What To Do if a Patient Falls – Tips for Staying Safe


When you or your loved one falls while on hospice services, there can be devastating consequences.  Preventing injuries and promoting safety is a priority for all of those involved in providing care.

According to the Center for Disease Control , more than 95% of hip fractures  are related  to falling,  with over 300,000 people hospitalized for treatment each year.  The National Hospice and Palliative Care Association  has a fall prevention campaign.  This is a general outline of how hospice providers need to assess for fall risks, and  provide   interventions to prevent them, as more than one-third of all falls occur in  people over the age of 65.

Hospice patients do fall down sometimes, and it can be overwhelming for a caregiver when it happens.  Serious illness or disease can contribute to changes in a person’s functional abilities very quickly.

 You or loved one may become weaker, increasingly unsteady, or even lose the ability to walk.  This is when things can become dangerous, and the general suggestions of removing throw rugs and providing adequate lighting are not really helpful.  To compound the problem, side effects of medications, increased confusion, and increased impulsivity can further jeopardize someone’s overall safety.

If a fall were to occur, and there was an injury present like a bone fracture, skin tears, or a serious bump to the head, there are two general approaches to treatment.  Often medical management of an injury will only be necessary.  This involves splinting or casting a fracture, suturing a laceration, and the use medications to manage pain and inflammation.

 In more serious incidences, especially hip fractures, surgical management might be recommended.  Unfortunately most hospice patients are not very good candidates for surgery, and it can really create a predicament for you or your loved one.   When a hip fracture is medically managed, the patient is usually no longer able to bear any weight on the affected side, and pain management becomes the main focus.

What happens if your loved one falls while on hospice services?

The first thing to do, if you or your loved one falls down, is to assess for injuries.  Of course, if there is uncontrolled bleeding or total loss of consciousness related to a head injury, you may require emergent assistance.  Listen to your instincts, and call 911 if you feel there is a need.   In most cases, there is no need to panic.

The truth is … calling EMS or 911 is not always the most sensible reaction in the event of a fall.  Trips to the hospital can be costly, tedious, and exhausting for everyone involved, and hospice may have a better approach.

As a hospice nurse, I always sit down with my patients and their loved ones, and discuss what to do when there is a fall.  Prevention is the key, but I am a realist and it does happen.  I would rather have a plan of action set up as an additional precaution.

 If you are unable to get up with assistance, and your loved ones are not capable of helping, you may need additional assistance in order to prevent further injury.

My recommendation is to call  your local non-emergency medical number, and request assistance in picking up your loved one up off of the floor.   EMS or the Fire Department will come and lift the patient back into bed.  This is usually a free service, as long as they do not do any assessments.

It does not matter what time of the day it is, please call hospice if in the event of a patient fall.

If it is during the day, your hospice nurse will come and assess for injuries.  After hours, there is always a nurse available to you 24/7. As a nurse, part of the initial assessment on the phone is to determine if someone is having pain.  I am able to provide some direction, while I am in route to do a home visit.

It is very important that the patient has a Comfort Pack available in the home in this instance. If there is no ability to control moderate to severe pain, these patients will need to go the emergency room.

 Often times, when pain is moderate to severe your hospice doctor will have prescribed some liquid morphine that is very quick and effective.  Your hospice nurse will guide through the safe administration of this medication. The nurse will assess for injuries, and collaborate with the hospice doctor.  If there is concern of a possible fracture, the doctor will usually order an x-ray.  In some cases, the doctor may advise that the patient be evaluated in the Emergency Room.

In hospice, it is a benefit to the patient to have a radiology technician come directly to their home, and take the x-rays, without them having to leave their bed.

 Those x-ray results are reviewed by a radiologist, and then reported to the hospice physician.  If a patient does need treatment at a hospital level, the hospice doctor will direct the nurse to facilitate that transfer.  Often times, the patient will remain on hospice services during this time.  The treatment provided by the hospital would be the responsibility of the patient, as the care is not directly related to the hospice diagnosis.  Medicare will still pay for services provided in a hospital setting, and there should not be a conflict.

How Do We Prevent Falls from Happening?

There are many different types of assistive devices that your hospice team relies on to minimize the risks for falling.  We will often order a lot of Durable Medical Equipment, and all of these items are provided by hospice.  Medicare pays 100%, and there is no cost to you.

