Tom Sharon
Standard tool for calculating the level of risk of falling


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How to Prevent Falls and Injuries

Nurses are required without exception to prepare a care plan for all new patients. Moreover, they must also review and update these plans daily. Many nonmedical people think of nursing as a task-oriented menial and subservient job. But nursing is in fact a health science with an independent body of knowledge based on academic methodical research conducted at major universities throughout the world. One major benefit of this is that nurses can independently diagnose and treat human responses to existing and potential health problems.

Accordingly, a nurse has to figure out how a patient is likely to respond to biological and psychological changes, social interactions, and environmental influences. In so doing, nurses must learn to calculate the probability of untoward events -accidents- for each patient. They must then plan for and implement ways to prevent occurrences.
In keeping with this form of accountability, nursing leaders have devised a standard tool for calculating the level of risk of falling and implementing protocols for prevention. This tool takes each of the risk factors listed above and assigns a numerical value. The nurse adds the values present, and the total determines whether the risk is low, moderate, or high. The actual numbers vary from one institution to another and are not important because they all translate to the three basic levels of risk.
Patients who are considered low risk can still fall and get hurt, and they often do. Perhaps because a patient is rated low risk, the staff conclude that there is no risk, which actually increases the likelihood of an accident because there is less vigilance with preventive measures. The standard prevention protocols, which are inadequate, are as follows:
  Teach the patient about the dangers of falling and to call for assistance before attempting to get out of bed.
  Keep the side rails up at the head of the bed.
  Keep the call bell within reach.
  Provide immediate response to calls for assistance.
  Keep urinals and bedpans within reach.
  Keep water and other fluids within reach.
  Keep other personal items within reach.
  Conduct pain assessments and take action to relieve discomfort.
  Make rounds at night at least once per hour to check..
The nurses actually have to do all of these things. If they disregard any of these items, there is a potential for disaster. And even when they overlook nothing, people still fall and sustain serious injury. As said before, the missing element is continuous monitoring. There are advertisements on the Internet offering wide scanning wireless video surveillance cameras that transmit the images to a desktop computer. The retail price is about $80 each for the complete kit. A hospital with five hundred beds would need to purchase about two hundred kits for a total cost of $16,000 less volume discounts. The desktop computers at the nurses' station could carry multiple images of those rooms under observation. Even at four times the price, it would be a small amount to pay for added patient safety.
Moderate risk involves people who seem to be lucid and oriented to person, place, and time but have some physical impairment predisposing them to falls. Additionally, moderate risk could pertain to someone who has no physical impairment but is slightly confused at times (there are no absolutes in calculating risk). In any event, the four side rails should remain up at all times, and there should be a requirement for more frequent bed checks. The rest of the items remain the same. These people should also be no more than five doors away from the nurses' station.
High-risk individuals are likely to fall or harm themselves or others unless constantly monitored. These people are always confused and/or continuously uncooperative. Sometimes there is a risk of violent or suicidal behavior. High-risk patients generally require a person within arm's length at all times. The charge nurse usually accomplishes this by assigning a nurse's aide to sit with the patient and provide custodial care. Sometimes various forms of restraints are necessary, especially if there is a risk of a combative patient assaulting the sitter. Often, combative behavior results from the patient being frightened and not understanding what is going on. Such patients believe that they are fighting for their lives. The staff members must be educated to this point and refrain from reacting with anger or disdain. Having a family member remain with the patient whenever possible helps to alleviate much of the fear factor because this is someone with whom the patient is familiar. It does not always work but it can be most helpful, and as my Jewish mother always said, "It couldn't hurt."
Patients or family members should always ask the nurse to state what risk level he or she has assigned. It is also advisable to ask the nurse to provide a copy of the fall prevention care plan. Additionally, for those who wish to engage in community activism, attend the next community board meeting at your hospital and lobby for more video surveillance. If the hospital is severely strapped for cash (as many are), then it would be most helpful to plan a fund-raising drive to pay for such equipment.

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