Workers are hurt when patients fall
Trying to protect a patient from a fall may be one of the most dangerous things your employees do. They will put themselves at risk to cushion a patient. And often, that results in a serious musculoskeletal injury.
Fall prevention and safe patient handling are interconnected they are both important to protect patients and health care workers, says Stephanie Radawiec, PT, DPT, MHS, MBA, a clinical consultant with Diligent Services, a division of the equipment manufacturer Arjo Huntleigh in Addison, IL. Radawiec spoke on fall prevention at the recent Safe Patient Handling and Movement Conference in Orlando, FL.
About one-quarter to one-half of MSD injuries occur while the worker is trying to prevent or cushion a patient fall, Radawiec says, based on her work with health care clients. "It can impact any body part. Frequently, you'll see a rotator cuff tear, cervical strain, and even knee injuries. What really puts the caregiver at risk is that it is a sudden change of the amount of assistance the caregiver is providing. It is not necessarily a balanced load."
A patient fall is typically described as "unexpected," but nurses should know if a patient is at risk for falls. Patients should always be evaluated for fall risk, just as they should be assessed for mobility and patient handling needs, she says. "If the person is determined to be at risk for falls, they should be considered for a piece of safe patient handling equipment to protect both the patient and the caregiver," she says.
Lifts help ambulation
There are a variety of reasons that a patient may be at risk of falling. They may be disoriented or very fatigued after blood loss in surgery. They may have urinary frequency and feel the need to get out of bed often. They may have poor vision, vertigo or muscle weakness.
The Morse Fall Scale provides a numerical score that helps nurses assess the patient's risk. They may respond by making sure the room is clutter-free, lowering the height of the bed and installing a bed alarm.
But patient handling equipment also provides important protection. A sit-to-stand lift helps patients who need assistance getting out of a chair. Patients who are weak or who become fatigued even after sitting may need a full lift to safely transfer, Radawiec says.
There's an emphasis on getting patients out of bed to prevent complications and hasten recovery. "It's not a choice. You have to get that patient up even if they're at high risk of falls," she says.
Ceiling lifts have ambulation slings that allow the patient to walk on their own but provide protection from a fall. There are also special slings that will accommodate orthopedic patients.
Gait belts are not an effective tool to prevent patient falls, says Radawiec. In fact, health care workers may be injured as they grab the belt and try to block the patient's fall. "It ends up being a tool to protect the patient but not the caregiver," she says.
The hospital's fall prevention committee should include an employee health nurse, and an analysis of incidents should look at injuries to employees as well as patients, she advises.
Fast Facts: How to prevent MSDs
A work-related musculoskeletal disorder is an injury of the muscles, tendons, ligaments, nerves, joints, cartilage, bones, or blood vessels in the arms, legs, head, neck, or back that is caused or aggravated by work tasks such as lifting, pushing, and pulling. Symptoms include pain, stiffness, swelling, numbness, and tingling.
Lifting and moving clients create a high risk for back injury and other musculoskeletal disorders for home healthcare workers.
Employers should:
Develop policies to ensure all care plans determine whether ergonomic assistive devices are needed.
Provide ergonomic assistive devices (such as slide boards or gait belts) when needed.
Provide training on assistive ergonomic devices, their uses, the clinical situation requiring them, and how to order them in the plan of care.
Develop policies to assess the caregiver's competence with the assistive devices once he or she has been trained and is using them.
Employees should:
Participate in ergonomic training.
Use ergonomic assistive devices if available.
Products such as slip sheets, slide boards, rollers, slings, belts, and mechanical or electronic hoists (to lift the client) have been designed to help healthcare workers and clients.
Equipment such as adjustable beds, raised toilet seats, shower chairs, and grab bars are also helpful for reducing risk factors for musculoskeletal injuries. These types of equipment can allow the client to help during transfer.
Use proper body mechanics. Even when assistive devices are used during client care, some amount of physical exertion may still be necessary.
Move along the side of the client's bed instead of reaching while performing tasks at the bedside.
When manually moving the client, stand as close as possible to the client without twisting your back, keeping your knees bent and feet apart. To avoid twisting the spine, make sure one foot is in the direction of the move. Using gentle rocking motions can also reduce exertion.
Pulling a client up in bed is easier when the head of the bed is flat or down. Raising the client's knees and encouraging the client to push (if possible) can also help.
Apply anti-embolism stockings by pushing them on while you are standing at the foot of the bed. You can use less force in this position than standing at the side of the bed.
Notify your employer promptly of any injury in the workplace.
Source: National Institute for Occupational Safety and Health, 2012.
Educate patient about lifts
When you choose new patient handling equipment, think about how it will impact both the patient and the worker, advises Kimberly Falco, MSN, RN, a safe patient handling expert in Las Vegas, NV. New lift devices are now being designed to assist patients with early mobility, she says. They have clips or holders for IV poles and oxygen tanks.
But before you buy, make sure you seek staff input. "It is absolutely imperative that the end user is involved and participating in any type of equipment purchase," she says. Evaluate the equipment you currently have to see how it can support patient ambulation.
It's also important to educate the patient about how patient handling equipment will support them as they regain their mobility, she says. "The patient needs to understand why we're using equipment," she says.
The equipment may make the patient feel secure and less likely to fall. In one case, a patient who hadn't walked in seven years was able to walk again with a use of a ceiling lift and an ambulation sling, Falco says.
"With some simple equipment and safety measures, you may never have to perform a rescue [of a falling patient]," she says. "It's so much more beneficial to be preventative than to react to an injury after it occurs."
[Editor's note: Resources for a fall prevention program are available from the VA at www.visn8.va.gov/visn8/patientsafetycenter/fallsTeam/default.asp.]
Trying to protect a patient from a fall may be one of the most dangerous things your employees do. They will put themselves at risk to cushion a patient. And often, that results in a serious musculoskeletal injury.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content