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Safety in Mobility

Overview of Fall Risk Management

  • Nursing Course Context: Course focused on nursing safety practices related to mobility, specifically fall risk management.

  • Instructor: Lauralee Ballash, Nursing 221 class.

  • Schedule: Week of September 22, 2025.

Introduction to Patient Safety

  • Definition of Patient Safety:

    • Defined by the Canadian Patient Safety dictionary as the pursuit of the reduction and mitigation of unsafe acts within the healthcare system.

    • Also includes the use of best practices proven to lead to optimal patient outcomes (Sears et al, 2020, pp. 263).

Objectives of the Lab Lecture

  • Primary Goals:

    • Discuss safety and principles of good back health.

    • Review good body mechanics.

    • Evaluate posture alignment.

    • Discuss the impact of a fall on both client health and the health system.

    • Identify clients at risk for falls using a fall risk tool.

    • Complete a functional assessment using a case scenario.

Importance of Body Mechanics

  • Nurse Safety:

    • Nurses must practice good body ergonomics to prevent injuries:

    • Maintain proper body alignment.

    • Ensure safe movements and posture.

    • Patient Safety:

    • Nurses must assess the patient’s alignment, movements, and posture to minimize injury risk (Kostiuk & Arvidson, 2020).

Fundamentals of Body Alignment

  • Body Alignment Components:

    • Includes head, neck, shoulder, sacral area, center of gravity, knee, ankle, and hip joint.

    • Key conditions to monitor for include:

    • Forward tilt of head.

    • Curving of upper spine.

    • Flattened lumbar spine.

    • Hip and knee flexion.

Understanding Posture, Alignment, and Gait

  • Posture and Alignment Definition:

    • The relationship between body parts aligned along a horizontal or vertical line, avoiding excessive strain on any muscle or joint.

  • Balance Concept:

    • Achieved when the center of gravity is over a stable base of support, enhanced by good posture.

  • Gait Definition:

    • The manner or style of walking, which includes rhythm, cadence, and speed. Proper body alignment aids in maintaining balance and posture (Vihos & McCutchan, 2019).

Definition and Implications of Falls

  • Defining a Fall:

    • An event leading to a person resting inadvertently on the ground, floor, or lower level, with or without injury.

    • Considered a "complex multifactorial phenomenon" and a potential indicator of a worsening health condition (RNAO, 2017).

Types of Falls

  • Classification by Healthcare Excellence Canada:

    • Falls can be:

    • Anticipatory: Preventable through screening and communication.

    • Unanticipated: Occurs unexpectedly.

    • Accidental: Result from unforeseen events.

Statistics on Falls

  • Leading Cause of Injury:

    • Falls are a major cause of injury deaths, hospitalizations, and disabilities.

  • Demographics of Falls:

    • Approximately 30% of people over 65 fall at least once yearly, increasing to 50% for those over 80 years old.

    • 95% of hip fractures are linked to falls; 20% of hip fractures lead to death (RNAO, 2017).

Effects of Falls on Quality of Life

  • Falls can lead to:

    • Decreased quality of life and independence.

    • Increased anxiety, reduced physical activity, and deconditioning, resulting in a higher risk of further falls (RNAO, 2017).

Initiatives in Fall Prevention

  • Example Program:

    • Finding Balance Program: A health promotion initiative focused on fall prevention (https://findingbalancealberta.ca/).

Risk Factors for Falls

  • Identifying Risk Factors:

    • Over 400 risk factors identified.

    • Factors can be modifiable (by intervention) or non-modifiable (e.g., age).

    • Poor communication among healthcare team members may also increase fall risk (RNAO, 2017).

Fall Risk Management Policy: AHS PS-58

  • Components of the policy include:

    • Prevention and Screening

    • Assessment and Intervention

    • Data collection and evaluation

    • Continuous practice improvement (AHS, 2015).

Best Practice Guidelines for Falls

  • RNAO Recommendations:

    • Implement universal fall precautions in healthcare settings to benefit all patients.

    • Screen all adults for fall risk.

    • Tailor interventions based on identified risks and healthcare settings (RNAO, 2017).

Universal Fall Precautions

  • General Strategies:

    • Address environmental hazards, such as trip hazards and ensuring adequate lighting and signage (RNAO, 2017).

