Orthopedists see fractures from falls more than they would care to. Even a relatively young patient in the confusing situation of a hospital room can end up falling if the healthcare provider isn’t careful. However, it is the older adult that is at the greatest risk for falls and for complications from the falls.
Unfortunately, when falls occur and bones break, some patients are too debilitated to fully recover from the injury and subsequent surgery. For this reason, it is vitally important that that those patients at high risk of falling receive special attention when they are under the care of a health professional.
Of course, management stresses the prevention of falls, and many in-service meetings are on how to identify those most at risk. In the interest of keeping it simple, you should really focus on a few common sense practices that are going to keep your patient safely in bed.
Fall risk assessments are great, but most everyone that comes through the door of a hospital or care home is at risk of a fall. In this case, it helps to treat every patient, young and old, as a risk and perform these three simple assessment tasks before you leave the room.
All nurses and care providers know to ask if a patient needs something before leaving the room. Most of the time, this is to prevent the call light coming on immediately upon walking out the door. It is also a great way to prevent falls, broken bones, and fractured hips. Patients tend to get out of bed because they need something minor and don’t want to bother anyone. Now, many patients are confused and get out of bed for no reason, but these are generally the exception and not the rule.
For oriented patients who are unsteady on their feet, it helps to go through a predetermined list to make sure all their needs are met. First, ask if they need to use the toilet, as this is the number one reason they will try to get out of bed. Second, ask if they need anything to drink or eat. Pull the over bed table close to them so that they can reach everyday items – glasses, books, hard candy, and so on – without having to move from the bed.
Finally, make sure that call bell is in reach. Always explain to ring for help before they get out of bed, no matter how small a reason. Oriented patients usually understand these rules when explained carefully and with compassion.
Keep Rooms Clear
So much stuff seems to pile up in rooms. The bed itself takes up 75 percent of the space, but then you figure in tables, guest chairs, walkers, and patient belongings, and the amount of available space quickly diminishes. As health care professionals, we know how to work around them. It isn’t beyond our ability to reach over a ton of people and furniture to change the bag on an IV pole. Unfortunately, this clutter can lead to falls, even when patients are supervised.
Clearing the room may seem like housekeeping, and it may even seem like a futile exercise. It is important, though, for preventing the tripping that can come with an unsteady patient. Try to minimize the number of chairs in the room, and assure the patient more can be brought in for extra guests. Attempt to strategically place the tables to keep a clear runway between bed and bathroom.
Most patient excursions are to the toilet, and this is probably the most important area to keep clear. Also, ensure that equipment is nearby. IV poles should be on the side that will facilitate exiting the bed. Walkers should be close by the exit point to keep the patient from reaching for it on their own. Even those who walk with assistance should have their equipment placed nearby for emergency runs to the restroom.
Use Alarm Technology
Finally, alarm technology is useful for patients who are not oriented. In most states, putting up all the side rails is a restraint, and not all confused patients qualify for a dedicated sitter. In fact, most patients don’t need them. Most of the time, the alarm will remind the patient where they are and that they need to call for help. Unfortunately, this population of patients is most susceptible to falls and broken hips. Furthermore, they are also the ones who don’t recover well from the trauma of the fall, and it can lead to worsening of their conditions.
Not all alarm technology is created equal, and you need to know how to work the system that your facility has in place. It helps to test the equipment, as well, because sometimes the alarm has taken too much abuse to properly function.
Many newer beds now have movement alarms built into them, and they can be set to go off if the patient sits up, moves to the end of the bed, or stands. These alarms are tricky to use and sometimes malfunction, so check that your equipment is reliable, especially with patients likely to ambulate without your help.
Portable alarm systems are somewhat easier to use, but proper positioning and integrity of the alarm box can be questionable. You should also immediately respond to any alarm that goes off, even if momentarily. Some patients are clever enough to disable the alarm, ambulate without assistance, and wind up breaking their hip. For their safety and health, bed alarms and fall assessments are vital in preventing this common orthopedic emergency.
This post was provided by Sports and Spine Orthopaedics, specialists in operative and minimally invasive surgical procedures to treat injured joints. Learn more about these conditions and treatments and ask more questions on their facebook page.
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