Patient Safety & Fall Prevention

Prioritisation, because everything is a priority question

When a question gives you four reasonable actions, you need a rule. Use them in this order.

1. ABCs. Airway, breathing, circulation. An airway problem beats everything.

2. Acute over chronic. New chest pain beats long-standing back pain.

3. Actual over potential. A patient who is bleeding beats one at risk of bleeding.

4. Maslow. Physiological needs before safety, safety before psychosocial. Only reach for Maslow once ABCs don't separate the options.

5. Unstable over stable. Assess the deteriorating patient before the one awaiting discharge.

Assessment usually precedes intervention — but not when the intervention is life-saving and obvious. You do not assess a patient in cardiac arrest before starting compressions.

Who falls

Falls are the most common adverse event in hospitals and long-term care, and they are largely predictable.

Risk factor	Why
Previous fall	The single strongest predictor
Age over 65	Gait, vision, reaction time
Confusion or delirium	Poor judgment about ability
Medications	Sedatives, opioids, diuretics, antihypertensives
Toileting urgency	Rushing, often unassisted, often at night
Impaired mobility or new weakness	Post-op, post-stroke, deconditioned
Orthostatic hypotension	Standing too fast after lying down

Most falls happen on the way to the bathroom, at night, unwitnessed. That single fact drives most of what actually works.

What actually prevents falls

• Scheduled toileting rounds, especially overnight
• Call bell, water, glasses, and phone within reach before you leave
• Bed in the lowest position, wheels locked
• Non-slip footwear, not socks
• Adequate lighting, including a night light
• Sitting on the edge of the bed before standing
• Reviewing medications with the prescriber and pharmacist

Note what is not on that list: raising all four side rails. Four raised rails is a restraint, and patients climb over them and fall further.

After a fall

1. Assess before moving. Level of consciousness, pain, obvious injury, suspected head or spine involvement
2. Vital signs and neurological checks if head injury is possible
3. Notify the prescriber and the family
4. Incident report
5. Document the facts — where the client was found, position, your assessment, who was notified

Never document assumptions about how it happened if it was unwitnessed. Chart "found on floor beside bed", not "fell while getting up".

Restraints

A restraint is any device or medication that restricts free movement. Least restrictive alternative, always. Restraints are a last resort after everything else has failed, and they carry real risks including strangulation, injury, and worsening delirium.

They require a prescriber's order, must be time-limited, and need regular assessment of circulation, skin, toileting, and fluids. An order cannot be written as needed, and using a restraint for staff convenience is never acceptable.