The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [132]
The prevention of falls is complex and as with many other types of risk assessment and prevention, a systematic multiprofessional approach is recommended. Individual needs and the different environmental factors associated with different settings – for example, home, care home or hospital – will need to be assessed regularly.
There are many techniques which have been demonstrated to reduce the incidence of falls, including exercise programmes, identification bracelets, alarm systems and risk assessments (Ward et al. 2010). Part of the Chief Nursing Officer for England’s programme of ‘High Impact Actions for Care’ includes ‘Staying Safe – Preventing Falls’ (Ward et al. 2010), the aim of which is to demonstrate a year-on-year reduction in the number of falls sustained by older people in NHS-provided care. However, patient safety must always be carefully balanced with patient independence and their right to make informed choices (NHS Institute for Innovation and Improvement 2010). Following on from this, Ipswich Hospital Trust developed a checklist for nurses to use on the wards regularly throughout the day (NHS Institute for Innovation and Improvement 2009).
Hydration: making sure patients have something to drink.
Checking toilet needs.
Ensuring patients have the right footwear.
Decluttering the area.
Making sure patients can reach what they need, such as the call bell.
Making sure bedrails are correctly fitted.
Ensuring patients have an appropriate walking aid, if applicable.
Key principles of risk management
Related theory
Good risk management awareness and practice at all levels is a critical success factor for any organization. In healthcare it can mean the difference between success and failure, not only in terms of an individual patient clinical outcome but also of the organization as a whole (Roberts 2002).
Nurses have a pivotal role to play in risk management and promoting safety and, indeed, a moral obligation to protect those we serve and to provide the best possible care (Wilson 2005).
Nurses are not only the main caregivers in wards and departments but also have a surveillance role, ensuring that they remain vigilant and able to identify risks which may adversely affect the patient experience. When discussing the vigilant nurse, Meyer and Lavin (2005) suggest five components, which are key in the role of the nurse.
Attaching meaning to what is: this is described as the ability to differentiate ‘adverse signals’, which indicate that there are dangers, from the ordinary ‘noise’, the normal signs and symptoms.
Anticipating what might be: observe, as the normal procedures and response are described so the abnormal becomes more apparent.
Calculating risks: understanding that there is an inherent risk in every situation.
Readiness to act: developed from a knowledge base, this allows the nurse to know what might be required in a situation and to make sure interventions can be carried out quickly when necessary.
Monitoring the results of interventions.
Patients want to be assured that nurses have the ability to assess their needs as well as recognize their limitations and potential risks. With this comes the need for the nurse to have knowledge of risk and how it works within the organization. Understanding the policies, processes and procedures for managing risk is then a key component of ongoing learning for all nurses and healthcare professionals.
References
Age UK (2008) Ways to Make Tasks Easier Around the Home. England.
Alaszewski, A. (2002) The Impact of the Bristol Royal Infirmary disaster and inquiry on public services in the UK. Journal of Interprofessional Care, 16, 371–378.
Anthony, D., Parbooteeah, S., Saleh, M. and Papanikolou, P. (2008) Norton Waterlow and Braden Score: a review of the literature and a comparison between scores and clinical judgement. Journal of Clinical Nursing, 17 (5), 646–653.
Becker,