Wheelchairs and Walkers

Hospice patients tend to have some weakness, and will often times become unsteady when they walk.  Pain and shortness of breath are also reasons that someone may need more assistance, and places them at a higher risk for falls.  Assistive devices like canes, walkers, and wheelchairs can be very useful in preventing injury.  In some instances, using a wheelchair for locomotion promotes safety, and is the better way to promote safety and foster independence.

Shower Chairs and Elevated Toilet Seats

The bathroom is a very dangerous place for someone to fall, and extra precaution is encouraged.  It is very common to have a shower chair or bench, just in case someone may need to sit while showering.  Dizziness and instability while showering can be very dangerous, and it is always my preference to have our hospice aide standing by to assist.  With toileting, the most common complaint is inability to get up from a sitting position.  There are a couple of options for creating a higher toilet seat, and they have the benefit of handrails for increased stability while going to a standing position.

Bedside Commodes, Urinals, and Bedpans

There may come a time when the bathroom is no longer a safe environment for you or your loved one, and we often need to make adjustments.   Sometimes if may just be during the middle of night, a bedside commode can be placed in close proximity.  The patient is able to safely get up to void, without having to maneuver to the bathroom.  Ensuring easy access for the ability to shower and use the bathroom can prevent a fall in the hospice.

Electric Hospital bed

When someone is ready for a hospital bed, this piece of equipment can be instrumental in promoting safety.  It is very common for falls to occur while trying to get in and out of bed.  There is a tremendous value in being able to adjust the height or position of the head of the bed.  There is an option of having side rails installed onto the bed.  These are helpful for a patient to steadying oneself while getting in and out of bed.  Side rails are not meant to be used as a restraint system, as that can be dangerous.  At night time, the bed can be adjusted to the lowest position. Fall mats can be placed on both sides of the bed, as an added precaution.  There are also bed alarms, this can be placed under the mattress, and will chirp when someone is getting out of bed.

Hoyer lifts

If someone is unable to stand, but does benefit from sitting in a chair, a hoyer lift might be an appropriate option.  It is hydraulic lift that suspends someone in a sling, so you can move someone from a bed to a chair.  This may be a safer option for the patient and the caregiver.

 Removing Hazards

One way to keep your loved one safe is to pay close attention to their environment.   Placing important items within reach of the patient during the day, some people will even use grabbers to extend their reach.  When someone is walking with an unsteady gait, try to keep the pathways clear, and ensure that the visibility is adequate.  Throw rugs can be especially difficult to navigate, and it is recommended to remove them.

Medications

As a caregiver, try to familiarize yourself with the medications and their side effects as much as possible.  Your loved will need your guidance in taking these medications, and your observations are critical.  Your input will help guide the hospice team’s evaluation of effectiveness and safety.  It is not unusual for a hospice patient to suffer from periods of restlessness and confusion, as result of the serious illness or the disease.  Caregivers will find themselves exhausted with trying to maintain their loved one’s safety.  As an alternative to wrestling with someone to keep them safe, it may be a better option to give them some medication, per the hospice doctor orders,  to calm someone down.  It may be necessary for the caregiver to administer these medications. The sedating effect can be the desired result, when it truly becomes a safety issue.  This is a subject that is taken very seriously within the medical community, and does raise some potential ethical questions.  This can be referred to as a type of chemical restraint, and sometimes may actually be necessary to prevent injuries.

I hope that you found this information useful.  Please feel free to ask a question or leave a comment.




12 Comments

  • Mike May 17, 2017 at 5:00 pm

    Falls are really dangerous, especially for the elderly and people who have weakened bones. You are right that if the person who fell couldn’t get up and those around him couldn’t help, they should get assistance.

    A friend of mine (who is in his senior years) fell once and only his grandchild was around. The kid tried to help but couldn’t lift his grandfather up, which resulting with my friend falling on the floor once again! That was when they called for emergency response. Thank goodness no bones were broken, but it was a really scary time for them.

    These are great tips, keep it up!

    Reply
    • Heather Williams RN CHPN May 18, 2017 at 8:32 pm

      Thank you for the nice comment, sharing your example. It can be challenging to get someone off the floor when they are not able to help themself, I hope the information was helpful.
      Take Care,
      Heather

      Reply
  • Jen May 17, 2017 at 5:02 pm

    As a caregiver, the most important advice is being attentive. Someone that is constantly watching/aware may be able to prevent a situation before it occurs. Obviously though you won’t be able to prevent everything so I really like the idea of calling the local non emergency number for help in getting a patient back into bed/chair if need assistance. If you are a caregiver, you are an angel to the patient. You are their eyes, ears, legs, arms, and brain at times. Do your best and treat your patient with the most kindness- someday this could be you.

