Nurses’ knowledge, attitude, and fall prevention practices that are designed to improve patient safety.

1. BY WONG PEI YIN (CHARISSA) BSN, SRN
FALL PREVENTION AND
MANAGEMENT IN HOSPITAL

2. FALLS
Definition:
• Sudden
• Unintentional
• Change in position
• Coming to rest on the ground
or other lower level

3. 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

4. STATISTICS HOSPITAL
SITE BEDSIDE
TOILET
ACTIVITY TRANSFERRING
WALKING
SHIFT 9PMTO 7 AM
YOUNG POSTURAL HYPOTENSION
ELDERLY MULTIPLE COMORBIDS
UNACCOMPANIED BY FAMILY

6. POSTURAL HYPOTENSION
• A drop in Blood Pressure (20/10mmhg) after standing up

7. 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.

9. GAIT ASSESSMENT
•How does the patient mobilise?
Independent
Dependent
With aid
Without aid

10. Ensure correct footwear
Frequent checks
Prepare walking aid next
to patient
Assist patient in
mobility

11. CONTINENCE & BLADDER
PROBLEMS
• Incontinence
(loss of bladder or bowel control)
• Frequency
(Needing to pass urine often)
• Urgency
(Needing to go in a hurry)
• Nocturia

12. GRAB BAR INTHE
TOILET
BEDPAN OR URINAL BOTTLE BESIDE PATIENTS
WEAR
PAMPERS

13. • Unable to see
• Poor contrast
• Colour contrast

14. INCREASE LIGHTING
ACCOMPANY PATIENT
REMOVE OBSTACLE AND ENSURE FLOOR IS
CLEAN

15. ATTIRE

16. BED RAILS UP
LOCKING CASTER
KEEPING BEDS INTHE
LOWEST POSITION

17. MORSE
FALLS SCALE

18. 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.

19. 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.

20. 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.

21. IV OR IV ACCESS
SCORE DESCRIPTION
0 No
20 Patient has an intravenous apparatus or a saline/heparin lock
inserted.

22. 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.

23. 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.

24. 65

25. 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.

26. 35

27. 5 FALLS INTERVENTION TASKS

28. 5 EDUCAT
ION
AIDS
SUPERVI
SION
Falls Intervention
Tasks
FALLS ALERT
Tag Bedhead
Tag Patient
SUPERVISION
ASSISTANCE
AIDS
Mobility
Vision
Hearing
COMMUNICAT
E
Patient
Family
Team
BED
Height
Railings
Locked

29. 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.

30. 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

31. BED
• HEIGHT OF BED should
always be adjusted accordingly.
• Railings should be PUT UP if
required.
• Bed should be LOCKED at all
times.

32. 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.

33. 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.

34. WHATTO DO
AFTER A FALL?

35. REPORT - ALL FALLS
- Witnessed
- Unwitnessed
- With injury
- Without injuries

36. 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

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

38. REPORTING
INCIDENT
REPORT

39. WHATTO INCLUDE IN REPORT??
When
Where
How
Why
Vital signs
Injury
Action taken

40. THANKYOU
PREVENT
FALLS
SAVES
LIVES