Best Practices for Nurses to Prevent Falls in Older People

As a nurse, you have a duty of care to ensure your patients do not come to any harm whilst under your supervision. Knowing how to prevent falls in older patients is vital. As a nurse, you should be able to recognize a change in your patient’s risk of falling, and be able to effectively communicate this to other members of the health care network.

The Australian Commission on Safety and Quality in Healthcare has published advice on the best practices to prevent falls.  As a result, some hospitals have introduced falls prevention programs. These use a combination of falls prevention care plans based on the individual’s needs and routine interventions that are delivered alongside the program.

How you can help prevent falls

• Play a pivotal role in the care plans of older patients based on the outcome of their screening or assessment.
• Make fall prevention a part of older people’s routine care.
• Take part in coordinated discharge planning.

Fall prevention intervention guidelines

The following fall prevention guidelines are highly recommended for inclusion in routine healthcare practice:

• Review all medications regularly.
• Arrange routine physiotherapy reviews for any patients suffering from mobility problems.  To do this, first communicate with both the staff and the patient to establish the patient’s mobility status.  Then always ensure walking aids are placed on the side of the bed the patient feels more comfortable to get up from.  Actively encourage the patient to get/keep involved in some kind of exercise as prolonged bed rest can cause further health problems.  Supervise or assist the patient as required.  When arranging rehabilitation, organize sessions that are physiotherapist-led that aim to improve balance, such as tai chi.
• Always ensure older patients have any visual aids they need to hand.
• Carry out routine screening to detect any urinary tract infections that may be present.
• Measure the patient’s blood pressure to identify any significant drops.
• Ensure patients know how to correctly use any assistive devices such as walking frames or canes.
• Record any relevant training staff, patients, or carers undergo.
• Have a clear policy in place for reducing the use of bedside rails and restraints and having alternatives in place instead.
• Establish a care plan to ensure bowel and bladder function is maintained.
• Consider introducing vitamin D supplements with calcium to older patients who can still walk as part of a routine management plan.  For those less mobile, consider osteoporosis management.
• Make sure that any patients being discharged or transferred to another unit are aware of their medications and doses, as is the relevant medical team.
• Make sure that higher-risk patients are stationed closer to the nurse’s area.
• Maintain a safe environment at all times by making sure all beds are in the appropriate positions and that rooms are kept clutter and spill-free.  Ensure their bathroom has the appropriate safety railing and shower commodes chairs. Ensure adequate lighting is provided in all rooms, and make sure patients know where their belongings are at all times.
• Consider alarm devices or hip protectors for those who are at high risk of falling.
• Take the patient to their rest area and make sure they know how to get help should they need it.  Some elderly people may have cognitive impairment and might need you to do this several times before it sinks in so just be patient with them.