A fall in the hospital happens in an instant, but it can change a life forever. Too often, a patient was on the road to recovery until a fall happened, and then everything went downhill. When a fall causes a major injury like a hip fracture – as it does so often in an elderly patient – the fall can even lead directly to the patient’s death.
Many falls in the hospital can be prevented. But that takes planning by the hospital staff.
Here is a list of the medical risk factors for falling that MUST be assessed by the staff to see if the patient needs special protections. This list comes from the Department of Veterans Affairs’ National Center for Patient Safety. Explanations for some terms are inserted by Patrick Malone. (Note that this list was written for health care providers but it’s useful to show all the things that hospital staff and families need to think about to prevent falls.)
The VA says that if ANY of these medical factors are present, fall prevention interventions need to be put in place.
- Agitation/Delirium- infection, toxic/metabolic, cardiopulmonary change, CNS (central nervous system), dehydration/ blood loss, sleep disturbance.
- Medications: psychotropics, CV [cardiovascular] agents (digoxin especially), anticoagulants (increased risk of injury), anticholinergic, bowel prep, diuretic (thiazides>loop diuretics)
- Orthostatic hypotension [blood pressure drops when standing up], autonomic failure
- Frequent toileting
- Impaired mobility
- Impaired vision, inappropriate use of assistive device/footwear
- History of Falls
- Antihistamines/benzodiazipines- withdrawal has shown decrease in falls risk.
- Antidepressants- Tricyclics higher risk than SSRI, but SSRI’s have risk as well, high level of phenytoin;
- Cardiac drugs/antihypertensives-
- Anticoagulants – subdural hematomas are rare; avoid only if very unstable gait or balance, concurrent use of alcohol, or other drugs that interact and increase bleeding, or non-compliant with regimen or lab follow up
- Drugs treating nocturia [bedwetting] (consider tamsulosin due to lower risk of orthostasis)
In addition to these medical factors, external hazards need to be eliminated, such as tripping hazards from electric cords, slippery surfaces, etc.
Fall Prevention Techniques
Many things can be done to reduce risk of falls, such as adjusting medications, having staff closely watch the patient, or implementing other safeguards.
Technology, either high-tech or low-tech, also can help prevent falls. Examples include:
- Bed and chair exit alarms.
- Nurse call systems and communication systems.
- Low beds for patients at risk for falls.
- Video camera surveillance.
- Non-skid floor mat
- Raised edge mattress.
Falls are often the beginning of the end for a healthy elderly person. In the hospital, the most common cause of a fall is no surprise: the patient has to go to the bathroom in the middle of the night, in an unfamiliar place, and may have medicines on board that add to confusion and wooziness. They punch the call button. The nurse never seems to come. So they try to negotiate the trip on their own. And the predictable happens. Read More…
Consult with an Experienced Malpractice Attorney
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