Melissa A. Grier, MSN, APRN, ACNS-BC
Those of us who are klutzy realize that tripping, stumbling, and face-planting are part of everyday life. We pick ourselves up, dust off, and keep on moving. However, when our patient experience falls, they may not bounce back as quickly. Fractures, internal bleeding, and other injuries can add days or weeks to a hospitalization – not to mention the countless other negative implications associated with preventable falls. So, what can nurses do to help?
Talk About It
If you have worked in healthcare for any amount of time, you can probably talk about fall prevention in your sleep. But how often do we really talk to our patients about fall prevention? Is a pamphlet or a patient education leaflet the extent of what we provide? How can we make sure they get the message?
Making fall prevention part of your initial conversation with a patient and continuing to talk about it throughout treatment is the key. Although it may seem obvious that we need to prevent falls, it’s not high on the list of the things patients are worrying about. Tailor information about fall prevention to each patient's specific situation. Stress the importance of asking for help, especially when they’re in an unfamiliar setting (ie, in the hospital, connected to an IV pump or oxygen).
Encouraging your patients to call for help, however, means getting there quickly when they need you. A 5-minute wait while you finish adding a note to the chart may not seem like a long time to you, but it can seem like an eternity to your patient. Keep in mind that the same risk for falls (eg, pain, fatigue, dizziness, weakness) are the same things that make it difficult for them to sit on a toilet or commode for an extended period. If they’re kept waiting long enough, they’ll try to remedy the situation themselves, which is when a substantial number of falls with severe injury occur.
While we’re on the subject of toileting, let’s address the elephant in the room: protecting patient privacy. That’s what we think we’re doing when we leave a patient unattended for a few minutes while they use the restroom. The problem is, however, a few minutes can turn into 10 or 20. Patients may also experience an unforeseen complication that requires immediate attention. (Use your imagination. Anything that can happen will happen while your patient is on the toilet). If you're right there to address the situation, the likelihood of patient harm decreases significantly. Again, talk to your patient about why you're staying right there. Chances are they won't have a problem with your company.
There’s nothing more frustrating than running your tail off to keep your patients safe and coming back for your next shift to find out that one of them fell. Fall prevention can’t be the responsibility of 5 or 6 people on a large team of healthcare providers. It must be a priority for every person on your unit—even those who aren’t responsible for direct patient care. Volunteers, unit secretaries, and other ancillary staff may not be trained to assist patients with ambulation, but they can help by retrieving a personal item that’s out of reach or by providing reassurance until trained staff arrives.
Each time you enter a patient’s room, take a moment to look around. What environmental hazards might place them at risk while you’re out of the room? Cords running across the floor, small spills, and trash that missed the wastebasket are just a few things that can be quickly corrected. If you work in a clinic or an infusion center, consider the layout of each patient care area. Is there enough room to navigate with a walker or an oxygen tank? Are chairs locked and tray tables out of the way? Be mindful about the minutiae; overlooking something small may have a tremendous impact on your patient’s well-being.