Identifying Cues to Prevent Inpatient Falls Among High-Risk Patients

Recognizing the Unspoken

Author: Jacqueline Wastephen, Nurse Extern – Trident Medical Center (Post Surg), BSN-RN Student, Charleston Southern University/MA Communications

Mentors: Chrissy Smalls (Manager, Post Surg), Linda Davies (Educator, 7th floor), and Mellisa Grossman (Director 5th & 7th Floor), et al.

Introduction

Inpatient falls according to the BMC Health services Research are indicators of poor quality of care, thus necessitating thorough investigations into their causes. These incidents despite the Morse fall scale categorization during admission can happen suddenly, leaving patients on the floor with new and severe injuries, triggering rapid response protocols, disrupting services, revealing process gaps, and causing self-guilt among sitters. Tragically, falls can even result in loss of life.

No patient intends to fall or cause distress to the nursing care team. Falls typically occur due to health challenges and situational struggles, including feelings of hopelessness, pain, and mental challenges related to their conditions. This underscores the need for vigilant and empathetic care.

Hospital sitters play a crucial role in safeguarding high fall-risk patients, whose vulnerability often demands constant vigilance. Falls among these patients can lead to severe complications, extended hospital stays, increased healthcare costs, and serious legal consequences. Understanding and identifying subtle cues from these patients is essential for preventing falls and ensuring their safety.

The Silent Struggle: A Personal Experience

"Why did the patient fall twice in the same shift?"

This troubling question lingered after I was briefed about my shift. During a 12-hour shift, I was determined to figure out why?

I was responsible for a high fall-risk patient with a severe traumatic brain injury (TBI). This technically nonverbal patient posed a significant communication challenge. Unlike all the other patients I had sat whether on restraints or not, this one was different. I had a patient fall in my shift once and I had vowed never again, but how?

Despite the patient’s silence, they exhibited repeated cues indicating a need; I was troubled for all reasons. However, I was determined to answer the why? Remember, the patient had already experienced two falls on a different floor, in the same shift. So, what was the meaning of the nonverbal cues? After careful consideration, I realized the patient was thirsty.

Initially, the patient’s behavior seemed erratic and concerning and I was becoming anxious! Struggling to lean towards the edge of the bed and using an immobile hand to signal distress, apparently, they were attempting to reach out to an empty cup by the sink, some meters away. Recognizing this, I quickly addressed his need for drinking water which he gobbled several milliliters at once. This experience underscored the importance of being attuned to nonverbal cues and changes in a patient's behavior.

The Importance of Vigilant Observation

Vigilant observation is crucial for patient safety in nursing care. Sitters and nursing staff must cultivate awareness and empathy to understand these signals. Here are some strategies to enhance this vital skill:

1. Active Observation: Constantly monitor the patient’s movements, facial expressions, and body language. Even minor changes can indicate discomfort or unmet needs.
2. Understanding Baseline Behavior: Familiarize yourself with the patient's usual behavior patterns. Deviations can provide critical clues about their condition.
3. Communication with Care Team: Regularly share observations with the nursing team so that everyone is on the lookout.
4. Environmental Adjustments: Ensure the patient’s immediate environment is safe and comfortable, with frequently used items within reach to minimize fall risks, Note: you would rather clean up than regret the consequences.
5. Empathetic Engagement: Approach the patient with empathy and patience to significantly impact their comfort and willingness to communicate, even non-verbally.

The Dilemma of Restraints

High fall-risk patients often end up in restraints to prevent injuries. While restraints can be a safety measure, they also lead to emotional, social, and personal isolation, depriving patients of essential human interactions and dignity. Restraints can exacerbate feelings of frustration, anxiety, and helplessness, making it even more crucial to identify and address their needs promptly and effectively.

Legal Implications of Falls

Falls in hospitals pose threats to patient safety and have serious legal implications. Hospitals and healthcare providers can face lawsuits, penalties, and reputational damage if a fall is deemed preventable. This adds urgency to the need for vigilant observation and proactive care to prevent falls.

Tailoring Care to Individual Needs

Different patients with different conditions require tailored care. Sitters should take the time to learn the specific needs of each patient and act appropriately. Ignorance can increase agitation, as patients may feel ignored, leading to falls or other forms of self-harm. It is crucial to be vigilant and responsive to each patient's unique signals.

Real-Life Applications: Enhancing Patient Safety

By recognizing and responding to nonverbal cues, sitters can significantly reduce fall risks and the need for restraints. For example, a patient attempting to get out of bed might be trying to reach for water or a personal item. Remember, patients are human and the moment they realize they are facing isolation measures like restraints or a sitter, they would react differently in return – they want to be treated as normal people regardless.

In my experience with the TBI patient, understanding the signals for thirst allowed me to address the needs proactively, building a sense of trust and thus preventing agitation and potential 3rd and 4th falls.

Conclusion: The Power of Awareness

Sitters and nursing staff have the power to make a substantial difference in the safety and well-being of high-risk fall patients. By honing observational skills and understanding nonverbal cues, they can prevent falls, reduce the need for restraints, and improve patient outcomes. This proactive approach also minimizes the legal risks associated with patient falls.

In the fast-paced hospital environment, where every second counts, the ability to decode nonverbal cues is key to preventing falls and ensuring the safety of our most vulnerable patients.