Falls Prevention Best Practice

For older patients suffering from delirium or cognitive impairment, where it is unsafe for them to mobilise or transfer without help, individual observation and surveillance must be increased, and help with transfers must be provided as required. Ideally, one-on-one supervision should be applied for those patients with a mobility impairment for which they lack insight (eg cognitive impairment), and who impulsively attempt to exit their bed or chair without assistance. A fall happens in a split second and if there is no nurse in the immediate vicinity it is more likely than not that the patient will fall, sustaining a life-threatening fracture.

There is evidence for the benefits of this approach from nonrandomised controlled trials. Bed exit alarms have not been assessed adequately in appropriate trials, but they are increasingly being used for similar patients, to alert nursing staff when a high-risk patient attempts to climb out of bed. I don’t think that more research is required to see whether these devices are effective in reducing falls rates in hospitals and residential aged care facilities.

My preference is for one-on-one supervision 24/7. That means three nurses/carers every day to remain with the patient the whole time.

References

Donoghue J, Graham J, Mitten-Lewis S, Murphy M and Gibbs J (2005). A volunteer companion-observer intervention reduces falls on an acute aged care ward. International Journal of Health Care Quality Assurance Incorporating Leadership in Health Services 18(1):24–31.

Preventing Falls and Harm From Falls in Older People Best Practice Guidelines for Australian Hospitals 2009. Australian Commission on Safety and Quality in Health Care (ACSQHC).