Running head: FALLS

Falls
Katherine Sheppard
Bon Secours Memorial College of Nursing

NUR3206

Honor Code:
On our honor, I have neither given nor received aid on this assignment or test, and I pledge that
I am in compliance with the BSMCON Honor System.

Abstract

Falls are a serious issue in nursing practice because of the detrimental effects that it can have for
the patient and staff members. There are many risk factors that nurses should be aware of and
help to prevent falls at their facilities. Like many complications; falls can be prevented by
following seemingly simple steps that are backed by scientific evidence. Falls need to be

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monitored and reported so that nurses and other healthcare personnel can continue to improve.
By identifying the causes of falls and how to prevent falls nurses can better care for their
patients.

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Falls affect one out of three older adults and according to the Centers for Disease Control

and Prevention falls are the leading cause for fatal and nonfatal injuries (Centers for Disease
Control and Prevention, 2015). Falls continue to be a large issue in nursing practice and because
of this nurses need to be educated on the causes of falls and how to prevent them. Educating
nurses on fall risk and prevention will not only help the patients safety but it will also help to
decrease medical costs. In 2013, the direct medical costs of falls, adjusted for inflation, were
$34 billion dollars (Centers for Disease Control and Prevention, 2015). As you can you can see
falls are a problem in the healthcare field that need to be addressed and there are many causes
that can help maintain patient safety.
The first thing a nurse can do to control the problem of falls is to evaluate the
surroundings. There are many questions that a nurse can ask regarding the environment: How is
the lighting? Is the walkway clear of clutter? Is the patients bed or chair in a locked position
at all times? Are call bells easily accessible for patients to call if help is needed? All of these
are good questions and lead the nurse to begin a thorough assessment of patient risk factors in
the environment. Evidence shows that adequate lighting helps prevent falls, so the nurse should
ensure there is appropriate lighting for the patient (Hatcher, Field-Sykes, & Dowd, 2014). An
example of providing adequate lighting could be the use of a night light during the evening
hours. Other extrinsic factors that increase the patients risk of falls include the use of throw rugs
and slippery floors (Lippincott Procedures, 2015). The causes of falls does not end with the
environment; another cause of falls could stem from the use or disuse of equipment. One thing
that should be noted when a floor is wet is whether or not the use of a wet floor sign has been
used. In many instances with not only patients, but staff members, a wet floor sign has not been
placed where it is visible for the person to see, resulting in a fall. To promote safety for the

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patient eliminate all of the risks mentioned by minimizing clutter, securing carpets, placing
handrails, and securing loose wirers (Lippincott Procedures, 2015).
We have discussed many issues of what we can change in the environment that could
result in a fall but what happens when there are other factors that we cannot? What do we do to
help our patients who are at risk for falls because of medication or vision issues? According to
the reading on Fall Prevention by Lippincott some intrinsic or physiological factors include
weakness, vertigo, orthostatic hypotension, depression, failing eyesight, and functional or
cognitive impairment (Lippincott Procedures, 2015). When a patient is admitted to the hospital
during the admission process there should be an assessment of the patient. Some facilities use
scales to measure out how high of a risk a patient is for falls. One common standardized fall
scaled is the Morse Fall Scale (MFS). The MFS is a method to determine fall risk using six items
that have been established as a reliable and valid tool. (Morse, 2002). The Morse Fall Scale is
used to assess the patient on arrival to the facility and when the patient has any changes in status.
Some parameters that the tool uses include: the patients history of falls, secondary diagnosis,
ambulation tools (crutches, cane, and walker), medication therapy, gait, and mental status. The
higher the number on the Morse Fall score then the higher the fall risk is for the patient. (The
Morse Fall Scale Training Module, n.d.). Each of the six categories that the Morse Fall Scale
assess can be a cause of a fall. Examining if a patient has a history of falls in the past could help
the nurse to determine what interventions should be done for the patient to prevent a future fall.
Fall bands and signs have been used in hospitals to indicate the risk of the patient alerting other
healthcare personnel. A history of one or more recent falls, for any reason, within six months
should also be listed as a problem in the patients record (National Guideline Clearinghouse,
2011).

