?
Recommending the use of assistive devices to patients is inappropriate in dialysis centers.

19. TRUE OR FALSE?
Recommending the use of assistive devices to patients is inappropriate in dialysis centers.
FALSE
Recommending assistive devices may be part of effectively addressing patient physical functioning and strength issues affecting the risk of patient falls.

20. Prior to dialysis, patients should be asked about?
Any falls that have occurred since their last dialysis treatment
Falls occurring ONLY in the dialysis facility
Any fall that resulted from dizziness
ONLY falls that resulted in injury

21. Prior to dialysis, patients should be asked about?
Any falls that have occurred since their last dialysis treatment
Falls occurring ONLY in the dialysis facility
Any fall that resulted from dizziness
ONLY falls that resulted in injury

22. The physician must be notified:
When a patient requests physician notification
ONLY when the fall results in serious injury
ONLY when a fall occurs in the dialysis facility
D. When there is any acute change in patient condition subsequent to a fall
E. ONLY if the fall was witnessed by two or more people

23. The physician must be notified:
When a patient requests physician notification
ONLY when the fall results in serious injury
ONLY when a fall occurs in the dialysis facility
D. When there is any acute change in patient condition subsequent to a fall
E. ONLY if the fall was witnessed by two or more people

24. Adjustment in dialysis heparinization should be considered:
ONLY if a patient requests it
When a Prothrombin time/International Normalized Ratio has been performed
When a patient receives Warfarin
When a patient has fallen prior to dialysis treatment.

25. Adjustment in dialysis heparinization should be considered:
ONLY if a patient requests it
When a Prothrombin time/International Normalized Ratio has been performed
When a patient receives Warfarin
When a patient has fallen prior to dialysis treatment.

26. Additional Resources
Tool for Preventing Falls - Joint Commission –
National Institute for Health and Clinical Excellence –
Falls among hemodialysis patients: potential opportunities for prevention? Clinical Kidney Journal–