Editing Infection Control and Safety (section)

== Fall Prevention ==

Falls are among the most common adverse events in hospitals and long-term care. Prevention begins with structured risk screening on admission, after any change in condition, after a transfer, and after a fall, using a validated tool such as the Morse Fall Scale or the Hendrich II Fall Risk Model.

=== Risk factors ===

* '''Intrinsic:''' history of falls (the strongest single predictor), age over 65, muscle weakness and gait or balance impairment, orthostatic hypotension, confusion or delirium or dementia, impaired vision or hearing, peripheral neuropathy, urinary urgency and incontinence or nocturia, pain, and fear of falling.
* '''Medications:''' benzodiazepines and other sedative-hypnotics, opioids, antipsychotics, antidepressants, anticholinergics, antihypertensives, diuretics, insulin and sulfonylureas, and above all polypharmacy. Anticoagulants and antiplatelets do not cause falls but greatly increase the harm from one.
* '''Extrinsic:''' clutter, wet floors, poor lighting, inadequate footwear, high beds, unlocked wheels, tubing and cords, unfamiliar environment, and equipment such as intravenous poles and drains.

=== Interventions ===

Keep the bed in the '''lowest position with wheels locked'''. Place the call light, phone, water, tissues, and glasses '''within reach''' and confirm the patient can demonstrate use of the call light. Provide nonskid footwear. Ensure adequate lighting including a night light and a clear path to the bathroom. Use hourly or purposeful rounding addressing the four Ps: pain, position, personal needs (toileting), and placement of belongings. Offer scheduled toileting rather than waiting for a request. Assist with the first ambulation after surgery, sedation, or prolonged bed rest, and check orthostatic blood pressures. Use a gait belt and appropriate assistive devices. Consider a bed or chair exit alarm, a low bed with floor mats, video monitoring, or placement near the nurses' station. Communicate risk with the facility's visual cue system and in handoff.

'''Side rails.''' Two upper side rails are generally used as a mobility aid and a reminder. '''Raising all four side rails, or any configuration that prevents the patient from leaving the bed voluntarily, is a restraint''' and carries the risk of entrapment and of a more injurious fall over the rail. Assess for entrapment risk in patients who are confused or small in stature.

=== After a fall ===

'''Assess the patient before moving them.''' Check level of consciousness, vital signs, pain, and for deformity, shortening or external rotation of a leg suggesting hip fracture, and head injury. Perform neurologic checks if the head was struck, the fall was unwitnessed, or the patient takes anticoagulants. Notify the provider and the family per policy, treat injuries, and reassess the fall prevention plan. Document objectively what was found, what the patient said, the assessment, and the actions taken. An '''incident or occurrence report is an internal quality document''': complete it, but do not chart in the medical record that one was filed and do not place a copy in the chart.