Potential for Falls

Potential for Falls

Category / Primary Body System

• Musculoskeletal / Safety

Problem

• Patient is at risk for falls due to decreased muscle strength.

Goal

• Patient will not experience any falls with injury for the next 90 days.

Plan/Approach

1. Risk Assessment

   • Assess for risk of falls on admission, quarterly, and as needed to identify and address potential hazards.

2. Call Light Accessibility

   • Ensure the call light is within reach and check the patient frequently if they are unable to use it to call for assistance.

3. Toileting Needs

   • Monitor the patient for toileting needs to prevent falls related to urgent or frequent trips to the bathroom.

4. Physical and Occupational Therapy

   • Arrange for PT/OT evaluation and treatment as needed to improve muscle strength, balance, and mobility.

5. Medication Management

   • Administer medications as ordered and monitor for side effects that could increase fall risk, such as dizziness or sedation.

6. Lab Monitoring

   • Conduct lab tests as ordered to monitor for conditions that might contribute to fall risk (e.g., electrolyte imbalances, anemia).

7. Psychological Support

   • Provide a psych consult as needed to address any cognitive or emotional issues that might contribute to fall risk.

8. Assistance with Mobility and Transfers

   • Assist the patient during mobility and transfers to ensure they are safe and supported.

Rationale

1. Risk Assessment

   • Regular assessment helps identify changes in fall risk and allows for timely interventions.

2. Call Light Accessibility

   • Ensuring the call light is within reach provides the patient with a quick way to request assistance, reducing the risk of unassisted movements.

3. Toileting Needs

   • Monitoring toileting needs helps prevent falls that can occur when patients rush to the bathroom unassisted.

4. Physical and Occupational Therapy

   • PT and OT can help strengthen muscles, improve balance, and teach safe mobility techniques.

5. Medication Management

   • Monitoring for medication side effects helps prevent falls caused by adverse reactions.

6. Lab Monitoring

   • Regular lab tests can detect underlying health issues that might increase fall risk.

7. Psychological Support

   • Addressing cognitive and emotional factors can help reduce fall risk related to confusion, anxiety, or depression.

8. Assistance with Mobility and Transfers

   • Providing assistance ensures that the patient moves safely, reducing the risk of falls during transfers and ambulation.

Actions

1. Risk Assessment

   • Perform fall risk assessments on admission, quarterly, and as needed, documenting findings and implementing appropriate interventions.

2. Call Light Accessibility

   • Ensure the call light is within easy reach and check frequently on patients who are unable to use it.

3. Toileting Needs

   • Monitor and assist with toileting needs, ensuring timely assistance to prevent unassisted movements.

4. Physical and Occupational Therapy

   • Schedule PT/OT evaluations and follow through with treatment plans to improve strength and mobility.

5. Medication Management

   • Administer medications as prescribed, monitoring for and documenting any side effects.

6. Lab Monitoring

   • Draw labs as ordered, reviewing and reporting results to the healthcare team.

7. Psychological Support

   • Coordinate psych consults and follow through with recommendations to address cognitive and emotional health.

8. Assistance with Mobility and Transfers

   • Assist the patient with mobility and transfers, using gait belts or other assistive devices as necessary.