It might surprise you to learn that at Monash Health, one of our biggest organisational risks is patient falls.
Nursing Clinical Practice Project Officer and Falls Sub-Committee secretariat Gina Moschos says we have many falls across the health service each month and there are important risk factors to look out for and actively manage.
Gina said watching out for risk factors such as patients with toileting trouble, visual impairment, mobility issues or those who have been prescribed multiple medications can help clinicians identify who is at higher risk for falls when moving around – and who may need some additional support.
“Most of our patients that fall are people aged over 65-years, with male patients more likely to experience a fall resulting in harm.” she said.
“Patients who are clinically unwell, patients with cognitive impairments and our culturally and linguistically diverse patients also have a higher risk for falls,” she said.
During April Falls Month, Clinical Practice Nurse Consultant and Falls lead Jess Baker said it was a great time for nurses, midwives, allied health clinicians and medical practitioners to create sustainable practices at the bedside to mobilise patients safely and prevent immobility harm.
“Taking advantage of incidental activity is key, for example, encouraging patients to sit out of bed for their meals if they are able to,” she said.
It’s important to engage patients in discussions around their own capabilities to help reduce the risk of falls.
Immobility harm is when harm comes to a patient because of being immobile and not moving around, which is more common in a hospital and clinical setting. It can cause a higher risk of functional decline, pressure injuries, delirium, venous thromboembolism and namely falls, but can also have poor psychological impacts as well.
“If you’re lying in bed all day, you can imagine how hard it can be; patients can deteriorate mentally and become disengaged from their care, particularly if they were previously very active at home,” Jess said.
To help further prevents falls, it’s important for clinicians to prevent muscle wasting and improve co-ordination, balance and strength by implementing the following:
- Ensure patients are completing at least 150 minutes of mobilisation activities per week, specific to their ability
- Keep rooms well-lit and free from clutter.
- Incorporate more movement and incidental exercise into a patient’s daily routine such as going for a walk while doing an assessment or check-in.
- Complete hourly rounding, ensuring patients are asked each time if they need to go to the toilet, and actively engaging them in exercises such as sitting up and standing up.
- Involve patients in early discussions around what they need to be aware of and what their own capabilities are, as many patients overestimate their abilities, to ensure they understand what requirements need to be met for discharge.
- Ensure patients, as well as maintaining a balanced diet, are kept hydrated to assist in strength and co-ordination.
- Support patients to walk around the ward and become familiar with their surroundings.
When in doubt about whether it is safe to engage a patient in movement, both Gina and Jess said clinicians should defer to the Give it a Go! Guide.
“We have a real challenge with falls, and we need to think about addressing it from a different perspective by implementing behavioural and cultural changes in relation to mobilisation, as well as existing practices like risk assessments and care planning,” Gina said.
To further sharpen your knowledge about falls prevention, several extra resources have been made available to our employees including:
- Extra training sessions throughout April including informative webinars – attendance can be registered via the Falls Intranet Page
- A comprehensive Falls Toolbox for clinicians
- The ‘National Standards Training – Preventing Falls and Harm from Falls’ eLearn is available to complete on LATTE to help support clinicians to understand and deliver effective falls prevention and management strategies
- A range of Monash Health policies, procedures, patient information and clinical guidelines related to falls prevention and management are accessible via PROMPT
For even more information on falls prevention and the above, please see the complete Give it a Go! Guide and head to the dedicated Falls Prevention page on our Intranet.
Approved by Falls Committee Chair, Karin White