1. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Chapter 11 Preventing Falls All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

2. Falls   Falls are the most common accidents in nursing centers.   The risk of falling increases with age.   A history of falls increases the risk of falling again.   Falling is often a sign of other health problems.   Persons older than 65 years are at risk. 2 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

3. Causes and Risk Factors for Falls   Most falls occur in resident rooms and bathrooms.   Falls are most likely to occur:   Between 1600 (4:00 PM ) and 2000 (8:00 PM )   During shift changes   Poor lighting, cluttered floors, incorrect bed height, and out-of-place furniture are causes; so are wet and slippery floors, bathtubs, and showers.   Wheelchairs can cause falls if they do not fit the person or are in poor repair.   Needing to use the bathroom, usually to urinate, is a major cause of falls. 3 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

4. Fall Prevention Programs   Nursing centers have fall prevention programs.   Common sense and simple safety measures can prevent many falls.   The goal is to prevent falls without decreasing the person’s quality of life.   The entire health team must protect the person from harm. If you see something unsafe, tell the nurse at once. Do not assume the nurse knows or that someone is tending to the matter.   The care plan also lists measures for the person’s specific risk factors. 4 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

5. Bed Rail Regulation   Bed rails   A bed rail (side rail) is a device that serves as a guard or barrier along the side of the bed. Bed rails are raised and lowered. They lock in place with levers, latches, or buttons. Bed rails are half, three quarters, or the full length of the bed.   If a person needs bed rails, keep them up at all times except when giving bedside nursing care.   Bed rails present hazards. Entrapment is a risk.   Bed rails are considered restraints by OBRA and the Centers for Medicare & Medicaid Services (CMS) if: The person cannot get out of bed. The person cannot lower them without help.   Accrediting agency standards and state laws affect bed rail use. 5 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

6. Bed Rail Regulation (Cont’d)   Bed rails cannot be used unless needed to treat a person’s medical symptoms. The need for bed rails is carefully noted in the person’s medical record and the care plan.   Bed rails are allowed when the person’s condition requires them.   If a person uses bed rails:   Check the person often.   Report to the nurse that you checked the person.   If you are allowed to chart, record when you checked the person and your observations. 6 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

7. Hand Rails, Grab Bars, Wheel Locks-Safety Devices   Hand rails are in hallways and stairways.   Grab bars are in bathrooms and in shower/tub rooms.   Bed legs have wheels. Each wheel has a lock to prevent the bed from moving. They are locked at all times except when moving the bed.   Make sure bed wheels are locked:   When giving bedside care   When you transfer a person to and from the bed   Wheelchair and stretcher wheels are locked during transfers. 7 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

8. Transfer/Gait Belts   A transfer belt (gait belt) is a device used to support a person who is unsteady or disabled.   It helps prevent falls and other injuries.   The belt goes around the person’s waist.   Grasp under the belt to support the person during the transfer or when assisting the person to walk. 8 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

9. The Falling Person   Falling may be caused by:   Weakness, lightheadedness, or dizziness   Fainting   Slipping or sliding on spills, waxed floors, throw rugs, or improper shoes   Do not try to prevent the fall.   If a person starts to fall, ease him or her to the floor.   Do not let the person move or get up before the nurse checks for injuries. 9 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

10. After a Fall   An incident report is completed after all falls.   A confused person may not understand why you do not want him or her to move or get up after a fall.   You may need to let the person move for his or her safety or your own.   Never use force to hold a person down.   Stay calm and call for help. 10 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

11. Quality of Life   Residents have the right to feel safe. Fear of falling does not make a person feel safe.   A fall can seriously affect a person’s quality of life.   Some persons may feel restricted by the use of safety devices.   Before moving a person, explain what you are going to do and what he or she needs to do. Also give step-by-step instructions as you progress. Do not move the person without telling him or her first. These measures help increase the person’s comfort.   Do not let the person talk you out of performing a safety measure or using a safety device. Safety is always a priority.   You must help prevent falls.   You must not interfere with the person’s rights. 11 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.