Revised Fall Prevention Guidelines will be published soon, and include universal fall prevention interventions. These are mostly common sense ways to keep every patient's room environment safe and free of obstructions.  

Universal Fall Prevention for all Patients

• Keep bed height at lowest functional level
• Keep equipment that patient may need within reach
• Ensure call light within reach & respond to calls promptly
• Ensure that patient has access to personal assistive devices such as eyeglasses, hearing aids, etc.
• Orient patient to environment
• Encourage non-skid footwear
• Eliminate environmental hazards, maintain clutter-free environment

These interventions are called Universal because the goal is to use them as general safety precautions for all patients.  

Fall prevention in elderly hospitalized patients should also include measures to prevent delirium.   Elderly patients are particularly at risk for delirium once they leave their familiar environment. Things that further increase this risk are:

• Polypharmacy (multiple prescriptions increase risk of medication interactions
• All medications used for sleep or to decrease anxiety
• Metabolic disruption and infection
• Sleep interruption and/or sleep deprivation.

 Sensory deprivation is also a factor associated with delirium, and can result from:

• Decreased kinesthetic stimulus (the sensation of bodily motion)
• Reduction in sources of social interaction
• Decrease in variety of environmental stimulus

 Use of restraints for fall prevention

Patients have the right to not be restrained just because they MIGHT fall.  If a patient is unsteady and has the potential to fall, all appropriate alternatives to restraints must be considered and trialed. Patients and/or family should be involved in planning what may work to keep them safe. If alternatives are not effective and the patient is cognitively impaired then the least restrictive safe restraint possible should be used. Use of restraint for fall prevention is not appropriate for patients who are not cognitively impaired.

 The patient may still end up falling even after all we do, maybe even more than once. Our job as healthcare workers is to keep the patient from sustaining serious injuries. Knowing the negative outcomes to a patient of being in restraints (e.g. pressure sores, incontinence, contractures, depression, etc.), we must weigh the benefits of using restraints against the risks. The decision should always be based on individual patient evaluation, as what works best for one patient may not work for another.

Quiz