Your patient attempts to sit down in the bedside chair after ambulating in the hallway with crutches

Patient falls are the most reported patient safety events in British Columbia and account for 40% of all adverse events (BCPSLS, 2015). Falls are a major priority in health care, and health care providers are responsible for identifying, managing, and eliminating potential hazards to patients. All patient-handling activities (positioning, transfers, and ambulation) pose a risk to patients and health care providers. Older adults may be at increased risk for falls due to impaired mental status, decreased strength, impaired balance and mobility, and decreased sensory perception (Titler, Shever, Kanak, Picone, & Qin, 2011). Other patients may be at risk due to gait problems, cognitive ability, visual problems, urinary frequency, generalized weakness, and cognitive dysfunction. Specific treatments and medications may cause hypotension or drowsiness, which increase a patient’s risk for falls (Hook & Winchel, 2006).

Fall Prevention Strategies

All clients should be assessed for risk factors, and necessary prevention measures should be implemented as per agency policy. Table 3.7 lists factors that affect patient safety and general measures to prevent falls in health care.

Lowering a Patient to the Floor

A patient may fall while ambulating or being transferred from one surface to another. If a patient begins to fall from a standing position, do not attempt to stop the fall or catch the patient. Instead, control the fall by lowering the patient to the floor. Checklist 31 lists the steps to assisting a patient to the floor to minimize injury to patient and health care provider (PHSA, 2010).

Special considerations:

• Use a falls risk assessment tool for all patients according to agency policy.
• Younger patients may not be aware of the effects of medication and treatments leading to dizziness and orthostatic hypotension.
• Inform patients and family members about the potential risks for falls in the hospital. If informed, people are more likely to call for assistance.
• Always ensure call bell is in place. Many falls occur due to incontinence issues. The call bell allows patient and family to obtain assistance quickly.
• If appropriate, educate patient about home maintenance and safety to prevent falls when returning home.
• Fall prevention is interdisciplinary. Proper communication by the care team is required to prevent falls.

Take this Lowering a Patient to the Floor course for more information on lowering a falling patient to the floor.

Video 3.7

Watch the video Assisted Fall by Kim Morris, Thompson Rivers University.

1.  Name four fall prevention strategies that will help keep a patient safe when ambulating in the hospital.
2. A patient is ambulating for the first time after surgery. Is it safe to encourage the patient to ambulate independently?
3. Many physiological risk factors can be identified from a routine assessment. Name three risk factors and three prevention strategies to manage these risks. For example, if a patient has frequent toileting needs, a preventive action is to offer assistance to the toilet every hour, and to ensure the call bell is within reach at all times.

Additional Videos

Video 3.8

Watch the video How to Use a Hammock Sling by Kim Morris, Thompson Rivers University.

Video 3.9

Watch the video How to Use a Hygiene Sling by Kim Morris, Thompson Rivers University.