Safety: Preventing Patient Falls

It’s the middle of a hectic day and your worst nightmare just happened. A patient has fallen, and now you must check for potential injuries and reassure them and their family members that everything is alright. That’s the best-case scenario. Patients who fall are at risk of suffering fractures, joint dislocations, closed head injuries or subdural hematomas — serious injuries that jeopardize their long-term health and have the potential to put your facility in legal jeopardy. Implementing these basic steps into your perioperative routines will help to protect patients from fall-related harm.

• Ensure safe transfers. Follow best practices for moving patients from stretchers to OR tables. AORN guidelines state that staff members at the side of the stretcher and table should assist patients as needed to ensure their safety. That might sound like a basic recommendation, but it doesn’t always happen.

As the director of surgery in a large university setting, I had just begun making rounds in the surgical department and asked a neurosurgeon about his day. He said, “It’d be better if your staff didn’t let my patient fall on the floor.” He wasn’t one to joke, so I quickly felt a pit in my stomach and followed him to the OR.

The surgeon’s patient had been self-turning from supine on the stretcher to prone on the OR table. While both the stretcher and the bed were locked in place, there was no one on either side to assist the patient. As the patient turned, the stretcher shifted slightly and he fell face first onto the floor. Though he was unhurt, we crossed our fingers for months hoping he would not file a lawsuit.

The OR nurse who was overseeing the patient transfer in this case had been properly trained, but chose to stand at the foot of the stretcher instead of stabilizing the surface and the patient from the side. At a minimum, the nurse should have positioned herself on the stretcher side of the patient, a surgical tech or other member of the surgical team should have been on the receiving side of the table and the anesthesia provider should have been actively involved in the transfer.

• Monitor bathroom breaks. Escort patients to the restroom after their procedures —and stay with them. Too often I’ve seen nurses direct the patient to the restroom or leave them after guiding them to the door. Patients will tell you they’re OK by themselves, but don’t assume they’ll be able to use the emergency call light if they need you and, by then, it’ll likely be too late to prevent them from falling and injuring themselves. It’s not uncommon for patients to fall while sitting on the toilet, so leave the door slightly cracked and stand by to ensure their privacy and safety.

• Provide assistance in post-op. Help patients get dressed when they’re ready to head home after surgery, regardless of the type of anesthesia they received. The lingering effects of general anesthesia can impair the judgement of patients as they’re being discharged, so they might think they’re steadier on their feet than they actually are, and local blocks can compromise their motor skills.

As a former PACU nurse and surgery center administrator, I understand the pressure you feel trying to get patients ready for timely discharges and the multiple tasks you must manage throughout the day. However, taking an extra minute or two to help patients get dressed after surgery provides an extra layer of safety for them and peace of mind for you. Having them get dressed by themselves or having a family member help them increases the risk for falls, and does not release you from your responsibility as their caregiver.

• Observe pick-ups. Consider the liability and potential for injury before releasing a patient. Walk discharged patients all the way to their car, help them get in and make sure they’re seat-belted in. As an ASC administrator, I once observed a nurse walk her patient to the front door of the center and wave goodbye to them. Not only was I concerned for the patient’s safety, I was worried about the liability of the center and the nurse if the patient had fallen on the way to the car. During accreditation surveys, I’ve also observed staff accompany patients to the door of the waiting room and release them without making sure they were safely in the car that would take them home.

It’s best practice to ask the patient’s escort to pull up to the discharge area and have a staff member assist the patient fully into the car. In addition to providing safer care, this allows you another opportunity to establish relationships with patients and their significant others, a factor that can go a long way toward improving how well your facility fares on patient satisfaction surveys.

• Document the steps. Remember to record the precautions you took to prevent patient falls throughout the perioperative process. As an expert witness and consultant, I’m often called to provide opinions on the liability of surgical facilities during lawsuits filed by patients who fell during their care. Taking every precaution to prevent patient falls, and documenting that you have done so will lead to better care for your patients and potentially protect your facility from liability.