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Elderly patients aged 65 or older are more at risk for falls. The Centers for Disease

Control and Prevention (2015) examines those who are at risk for fall related deaths and injuries
and states In 2013, about 25,500 older adults died for unintentional fall injuries (Centers for
Disease Control and Prevention, 2015). Some ways that the patient can help to reduce falls
include exercise to improve balance and avoiding environmental hazards. Annual visual
examinations are another way that the older adult can prevent falls.
Medication is a huge risk factor for falls. Lippincott (2015) lists classes of medications
with potential adverse effects that could increase the patients risk of falls. One main adverse
effect to each medication include hypotension and sedation. The medication classes that effect
falls are diuretics, antihypertensive, beta-adrenergic blockers, nitrates, vasodilators, tricyclic
antidepressants, antipsychotics, benzodiazepines, antihistamines, opioids, hypnotics, antidiabetic
drugs, and alcohol (Lippincott Procedures, 2015). The nurse should assess the medication list of
the patient and consult with the interdisciplinary team regarding ways to assist patient with risks.
Many of the causes stated are preventable or observable. Patients who experience
complications of falls can have minor to major injuries that could be prevented by the nurses.
Education on fall causes should continue to be taught throughout the hospital and other facilities
to maintain patients well-being.

Root Cause Analysis of a Safety Problem: Falls

Equipment:
- Is the bed in the
lowest position?
- Are wheels locked
on beds and chairs?

Environment:
- Does the patient have adequate
lighting?
- Is the patients pathway clear of
clutter?
- Are there signs that indicate fall
risk to make others aware?
- are we cleaning up spills

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Falls

Policy/Procedures
- Are the policies clear
on how to prevent falls?
The policy for this
assignment will follow
Mary Immaculate Fall
reduction program
(Hatcher, Field-Sykes, &
Dowd, 2014)

Personnel:
- Are we monitoring the patients medications
that affect balance?
- Is the patient asking for assistance when
needed?
- Does the patient wear their non-slip footwear
when he/she is out of bed?
- Is staff assisting with transfers?
- Does the patient have a fall band?
- How is the patients vision?

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References
Centers for Disease Control and Prevention. (2015, March 15). Falls Among Older
Adults: An Overview. Retrieved from Centers for Disease Control and
Prevention:
http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
Hatcher, T., Field-Sykes, K., & Dowd, C. (2014, January). Fall Reduction Program.
Retrieved 2014, from Mary Immaculate Hospital Policy and Procedure Manual:
http://spweb/localsystems/virginia/locations/maryimmaculate/policiesandproc
edures/Provision%20of%20Care/falls2015.pdf
Lippincott Procedures. (2015, January 09). Fall Prevention. Retrieved from Lippincott
Procedures:
http://www.healthstream.com/HLCSCP/hstmfiles/hstmdeliver.aspx?
configuration=1%7c902b96a7-71bd-db11-bf7b000423d6b5c1%7cFalse&registration=d3c93cd2-e82a-558c-a2914ed50e92c2bf
Morse, J. M. (2002, January 10-11). Enhancing the Safety of Hospitalization by
Reducing Patient Falls. Retrieved 2015, from Science Direct:
http://www.sciencedirect.com/science/article/pii/S0196655302000184
National Guideline Clearinghouse. (2011). Falls and Fall Risk in the Long-term Care
Setting. Retrieved from Agency for Healthcare Researh and Quality:
Advancing Excellence in Health Care: http://www.guideline.gov/content.aspx?
id=32669
The Morse Fall Scale Training Module. (n.d.). Retrieved from Partners Healthcare:
fall_tips_toolkit_mfstrainingmodule. pdf

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