Nurse’s Duty in Fall Prevention especially in patients undergoing Hemodialysis
Falls can happen at any time and place in a hospital setting. It is a major patient safety issue causing injury, distress and even death. According to Debra Hain (2012), “In 2010, there were 2.35 million emergency room visits for non-fatal injuries in older adults with over 25% requiring hospitalization” (pg. 251). Falls can interrupt a person’s quality of life but also have a financial effect on the healthcare system (Hain, 2012). Falls are preventable and in order to reduce the rates for falls nurses must be more vigilant in their assessments to identify patients that are at risk, especially for those undergoing hemodialysis.
Discussion
Hemodialysis works by connecting a patient to a machine that filters and removes the body of waste products through a dialyzer. Treatment complications can arise, such as post-dialysis hypotension and muscle cramping which places patients at risk for falls (Hain, 2012). Co-morbid conditions such as dementia, Parkinson’s disease, osteoporosis, diabetic neuropathy, or urinary incontinence can also put a patient at even greater risk (Hain, 2012). Frailty in patients can also be used as a predictive risk factor. A study (McAdams-Demarcol et al., 2013) reported that frailty can contribute to a higher risk for hospitalization and death for patients undergoing hemodialysis. According to McAdams-DeMarco1 et al. (2013), “one in seven patients undergoing chronic hemodialysis suffers a major bone fracture after a fall” (pg. 1).
Buchner (as cited in Hain, 2012) defined fall as “unintentionally coming to rest on a lower area, such as the ground, or floor (p. 252). In the hospital setting, nurses look for non-modifiable an...
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... (2013) study concluded that frailty was an independent risk factor and that frailty increases the short-term risk of experiencing a fall in patients undergoing hemodialysis. Hain’s article provided us with prevention strategies aimed at reducing falls that nurses can use to prevent them from occurring. Patients undergoing hemodialysis have a higher risk and nurses should be more thorough in their assessments to ensure patient safety and improve patient outcomes.
References
Hain, D. (2012). Fall Prevention in Adults Undergoing Incenter Hemodialysis. Nephrology Nursing Journal, 39(3), 251-255
Potter, P. A., Perry, A. G., Stockert, P.A., & Hall, A. (2013). Basic Nursing (7th ed.). St. Louis,
MO: Mosby-Elsevier.
McAdams-DeMarco et al.: Frailty and falls among adult patients undergoing chronic hemodialysis: a prospective cohort study. BMC Nephrology 2013 14:224.
The nurse would firstly identify if Mrs Jones is at risk of falls by conducting a falls risk assessment using an evaluation tool such as the Peninsula Health Falls Risk Assessment Tool (FRAT) (ACSQHC, 2009). The falls risk assessment enables the nurse to identify any factors that may increase the risk of falls (ACSQHC, 2009). The falls risk assessment tool focuses on areas such as recent falls and past history of falls; psychological status for example, depression and anxiety; cognitive status; medications including diuretics, anti-hypertensives, anti-depressants, sedatives, anti-Parkinson’s and hypnotics; as well as taking into account any problems in relation to vision, mobility, behaviours, environment, nutrition, continence and activities
It is important that key factors in determining who is and who is not a risk to fall are sought out by the health care team. In this paper we will focus on how to determine who is a fall risk.
Ms. Bardsley functions as a hemodialysis liaison and leader in clinical practice with the following roles: charge nurse, preceptor, and mentor for her colleagues. She is the resource person for the Hct-Line monitoring tool. The tool is used to monitor patient’s fluid removal during treatment to avoid hypotensive episodes associated with decreased perfusion to the heart. She routinely monitors the patient outcomes which to date has resulted in 0 admissions. She recently updated the policy to make it more user friendly for the staff and to maintain staff competency.
Certified Nurse Assistants (CNAs) are caregivers that work close to the elderly patients, also called residents. The CNAs are responsible for taking viral signs and helping the residents with activities of the daily living, such as: bathing, walking, eating, toileting, dressing and transferring. Taking care of patients that are not able to perform common tasks, like using the bathroom, can be difficult. For that reason, a great number of CNAs get injured in their work setting every year. In order to minimize the risk of work-related injured inside long-term care facilities, the facility should impose a non-lift policy and increase the use of lift machines, such as hoyers.
Registered Nurses’ Association of Ontario (RNAO). (2005). Prevention of falls and fall injuries in the older adult. Retrieved from http://rnao.ca/sites/rnao-ca/files/Prevention_of_Falls_and_Fall_Injuries_in_the_Older_Adult.pdf
Fundamentals of nursing: the art and science of nursing care (7th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
A fall is an “untoward event which results in the patient coming to rest unintentionally on the ground” (Morris & Isaacs, 1980). When it comes to patient safety in health care, there isn’t any subject that takes precedence. Patient falls are a major cause for concern in the health industry, particularly in an acute-care setting such as a hospital where a patient’s mental and physical well being may already be compromised. Not only do patient falls increase the length of hospital stays, but it has a major impact on the economics of health care with adjusted medical costs related to falls averaging in the range of 30 billion dollars per year (Center for Disease Control [CDC], 2013). Patient falls are a common phenomenon seen most often in the elderly population. One out of three adults, aged 65 or older, fall each year (CDC, 2013). Complications of falls are quite critical in nature and are the leading cause of both fatal and nonfatal injuries including traumatic brain injuries and fractures. A huge solution to this problem focuses on prevention and education to those at risk. ...
...chronic illnesses which makes people more at risk for falling. Unfortunately falls are very common in the elderly which makes the fall risk tool very important. Last but not least the depression scale is used a lot in the elderly because depression is a very common diagnosis. Elderly lose their loved ones, they have decreased social interactions, etc. By using these assessment tools they will make a person a better, accurate nurse.
Yates K. M., & Creech Tart. (2012). Acute care patient falls: evaluation of a revised fall
Preventing fall in the nursing facilites Introduction/ Background Fall is one of the major issues in nursing facilities. Of the 1.6 million residents in U.S. nursing facilities, approximately half fall annually (AHRQ, 2012). Those who fall will have the tendency to fall again. Falls in older patients can change their quality of life. Because people who fall are terrified of falling again that can affect their daily activities.
Patient falls in the hospital is a serious issue and challenging problem that could lead to prolonged hospital stay, longer recovery time for patients, increased costs for hospitals, and a source of distress and anxiety for patients, nurses, and families. Patient falls can cause minor or major serious physical injury depending on the situation and the age of the client. In addition to the physical harms, patients can suffer from psychological injuries which make them lose their independence and confidence on themselves and build a lot of anger, distress and fears of falling.
Taylor, C. R., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of nursing: The art and science of nursing care (7th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Patient falls is one of the commonest events within the healthcare facilities that affect the safety of the patients. Preventing falls among patients requires various methods. Recognition, evaluation, and preventing of patient falls are great challenges for healthcare workers in providing a safe environment in any healthcare setting. Hospitals have come together to understand the contributing factors of falls, and to decrease their occurrence and resulting injuries or death. Risk of falls among patients is considered as a safety indicator in healthcare institutions due to this. Falls and related injuries have consistently been associated with the quality of nursing care and are included as a nursing-quality indicator monitored by the American Nurses Association, National Database of Nursing Quality Indicators and by the National Quality Forum. (NCBI)
Davenport, Joan M., Stacy Estridge, and Dolores M. Zygmont. Medical-surgical nursing. 2nd ed. Upper Saddle River, N.J.: Pearson Prentice Hall, 2008, 66-88.
Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing (Seventh ed.). St. Louis, Mo.: Mosby Elsevier.