FALL PREVENTION AND

MANAGEMENT IN HOSPITAL
BY WONG PEI YIN (CHARISSA) BSN, SRN
FALLS
Definition:
• Sudden
• Unintentional
• Change in position
• Coming to rest on the ground
or other lower level
 FALLS STATISTICS

In general 1 in 3, aged > 65 falls per year

• 3-5 fall events per 1000 patient days
• 30% injury
• 10% severe injury eg. head trauma and fracture
• Those who had a fall, stays an average 8 days
longer
 STATISTICS HOSPITAL

SITE BEDSIDE
TOILET
ACTIVITY TRANSFERRING
WALKING
SHIFT 9PM TO 7 AM

YOUNG POSTURAL HYPOTENSION

ELDERLY MULTIPLE COMORBIDS

UNACCOMPANIED BY FAMILY
POSTURAL HYPOTENSION
• A drop in Blood Pressure (20/10mmhg) after standing up
POSTURAL MANAGEMENT

Drinking (500ml) glasses of water helps

expand plasma volume. It also, increasing
the standing systolic blood pressure by
more than 20 mm Hg for about 2 hours
and improving symptoms and
orthostatic endurance.

The head of the bed of a patient should

be elevated by 20 degree to decrease
nocturnal hypertension and nocturnal
diuresis

Physical counter maneuvers involve

isometric contracting the muscles below
the waist for about 30 seconds at a time,
which reduces venous capacitance,
increases total peripheral resistance, and
augments venous return to the heart.
GAIT ASSESSMENT

• How does the patient mobilise?

Independent
Dependent

With aid
Without aid
Ensure correct footwear

Prepare walking aid next

to patient

Frequent checks

Assist patient in
mobility
 CONTINENCE & BLADDER
PROBLEMS
• Incontinence
(loss of bladder or bowel control)
• Frequency
(Needing to pass urine often)
• Urgency
(Needing to go in a hurry)
• Nocturia
GRAB BAR IN THE
TOILET

BEDPAN OR URINAL BOTTLE BESIDE PATIENTS

WEAR
PAMPERS
• Unable to see
• Poor contrast
• Colour contrast
 INCREASE LIGHTING

REMOVE OBSTACLE AND ENSURE FLOOR IS

CLEAN

ACCOMPANY PATIENT
ATTIRE
 BED RAILS UP

KEEPING BEDS IN THE

LOWEST POSITION
LOCKING CASTER
MORSE
FALLS SCALE
HISTORY OF FALLING
SCORE DESCRIPTION

O Never fall

25 Patient has fallen during the present hospital admission or if

there was an immediate history of physiological falls, such as
from seizures or an impaired gait prior to admission.

Note: If a patient falls for the first time, then his/her

score immediately increases by 25.
SECONDARY DIAGNOSIS

SCORE DESCRIPTION

0 Only one diagnosis is listed on the patient’s chart.

15 More than one medical diagnosis is listed on the patient’s chart.

AMBULATORY AID

SCORE DESCRIPTION

0 Patient walks without a walking aid (even if assisted by a nurse),

uses a wheelchair, or is on bed rest and does not get out of bed
at all.

15 Patient uses crutches, a cane, or a walker.

30 Patient ambulates clutching onto the furniture for support.

 IV OR IV ACCESS

SCORE DESCRIPTION

0 No

20 Patient has an intravenous apparatus or a saline/heparin lock

inserted.
MENTAL STATUS

SCORE DESCRIPTION

0 Ask the patient, “Are you able to go to the bathroom alone or do

you need assistance?” If the patient’s reply judging his/her own
ability is consistent with the activity order on the Kardex, the
patient is rated as “normal”.

15 If the patient’s response is not consistent with the activity order

or if the patient’s response is unrealistic, then the patient is
considered to overestimate his/her own abilities and to be
forgetful of limitations.

Mental status is measured by checking the patient’s own self-assessment of

his/her own ability to ambulate.
 Scenario 1

 Mr. Azman is 55 years old man and has been

diagnosed post stroke seizure with medical illness
diabetes and hypertension for 10 years. He fell in the
toilet due to fitted at home. He was admitted for
investigation.

 He presented left leg weakness due to old stroke,

able independent and do ADLs by himself, mobilize
at home using walking aid.

 He is on amlodipine 5 mg od , aspirin 150 mg od,

Actrapid 12 u tds, Insulatard 16 u ON.
65
 Scenario 2

 Madam Brown, a 65 years old female, was admitted

and has been diagnosed early stage Parkinson
disease, with resting tremor, balance issue and
decreased strength/ROM. She experienced a minor
fall 1months ago.

 Able to walk about 200meter to garden and

performed ADLs independently.

 Currently none medication, received prescription for

madopar.
35
5 FALLS INTERVENTION TASKS
Falls Intervention
Tasks
5
AIDS
SUPERVISION Mobility
ASSISTANCE Vision EDUCAT
Hearing
ION

SUPERVI COMMUNICAT
BED AIDS E
SION
FALLS ALERT Height Patient
Tag Bedhead Railings Family
Tag Patient Locked Team
FALLS ALERT

• Patients BED HEAD

CHART should be tagged
within 24 hours of admission.

• ALL patients should be

TAGGED when leaving the
ward for investigations.
SUPERVISION &ASSISTANCE

• All patients with HIGH RISK of

FALLS should be assisted for ADLs
during their stay in the hospital.

• Some patients may be able to

ambulate independently with aid.
CLOSE SUPERVISION is required
for all ambulating patients
BED

• HEIGHT OF BED should

always be adjusted accordingly.
• Railings should be PUT UP if
required.
• Bed should be LOCKED at all
times.
AIDS

• PLEASE prepare the CORRECT walking

aid next to the patient and teach the
patient the correct way in using these
equipment.
• Ensure APPROPRIATE footwear is
available.
• HEARING AID & GLASSES should
be worn during their stay in the ward.
COMMUNICATION

• PLEASE ADVICE the patient to ask

for assistance for all ADLs.
• PLEASE INFORM patient’s family, if
patient is assessed to be of HIGH
RISK of falls.
• PLEASE hand over the patient with
HIGH RISK of FALLS every shift and
INFORM other ALLIED HEALTH
involved.
WHAT TO DO
AFTER A FALL?
 REPORT - ALL FALLS

- Witnessed
- Unwitnessed

- With injury
- Without injuries
IMMEDIATELY AFTER A FALLS

• Attend to patient
• Determine if there is injury and if patient needs
immobilisation
• If not, return patient to
bed or chair
• Assess and document

Notification
 ASSESS AND DOCUMENT??

• Lying standing BP
INFORM
• Heart rate
• Doctor on call
• Signs and symptoms post fall
• Doctor in charge next
• All injuries and action taken
morning
• Location of fall
• Staff nurse next shift
• Site of fall
• Sister in ward
• How patient fall
• Other allied health
• Family members
 REPORTING

INCIDENT
REPORT
WHAT TO INCLUDE IN REPORT??

When
Where
How
Why
Vital signs
Injury
Action taken
 PREVENT
FALLS
SAVES
LIVES

THANK YOU