    Reply
    • Heather Williams RN CHPN May 18, 2017 at 8:33 pm

      I could not agree with you more Jen about being attentive, it can go along way in prevention. Thank you the care you that provide, and I also agree with you on paying it forward.
      Many Blessings,
      Heather

      Reply
  • Thabo May 17, 2017 at 9:18 pm

    Hi heather,

    What an important and timely post. I have a mother, 87, with chronic back pain and her falling is in fact my number one concern. About a year ago I removed the big pillows from the sofa because I noticed that they tilted her body in such a way that she could easily lose balance and fall. I replaced them with more shallow ones that still supported her body but allowed her to take advantage of the entire couch.

    I have also looked into making the bathroom less slip proof. Sometimes it can be a simple solution like making sure I don’t wash the bath with a slick cleaning solution.

    In any case, I’ll be looking into other solutions that you have suggested.

    Reply
    • Heather Williams RN CHPN May 18, 2017 at 8:39 pm

      Hello,
      I am glad you found this post useful. Taking care of an aging parent can be worrysome, especially when they are living independently and requiring more assistance. Pain can really interfere with the ability to walk, I hope she is getting the care she needs to help keep her comfortable and safe. Also, Grab bars are a tremendous benefit in bathrooms.
      Many Blessings to you and your family.
      Heather

      Reply
  • Manuel May 18, 2017 at 3:03 am

    Great article.
    I agree with you in that NOT calling 911 is the most sensible thing to do, if there is not real life threat that is, great advice .
    I am a pro-prevention kind of person, I think that is the most important thing to keep always in mind.
    Do you know of any place or link that we can go to learn about legal advice, when related to fall that could have been avoided?

    Reply
  • Liz May 19, 2017 at 6:07 am

    I often worry about my mum falling. She is on her own after a severe stroke 20 years which left her quite disabled. She is very independent and has lots of things around to help her, as well as home help, but I do get concerned that she does not have the proper things in place should she fall and cannot get up. For example-those pendant things you can wear around your neck and press if you get into trouble? She lives in another state from me so not practical for me to come to her aid if she needed it. Do you recommend a pendant or something else?

    Reply
    • Heather Williams RN CHPN May 19, 2017 at 3:00 pm

      Hi Liz,
      Techonology has made some great strides to bringing everyone a little closer. Emergency Response Services are the agencies that will provide the button, and will respond when the button is activated. I do have one patient that had a stroke and lives with her daughter, and they have a nucleus device in the room. When the daughter is at work, she is able to check on her mom and talk to her at any time, and it does not require the need to be answered like a phone. She can literally pop into the room and look around at any time, and carry on a conversation with her mom. It is very cool, and gives the daughter a lot of peace of mind. Hope that helps.
      Take Care,
      Heather

      Reply
  • Carole June 8, 2017 at 8:47 pm

    Thank you for such an informative topic. I worked as a personal injury trial paralegal for many many years and we handled some medical malpractice and nursing home/hospital claims. While it is most unfortunate when someone falls and sustains an injury, it is quite common. Even with a preventative assessment, unless a patient has been declared incompetent they still maintain their right to make their own decisions. Even patients with little cognitive impairment can enter a moment of dizziness or confusion at any given moment which makes the risk of falling even more difficult for a patient to anticipate.

    I once read statistics concerning mortality after a fall causing a hip fracture in bedridden elderly patients and I believe it was six months at the time I read the article. Although the statistics may have changed I would assume they haven’t changed much. This stresses the importance of doing whatever is necessary to keep the patient safe. I have even heard of situations where it was necessary to use restraints. It may sound cruel to some but it is a literal life saving option.

    Thank you for the work you do to help others. You will reap your rewards.

    Reply
    • Heather Williams RN CHPN June 9, 2017 at 12:35 pm

      Thank you for your input. The use of restraints is controversial, and physical restraints are very dangerous. In some cases it may be necessary to give some medication to keep someone calm and prevent those falls. We always measure benefit vs risk to determine appropriate course of action.
      Take Care, Heather

      Reply

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