Chapter 3. Safe Patient Handling, Positioning, and Transfers
Patient falls are the most reported patient safety events in British Columbia and account for 40% of all adverse events (BCPSLS, 2015). Falls are a major priority in health care, and health care providers are responsible for identifying, managing, and eliminating potential hazards to patients. All patient-handling activities (positioning, transfers, and ambulation) pose a risk to patients and health care providers. Older adults may be at increased risk for falls due to impaired mental status, decreased strength, impaired balance and mobility, and decreased sensory perception (Titler, Shever, Kanak, Picone, & Qin, 2011). Other patients may be at risk due to gait problems, cognitive ability, visual problems, urinary frequency, generalized weakness, and cognitive dysfunction. Specific treatments and medications may cause hypotension or drowsiness, which increase a patient’s risk for falls (Hook & Winchel, 2006).
Fall Prevention Strategies
All clients should be assessed for risk factors, and necessary prevention measures should be implemented as per agency policy. Table 3.7 lists factors that affect patient safety and general measures to prevent falls in health care.
Prior to ambulation consider the following risk factors:
|Look for fall risk factors in all patients.||Identifying specific factors helps you implement specific preventive measures. Risk factors include age, weakness on one side, the use of a cane or walker, history of dizziness or lightheadedness, low blood pressure, and weakness.|
|Follow hospital guidelines for transfers.||Transfer guidelines provide a good baseline for further patient risk assessments.|
|Orient patient to surroundings.||Orient patients to bed, surroundings, location of bathroom and call bell, and tripping hazards in the surrounding environment.|
|Answer call bells promptly.||Long wait times may encourage unstable patients to ambulate independently.|
|Ensure basic elimination and personal needs are met.||Provide opportunities for patients to use the bathroom and to ask for water, pain medication, or a blanket.|
|Ensure patient has proper footwear and mobility aids.||Proper footwear prevents slips.|
|Communicate with your patients.||Let patients know when you will be back, and how you will help them ambulate|
|Keep bed in the lowest position for sedated, unconscious, or compromised patients.||This step prevents injury to patients.|
|Avoid using side rails when a patient is confused.||Side rails may create a barrier that can be easily climbed and create a fall risk situation for confused patients.|
|Keep assistive devices and other commonly used items close by.||Allow patients to access assistive devices quickly and safely. Items such as the call bell, water, and Kleenex should be kept close by, to avoid any excessive reaching.|
|Data source: Accreditation Canada, 2014; Canadian Patient Safety Institute, 2015; Perry et al., 2014; Titler et al., 2011|
Lowering a Patient to the Floor
A patient may fall while ambulating or being transferred from one surface to another. If a patient begins to fall from a standing position, do not attempt to stop the fall or catch the patient. Instead, control the fall by lowering the patient to the floor. Checklist 31 lists the steps to assisting a patient to the floor to minimize injury to patient and health care provider (PHSA, 2010).
- Use a falls risk assessment tool for all patients according to agency policy.
- Younger patients may not be aware of the effects of medication and treatments leading to dizziness and orthostatic hypotension.
- Inform patients and family members about the potential risks for falls in the hospital. If informed, people are more likely to call for assistance.
- Always ensure call bell is in place. Many falls occur due to incontinence issues. The call bell allows patient and family to obtain assistance quickly.
- If appropriate, educate patient about home maintenance and safety to prevent falls when returning home.
- Fall prevention is interdisciplinary. Proper communication by the care team is required to prevent falls.
- Name four fall prevention strategies that will help keep a patient safe when ambulating in the hospital.
- A patient is ambulating for the first time after surgery. Is it safe to encourage the patient to ambulate independently?
- Many physiological risk factors can be identified from a routine assessment. Name three risk factors and three prevention strategies to manage these risks. For example, if a patient has frequent toileting needs, a preventive action is to offer assistance to the toilet every hour, and to ensure the call bell is within reach at all times.