Preventing Falls in Elderly Patient with Dehydration

Assessing Patient's Level of Assistance Needed

The patient C.S has been diagnosed with dehydration. The patient needs to use the restroom now. Before providing assistance with ambulation to the restroom, it is necessary to assess patients regarding the level or extent of assistance needed for patients. The advantage of this assessment is that it can evaluate patient’s muscle strength, ability to mobilize, activity tolerance and the need to provide assistive devices. The level of assistance will also depend on patient’s condition, duration of hospital stay and presence of any previous mobility restrictions.  The assessment of the risk of fall during ambulation can be done. It can help to identify to implement appropriate fall prevention intervention during the ambulation process (Constantin & Dahlke, 2018).

Considering the fact that C.S is 78 years old, advancing age is the first risk factor for falls. The main rationale for this is that advancing age is associated with high risk of falls due to age related physiological changes such as frailty, cognitive impairment, visual deficits, joint pain and many other changes (Sousa et al., 2017). In addition, the patient was diagnosed with dehydration and it is also a risk factor for fall. Dehydration can contribute to impaired brain perfusion and dizziness. The risk of dehydration increases in older age because of many aging related change. Increase in fluid loss also increases the adverse effects of dehydration. All these changes can directly increase the risk of fall during ambulation (Hamrick et al., 2020). Hence, all the risk factors should be considered before implementing appropriate preventive steps.

As dehydration has been identified as one of the major risk factors of falls, the first intervention that will be important is to maintain adequate hydration for patient. It will ensure optimal outcomes for C.S. Oral hydration can improve blood osmality and control the risk of dizziness due to dehydration. Thus, any chances of fall can be prevented through oral hydration. In addition, nurses can track fluid intake of patients and document how much water the patient is having in a day (Hamrick et al., 2020).

The second intervention that could be implemented for fall prevention is medication review. The advantage of this strategy is that it can support nurses to evaluate if effect of different drug is the main cause behind fall or not. Medication review is a form of structured examination of a patient’s drug and optimizing the impact of drugs by reducing any medication related side-effects. It can help to exclude all those drugs from the medical order which increases the risk of falls. Therefore, medication review can be identified as a risk-reduction strategy that aims to achieve a balance between reducing drugd linked with falls and effectively treating medical conditions
(Browne,  Kingston & Keane, 2014). There is a possibility that C.S might be taking various drugs for her comorbidities. Thus, evaluating her drug schedule may help to detect drugs with risk of falling.

Evaluating Risk Factors for Falls in Elderly Patients

1. S was escorted to the rest room and she slipped on a small amount of urine. The primary assessments that will be important during this situation are:

- To monitor the B.P, pulse rate and blood pressure of patient

- Check the patient’s body for signs of cuts, bruises and injuries

- Look for signs of weakness, pain or dizziness.

- Checking patient’s deterioration in gait or mobility post the fall

- Evaluate what type of devices or tools needed to safely move the patient (Strini, Schiavolin & Prendin, 2021).

2. If C.S is found to be safe to move, then equipment such as a gait belt or a stick could be used to facilitate transfer of patient. After the patient has finished ambulating, it is also important to use equipment like the gait belt to transfer patient back to the room. The patient can also be given a walking stick to support unaided transfer.

Note: C.S, a 78 year old patient admitted with a diagnosis of dehydration. The client needed to use the washroom. After safety assessment, the client has been escorted to restroom. All safety protocols were followed but the patients slipped as a small amount of urine was left on the floor. Immediate assessment for injuries or bruised was done and patient’s pulse rate and BP post fall was measured. No physical injuries were noted. The patient was assisted back to the bed using a gait belt. The patient is found to be a little shaken because of the fall, but other vital signs are within normal limits (Constantin & Dahlke, 2018).

Safety event reports are the systems to provide a full summary of any reported events at the hospital. It is one approach to ensure that any safety or adverse events are adequately documented and all things implemented in response to the event has been recorded. It is also a means to support patient safety and implement patient safety culture in the organization (Gong et al., 2017). The safety event reports should give identity related information, detail about the type of adverse events reported, cause or situation of falling, assessment of patient post falls and the current condition of patient. In the case of C.S, the following can be documented in the Safety Event Report:

Date of event:

Title or role of the reporting event:

In relation to the event, the following can be documented:

Incidence type: Slipping in the washroom

Date of incident:

Location

Specific area of fall: washroom

Incidence description: Following safety assessment, the patient was ambulated to the washroom. Despite all safety protocol, the patient slipped because of urine on the floor. Immediate assessment post the event done and nor major injury reported. The client has been shifted back to the bed. The gait belt and walking stick was used to

Follow up action: Environmental modification and environmental assessment before ambulation

Supervisor name:

Signature

Thus, the entire event can be documented in the above format.

References

Constantin, S., & Dahlke, S. (2018). How nurses restore and maintain mobility in hospitalised older people: an integrative literature review. International journal of older people nursing, 13(3), e12200.

Gong, Y., Kang, H., Wu, X., & Hua, L. (2017). Enhancing Patient Safety Event Reporting. A Systematic Review of System Design Features. Applied clinical informatics, 8(3), 893–909. https://doi.org/10.4338/ACI-2016-02-R-0023

Hamrick, I., Norton, D., Birstler, J., Chen, G., Cruz, L., & Hanrahan, L. (2020). Association Between Dehydration and Falls. Mayo Clinic proceedings. Innovations, quality & outcomes, 4(3), 259–265. https://doi.org/10.1016/j.mayocpiqo.2020.01.003

Hamrick, I., Norton, D., Birstler, J., Chen, G., Cruz, L., & Hanrahan, L. (2020). Association Between Dehydration and Falls. Mayo Clinic proceedings. Innovations, quality & outcomes, 4(3), 259–265. https://doi.org/10.1016/j.mayocpiqo.2020.01.00

Sousa, L. M. M., Marques-Vieira, C. M. A., Caldevilla, M. N. G. N. D., Henriques, C. M. A. D., Severino, S. S. P., & Caldeira, S. M. A. (2017). Risk for falls among community-dwelling older people: systematic literature review. Revista gaucha de enfermagem, 37.

Strini, V., Schiavolin, R., & Prendin, A. (2021). Fall risk assessment scales: a systematic literature review. Nursing Reports, 11(2), 430-443.  

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