One of the common risk to safety of patients in hospital is
the risk of fall. Several epidemiological studies has found that on an average 3
to 5 patient fall incidence occur in every 1000 bed-days. It is also estimated
that a third of fall results into injuries which could be severe such as
fracture. Due to the widespread prevalence and resulting harm, prevention of
patient fall is included as one of the International Patient Safety Goals
(IPSG) of JCI standards for hospitals.
The first step to prevention of fall is identifying patient
who is at a risk of fall. Most accreditation bodies, including NABH and JCI
expects hospital to undertake a fall risk assessment of all admitted patient
and take preventive measures for those who are at a higher risk of fall.
The table below describes the points that should be used for
assessing risk of fall, and classifies features into very high, high, moderate
and low risk categories.
FEATURES |
RISK
LEVELS
|
|||
Very High Risk
|
High Risk
|
Moderate Risk
|
Low Risk
|
|
Age |
> 75 years |
70 to 75 Years |
65 to 69 Years |
60 to 64 years |
Fall History
|
History of two or more falls in last six months
OR
History of fall during current admission
|
History of one fall in last six months
|
History of one fall in last one year
|
-
|
Fall risk medications*
|
Patient on more than two fall risk medication
|
Patient on two fall risk medications
|
Patient on one fall risk medications
|
Patient occasionally takes a fall risk medication
|
Loco-motor ability
|
Patient entirely dependent on others for moving from one place to
another
|
Visual or auditory impairments that affects independent movement of
patient
|
Requires another person’s support or crutches for walking
|
Patient needs a walking stick
|
Cognitive ability
|
-
|
Impaired cognition
|
Impulsiveness
|
Altered awareness
|
Equipment attachment**
|
Three or more equipment attached to patient’s body
|
Two equipment attached to patient’s body
|
One equipment attached to patient’s body
|
|
Bowel and Urine Function
|
Incontinence with urgency/frequency
|
Incontinence or urgency/frequency
|
||
* Fall risk medications
include sedatives, psychotropic, opiates, anti-convulsants, diuretics,
anti-hypertensive and hypnotics
** Such equipment
include things like chest tubes, indwelling catheter, IV infusion etc.
Following points should be considered to determine the risk
level.
·
Presence of even one feature is sufficient to
classify the patient into the risk category, to which the feature belong
·
If a patient presents two or more features of a
category, the risk level of the patient should be raised to the next higher
level.
·
If a patient shows features from different risk levels,
the patient should be considered in the risk level which is the highest among
all. For example, if a patient shows one feature of ‘Low Risk’, one of ‘Moderate
Risk’ the patient should be considered as ‘Moderate Risk’
·
Patients who do not show any of the features should
be considered as ‘no risk’. Although, even such patient can have a fall, the
chance are very low and hence for all practical purpose, no special fall
prevention measures are required in such patients.
