If We Know How to Prevent Falls, Why Are Our Patients Still Falling?

Falls: at least ‘theoretically preventable.’

Sometimes it can feel as though managing fall risk takes up a big part of the day. You do your regular risk assessments, put safety measures into place, and still—patients fall.

Considering the frailty of some patients, the many meds that contribute to falls, and the fact that even mild cognitive impairment can be made worse by a hospitalization, it’s a tribute to good nursing care that there aren’t more falls.

But because falls sometimes cause serious injury and are, at least theoretically, preventable, it always feels like we’ve failed when a patient ends up on the floor.

A checklist for high-risk patients.

Nurses at one hospital decided that they needed a new way to approach fall safety. In “Using a Fall Prevention Checklist to Reduce Hospital Falls,” authors Madeline Johnston and Morris Magnan describe their use of a 14-item change-of-shift checklist based on the hospital’s existing fall prevention protocol. For a patient known to be at high risk for falls, oncoming staff went through the checklist to be sure that all prevention interventions were in place before taking responsibility for the patient. […]

2019-03-01T11:40:56-05:00March 1st, 2019|Nursing, patient safety|2 Comments
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The Risks and Benefits of Transfusion Therapy

Potential complications of transfusions.

Photo © GARO / PHANIE / agefotostock

If your patient develops mild jaundice or thrombocytopenia two weeks after a blood transfusion, would you consider their transfusion history an important part of your assessment?

When I think of monitoring a patient who is receiving a blood transfusion, I think primarily about watching for a hemolytic transfusion reaction or circulatory overload. To me, that means keeping a close watch during the transfusion and for about 24 hours afterwards. Yet “classic” hemolytic reactions and volume overload are not the only potential complications of blood therapy. Delayed reactions can occur days or even weeks after you’ve run through your saline flush and disposed of the blood bag.

Update of current transfusion practices.

In this month’s AJN, Margaret Carman and colleagues provide readers with an update of current practices in transfusion therapy. In “A Review of Current Practice in Transfusion Therapy,” the authors survey the benefits and risks of fresh whole blood (used today primarily in military or disaster settings) and blood components—red blood cells, plasma, cryoprecipitate, and platelets. […]

2018-05-29T11:19:05-04:00May 29th, 2018|Nursing, patient safety, Patients|0 Comments
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What the Patient Knew: Communication and Patient Safety

Anticipating emergencies.

by rosmary/via Flickr

At the start of every shift after receiving report, I take a moment to consider what emergencies I might anticipate for my particular patient in our PICU. Monitor for excessive bleeding in a liver failure patient. Monitor for an altered neurological status in a patient with a head bleed. I try to envision how I would start CPR in the room if required. I try to be thorough in checking that all my emergency equipment is present and working. I try to keep patient safety at the forefront of my mind and priorities.

I came to work one day and received report about my 9-year-old patient who was post-operative day one from a planned craniofacial surgery. He would remain nasally intubated with eyes sutured shut for a few days until the swelling had reduced, and then would return to the OR to be extubated and to have the eye sutures removed. I’d had patients like him before and felt he would be very easy to keep safe, especially given that per handoff report, he was comfortably sedated and not overly agitated when he did briefly waken with nursing care.

A patient’s question.

As I got to know him through the first couple hours of my shift, I found that he was indeed comfortably sedated though […]

2018-05-24T10:08:09-04:00May 24th, 2018|Nursing, patient safety, Patients|0 Comments
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Experienced Bedside Nurses: An Endangered Species?

“The trend toward our hospitals being primarily populated with nurses with less than two years’ experience is worrisome.”

At least three colleagues who’ve recently been patients in hospitals or had family members who were have remarked on the youthful nurses they encountered—and on their lack of experience. In two of the conversations, my colleagues cited instances in which this lack of experience was detrimental to care, one of them dangerous. That “sixth sense,” that level of awareness that comes with lived experience and becomes part of expert clinical knowledge, is important for safe, quality patient care.

In the February editorial, I report on the answers I received when I queried our editorial board members about new nurses’ inclination to work in acute care for only two years to gain experience and then leave to pursue NP careers. Many of the board members have seen a similar trend, one reflected by research on nurse retention, some of it published in AJN (most recently, see Christine Kovner’s February 2014 study on the work patterns of newly licensed RNs, free until February 6). […]

2018-01-29T09:54:37-05:00January 29th, 2018|career, Nursing, nursing roles, patient safety, Patients|28 Comments
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Helping Family Caregivers with Fall Prevention in the Home

“Because mobility in later life results in positive health benefits but increases exposure to falls, many researchers and health care providers in geriatric nursing and medicine have called for ensuring safe mobility while protecting older adults from harm. It’s especially important to identify strategies that can potentially reduce the risk of fall-related injuries in older adults.This increasing focus on fall-injury prevention—in addition to fall prevention—represents a major shift in safety practice.”

(Click image to enlarge)

How can nurses best help family caregivers?

How can nurses help family caregivers identify fall risk in their family members, prevent falls, and respond to them if they occur?

According to the authors of “Preventing Falls and Fall-Related Injuries at Home“—the latest in our ongoing series of articles and videos, Supporting Family Caregivers: No Longer Home Alone—the need for better education and resources on such topics is widespread among family caregivers:

“In a national survey of caregivers who provide unpaid care to a relative or friend, 46% reported they assisted with medical and nursing tasks. Of these, 43% said such help involved the use of assistive mobility devices, such as walkers or canes. Almost half of family caregivers are also known […]

2018-01-25T10:24:11-05:00January 25th, 2018|family caregiving, family caregiving, Nursing, patient safety|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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