Falls – Prevention Guidelines

A fall may be defined as ―an untoward event, which results in the patient coming to rest unintentionally on the ground or other lower surface‖ (Morris et al, 1980)

1. Environmental: a. State of the floor or ground (Uneven surfaces or irregular features on stairs) b. Any contaminants (objects or liquids) c. Height of furniture d. Lack of handrails and e. Type of footwear. 2. Lighting: poor lighting and visual effects may affect the patients‘ ability to walk safely. 3. Medication: sedation and antipsychotic medication may affect a patients mobility 4. Physiological: a. Extremes of age. b. Poor eyesight in elderly c. Brittle bones in elderly make the consequences worse. 5. Other patient factors: These include confusion, general strength which may be associated with a medical condition.

1. On Admission a. Do the Fall Risk Assessment by the Nursing Officer b. If any of the factors are present then the patient would need a comprehensive assessment by nursing officer

2. On-going Ward Assessment a. The treating team will frequently review the risk of falling in the ward setting. b. Assessment and review should be guided by a fall risk assessment tool c. High risk group

1. Multifactorial risk assessment

1.1 Detailed history 1.2 Assessment of gait, balance, mobility and muscle weakness 1.3 Assessment of functional status and fear of falling 1.4 Assessment of visual impairment 1.5 Assessment of cognition and neurological examination 1.6 Assessment of urinary incontinence

2. Medication review

Medical assessment on admission with regard to risk/benefit analysis of medications with due consideration as to whether they increase the risk of falls If at least one factor is present from annexure (above) then Medical assessment on admission with regard to conditions that might lead to increased risk of falling (e.g. epilepsy) Review of clinical condition or/ and medication by the medical team as frequently as required.

3. Multifactorial interventions

3.1 Risk/benefit analysis of medications in regard to sedative medications - try to avoid benzodiazepines in old age patients 3.2 Review medication frequently to avoid side effects. 3.3 Allocate a bed with side rails ; but use caution as confused patients may try to climb over it and may get injured. 3.4 Consider giving a bed close to the wash rooms 3.5 Strength and balance training by the physiotherapist when indicated

Use of walking aids for necessary patients after assessing the risk of injury with the aids (may be applicable to geriatric unit) a. Staff to support the patients who cannot mobilize without support b. Observation through CCTV or direct observation c. Manage incontinence d. Correction of visual impairment

1. Preparing FLOW CHARTS on what to do following a fall and to display them in the wards.

1.1 Immediate management – A, B, C, 1.2 Inform Medical Officer

1.3 Carry Out detailed assessment regarding injuries 1.4 Necessary investigations depending on assessment- CT brain, X-rays 1.5 Head injury observation if needed 1.6 Fill the incident form as soon as possible. 1.7 Assess the causes for the fall and modify the factors to prevent future risk in the patient.

3. Staff training a. Doctors , nurses and support staff training once a year b. Educating the staff on falls risk assessment, measures to minimize falls risk, techniques of holding a patient.

2. Support Staff should a. Liaise with nursing staff in reducing risks of falling b. Ensure that the floor is kept dry all the time c. Assist patients for safe mobility d. Yearly for the permanent staff and for new staff