Preventing falls
and
harm from falls
in hospital
Falls Prevention is everyones business
An event which results in a person
inadvertently coming to rest on the:
- ground
- the floor or
- other lower level
This can be from:
standing
a bed
a chair
1 in 3 of all patient incidents in
our hospitals involve a fall
Mostpeople who have a fall in
hospital are over 65 years of age
20%of falls occur outside of
aged care wards.
Falls in hospital some facts
NSW average 3.88 falls /1,000 occupied
bed day:
30-40% will result in a physical injury
60-80% are un-witnessed
70% occur around or from the bed
Medical Conditions Risk factors for falls
Stroke
Incontinence
Parkinsons disease
Dementia Sensorimotor & Balance
Delirium Muscle weakness
Impaired vision
Reduced peripheral sensation
Poor reaction time
Impaired balance
Medications
Psychoactives
Four or more medications
Environmental
Falls
Psychosocial & Demographic Poor footwear
History of falls Home hazard
Depression External hazard
Advanced age Inappropriate spectacles
Living alone
ADL limitations
Female gender
Inactivity
NeuRA 2012
Disorientation due to an unfamiliar
environment, noisy ward.
delirium fluctuating changes in
cognition: increased agitation, restless,
lethargy, aggression
acute infection
confusion postoperatively due to sedation
Death
Serious injury
Increased stay in hospital
Lossof independence -
changes in living arrangements
on discharge
Preventing falls
and Harm from Falls
in Older People
Guideline
Guidebook
Implementation guide
Australian Commission on Safety & Quality in Health Care
www.safetyandquality.gov.au
Screen Falls risk screen in ED, or
on admission to ward
Assess Falls risk assess and refer for
multidisciplinary input
Manage Implement interventions & if
possible multidisciplinary
plan of care
Report and Fall incidences & fall injury
monitor document in IIMS & notes.
Communicate with family.
Available from CEC website
www.cec.health.nsw.gov.
au/fallsprevention
ACSQHC 2009 Falls Best-
Practice Guidelines
Communicate falls risk
at staff- handover, and change of shift
document falls risk in patient notes-
(falls stickers)
discuss falls risk with patient
family/carer/friend & involve in care
plan
Available from CEC website
www.cec.health.nsw.gov.au/fallsprevention
CEC Post fall assessment & management
1. Immediate Response
initiate clinical care & call for assistance
rapid assessment- pain: bleeding: injury (do
not move until assessed check cervical spine
& immobilise if signs of injury)
take base-line observations
notify Medical officer
2. Observations & Monitoring for ALL Patients
At least hourly for a minimum of 4 hours:
then REVIEW
4 hourly for the next 24 hours or as clinically
required, then
REVIEW ongoing observations as required
(Seek clinical advice)
Ongoing Monitoring
If patient is on anticoagulants/antiplatelet therapy are at
HIGH RISK for bleeding if they fall
Call for medical review
CT may be indicated
If patient has fluctuating changes in confusion: aggression,
increasing confusion, agitation, restlessness or
changes in level of alertness (lethargy, flattened)
they are a high falls risk and may have a cerebral bleed.
Assess for Delirium
Call for medical review
CT may be indicated
If the patient has:
facial bruising, hit head when fell, or a
fracture
vomiting, headache
Call for medical review
CT may be indicated
Ongoing monitoring is important.
Note and report any changes in patients
condition
Communication & Documentation
all patient falls are to be reported to
medical officer
notify person responsible/family/carer
determine appropriate treatment options
with patient/ family & medical officer
document patient falls & communicate to
staff at handover
revise falls risk status and care plan
Communicate falls risk status and care plan
Patient, carers , families
GPs
Residential Aged Care facilities
Community Health Services: nursing, allied
health
Other health providers
Community Service Providers
Order on-line:
www.activeandhealthy.com.au
Falls Policy
PD2011-029
http://www.cec.health.nsw.gov.au/programs/falls-prevention.html
NSW Falls Prevention
network list serve
regular newsletters &
updates
annual Network forum
http://fallsnetwork.neura.edu.au
