Falls Prevention

The following excerpt is from the ANMF’s Falls tutorial on the Continuing Professional Education (CPE) website.

Falls can impact an individual in many ways. These impacts can cause physical injuries, have negative social consequences and induce psychological distress. Therefore falls prevention programs are essential to decrease the risk of an individual falling and experiencing these negative effects.

The World Health Organization (WHO) defines a fall as ‘an event which results in a person coming to rest inadvertently on the ground or floor or other lower level’.¹

Any falls-related injuries are classified as fatal or non-fatal, with most falls being within the non-fatal category.

• Although most falls are non-fatal, worldwide 37.3 million people require medical attention every year due to falls.
• Worldwide, falls are the second leading cause of death resulting from accidents of unintentional injuries
• People over 65 years of age have a higher risk of falling
• 30% of Australians over the age of 65 experience at least one fall per year
• In Australians aged over 65 years, falls account for 40% of all injury-related deaths
• With the population ageing, the number of people experiencing falls is also expected to rise.²

There are many different injuries associated with falling.

These include:

• Cuts and abrasions
• Soft tissue damage and bruises
• Fractures
• Head injuries

The hip and thigh are the most commonly injured areas following a fall that require hospitalisation.

Most hip fractures (91%) are caused by falls, and they are one of the most common reasons for hospital admission.

Hip fractures cause increased morbidity and increase the risk of death for the individual. They can also increase the likelihood that the individual will need to be admitted into a residential aged care facility following their fall and injury.

Wrist fractures are also a common injury following a fall due to the instinct to use your hands to break your fall. These injuries can be severely debilitating for the individual and result in a decrease in their level of independence.

People who have fallen can also develop a fear of falling and lose confidence in their ability to walk. This can then reduce their independence and consequently their quality of life. An increased burden can then be placed on their family and caregivers to undertake more care responsibilities for the individual.²

Facts

• Falls can occur in all age groups and in all environments.
• Adults over the age of 65 are more at risk of falling due to both environmental risk factors and personal risk factors.
• The more risk factors an individual has, the more likely it is they will fall.
• Both genders are at risk of falls equally. However, some studies have shown that males are more likely to suffer from fatal falls than females.
• Increased length of stay in a hospital setting increases falls risk.

Risk factors

Falls commonly result from a combination of risk factors as ‘the risk of falling increases with the number of risk factors that are present’.

The number of risk factors increases as a person ages.

Risk factors can be classified in a number of ways. One of the well-known methods is to classify them as either personal (intrinsic) or environmental (extrinsic).

Personal risk factors include individual characteristics such as age, gender, ability and health conditions.

Environmental risk factors refer to hazards found in and around the home and public places, such as uneven surfaces and the lack of hand or grab rails.³

The importance of falls risk screening and assessment

Falls risk screening and assessment tools identify patients at an increased risk of falling. They then prompt us to implement strategies to help decrease this risk of falling.

Screening can determine whether a person has a low or high risk of falls and assessment of risk can inform prevention strategies.

Currently, the National Standards require that all patients have a documented falls risk screen on admission to hospital and on transfer between settings.

Experts emphasise that drawing on our clinical judgement can be equivalent if not superior to using these types of tools. Given this, we should consider the following patients as having a higher risk of falling:

• Aged 65 and over.
• Aged between 50 and 64 who are at higher risk of falling (according to clinical judgement) due to an underlying condition, for example, Parkinson’s disease, stroke, early-onset dementia.
• All inpatients admitted following a fall.⁴

Falls risk assessments should be completed on those who have been determined at high risk of falling from the falls screening tool.

Any member of the multidisciplinary team can use falls risk screening and assessment tools.

The individual undertaking the assessment needs to understand and administer the tool, interpret the results and make any referrals as required.

Education needs to be provided to health care professionals before undertaking the use of the tool to ensure it’s used correctly.

Preventing falls – what nurses can do to help prevent falls?

Nurses play an important role in preventing falls. They are often the ones recognising a change in the patients’ falls risk status and communicating this change to other healthcare team members.

Nurses can:

• Ensure preventing falls is part of routine care for older patients and others who have identified risk factors.
• Ensure targeted and individualised falls prevention care plans are in place for older adults in hospital and others who have identified risk factors.
• Participate in coordinated discharge planning for the patient.
• Screen and assess all patients for their risk of falling and identify high-risk patients.
• Educate and discuss falls risk and falls prevention with staff, the patients and their carers.
• Orientate the patient to the bed area, room and ward.
• Ensuring the bed is at an appropriate height and the room is free from clutter or spills.
• Adequate lighting.
• The patient knows where their personal belongings are and can access them safely.
• Floor surfaces are clean, dry and not slippery.
• Ensure handrails are available to the patient.
• Use a non-slip mat when in the bathroom.
• Supervise the patient as required.
• Place any items the patient may need within easy reach, therefore eliminating the need for them to stretch to reach something and possibly fall.
• Place the call bell within the patients reach.
• Ensure that all walking aids are within reach of the patient.
• Ensure the patient is wearing the appropriate footwear.
• Organise physiotherapy review for patients with mobility difficulties.
• Ensure they know how to use any assistance devices such as walking aids.
• Place high-risk patients within view of the nurses’ station.
• Consider hip protectors and alarm devices for those at high risk of falling.
• Lock wheelchair, bed, commode and shower chair brakes before transfers.
• Ensure they have any sensory aids needed and these are in working order.²

It is important to consider all intrinsic and extrinsic risk factors that can increase the risk of falls for the patient.

The following information is a snapshot from ANMF’s Falls tutorial on the Continuing Professional Education (CPE) website.

The complete tutorial will give you two hours of CPD and covers the following topics: Falls facts, outcomes of falling, NSQHS Standards, risk factors, screening and assessment, risk assessment tools, preventing falls, restraints, hip protectors, communication, flagging, multidisciplinary teams, successful programs, what happens when a patient falls and incident reporting.

To access the complete tutorial, go to http://anmf.cliniciansmatrix.com

QNMU, NSWNMA and NT members have access to all learning on the CPE website free as part of their member benefits

For further information, contact the education team at education@anmf.org.au    /   anmf.org.au/cpe

References

1. World Health Organization (WHO) 2016. www.who.int/mediacentre/factsheets/fs344/en/. Accessed November 2019

2. Australian Commission on Safety and Quality in Health Care (ACSQHC) 2009. Preventing falls and harm from falls in older people: Best practice guidelines for Australian hospitals. safetyandquality.gov.au/wp-content/uploads/2012/01/Guidelines-HOSP1.pdf. Accessed November 2019

3. Queensland government. About falls risk factors. health.qld.gov.au/stayonyourfeet/for-professionals/about-risk-factors Accessed November 2019

4. Victorian government Department of Health (Vic. Govt.) 2019. Identifying falls risks./www2.health.vic.gov.au/hospitals-and-health-services/patient-care/older-people/falls-mobility/falls/falls-risks Accessed November 2019