The Seriousness of Fall Assessments

One of the most important issues in nursing is falls. Now I realize that, as nurses, we all hate doing fall assessments, post-fall notes, and post-fall neuro checks. And we don't hate them for the sake of patient safety (of course we realize they're important and need to be done!). We hate them because they add more work onto our already substantial workload.

When completing an assessment on any patient, look for reasons that they would fall. This can include advanced age, altered gait, and disease processes that affect balance and coordination such as Parkinson's disease and Multiple Sclerosis. Not all patients who fall are high risk... but many are! One of my favorite bloggers Marijike (self described "nurse writer") found a study conducted by researchers that involved having patients wear sensors that analyzed different gait variables. The study found that just a reduction in gait speed of 5cm/second was associated with an 86.3 percent probability of falling within the following three weeks. Does your patient have an altered gait? Does she stumble turning corners? Is her stride length shorter?

Now check your fall risk assessment and make sure it reflects what you see. Not all fall risk assessment tools are created equal. If you believe your patient is at risk for falls, your documentation better confirm it whether it's easily chartable or not.

Next, perform some interventions so that you don't look dumb when the patient, you know, falls. I say when because it's sadly an eventuality for most of us, at least related to age. Here are some interventions that can dramatically reduce the patient's risk of falling.

• Apply a fall bracelet. Stupid, but true. Alerting staff to the fact that the patient is a fall risk may cause them, for example, to wait for a patient using the bathroom rather than let the patient perform the action independently.
• Ensure a clear path to the bathroom. When you gotta go, you gotta go. Who hasn't had to run to the bathroom to prevent an accident before? What if you were unstable doing it but didn't want to embarrass yourself and did it anyway? 
• Place obvious items within reach. That may be a call bell, cell phone, remote, or drink of water. Anticipate the need and get it within grasp.
• Check the patient's footwear. Sneakers with a good base and traction are best for stability, but even rubber grip slipper socks are better than bare feet. Encourage your patient to wear their best option. Flats can be slippery and flip-flops especially are a tripping hazard.
• Ask the patient to ask for help. Some patients don't want to bother you because "you looked so busy." Remind them of all the fall paperwork and incident reports you have to fill out if they fall. Tell them it takes you five minutes to help them in the bathroom and fifty-five minutes to do charting after a fall. Say whatever you have to say to keep them safe.