Tools for Identifying Patients at Risk

  • Assessment Tools Include:

    • Functional Gait Assessment (FGA)

    • Hendrich II Fall Risk Model

    • St. Thomas Assessment Tool (STRATIFY)

    • Schmid Falls Assessment Tool

Detailed Schmid Falls Assessment Tool for Patients 65 and Older

  • Assessment criteria for:

    • Mobility:

    • (0) No gait disturbance

    • (1) Ambulates or transfers with an assistive device

    • (1) Unsteady gait, no assistance

    • (0) Unable to ambulate

    • Mental Status (Mentation):

    • (0) Alert, oriented x3

    • (1) Periodic confusion

    • (0) Comatose

    • Elimination Needs:

    • Scored based on independence with toileting, incontinence, etc.

    • Fall History:

    • Scoring based on history of falls before or during admission.

    • Current Medications:

    • Score for use of medications that increase fall risk (AHS, 2014).

Case Scenario Practice: Jane Jones

  • Patient Profile:

    • 86-year-old female with a history of falls.

    • Ambulates well with a walker and is oriented but has urinary incontinence.

    • Takes Digoxin and has fallen twice in the past six months.

Assessment Using Schmid Falls Assessment Tool

  • **Scoring for Jane Jones: **

    • Steady with walker = 1

    • Alert and oriented = 0

    • Independent but with occasional incontinence = 1

    • Digoxin use = 0

    • Previous falls = 1

  • Total Score Calculation:

    • Outcome indicates she is at risk for falls.

Intervention Strategies for Jane Jones

  • Recommended Interventions:

    • Use clear communication with patient and family about fall risk.

    • Conduct regular comfort rounds every 2-3 hours for basic needs.

    • Ensure bed height is appropriate and call bell is accessible.

    • Assess abilities for using a call bell and walking devices correctly and provide appropriate non-slip footwear.

    • Maintain a clutter-free environment (Vihos & McCutchan, 2019).

Additional Interventions

  • Enhancement Options:

    • Provide sensory aids (e.g., eye wear).

    • Conduct a medication review.

    • Suggest dietary changes and an exercise program.

Protocols After a Fall Occurs

  • Immediate Response:

    • Assess for injuries and provide treatment.

    • Monitor for injuries that may not be immediately apparent, based on AHS monitoring schedules.

    • Determine contributing factors for falls through post-fall assessments.

    • Modify or add to the care plan if needed (RNAO, 2017).

Important Protocols After a Fall

  • Key Actions Include:

    • Do not move the patient; seek help immediately.

    • Perform vital signs and conduct a thorough head-to-toe exam.

    • Keep monitoring vital signs for up to 48 hours post-fall, particularly for high-risk individuals and those with head injuries.

Student Responsibilities as Nursing Students

  • Initial Actions:

    • Assess for signs of life (airway, breathing, consciousness).

    • Provide reassurance and call for help if the patient is breathing and has a clear airway.

    • If a head injury is suspected or the fall was unwitnessed, immobilize the head and keep the patient still until help arrives.

Investigating Root Causes of Falls Using the 5 Whys Technique

  • Example of Cause Analysis:

    • Why did the fall occur? – The patient tripped.

    • Why did they trip? – Their foot caught the edge of a chair.

    • Why was the chair positioned there? – Someone didn’t return it after use.

    • Why was it cluttered? – Too many visitors brought in extra chairs.

Preventive Questions for Fall Management

  • Key Inquiries:

    • Have any patient falls or near misses been recorded recently?

    • Are falls risk assessments being conducted universally?

    • What preventive measures can be taken immediately to enhance patient safety?

    • What support from leadership could improve safety practices?

Course Theme and Interrelations

  • Nursing 221 Emphasis on Safety:

    • Each week, a core theme of safety is emphasized within the course, culminating in certification in "It’s Your Move."

References

  • Key Literature and Guidelines:

    • Alberta Health Services (2015). Falls risk management policy. PS-58.

    • RNAO (2017). Clinical best practice guidelines: Preventing falls and reducing injury from falls.

    • Vihos, J., & McCutchan, J. (2019). Activity and exercise. In B. J. Astle & W. Duggleby (Eds.) Canadian fundamentals of nursing. Elsevier Canada.