Assessment
A fall risk assessment for inpatient staff is to be routinely completed with every _____________.
Done at a minimum...
head to toe assessment
Inpatient fall risk interventions that the patient can wear include:
gait belt, yellow fall risk band, gripper socks
The RN should notify the.....
provider
for outpatient staff, a fall risk assessment is completed how often for a patient?
every admission and/or change in condition
Outpatient nurses: fall risk interventions include...
patient and family education, keeping the direct environment free of clutter/obstacles.
The nurse should assess the patient's......
Vitals and pain
For inpatient nurses: an additional fall risk assessment is completed when this occurs
change in condition, patient fall, staff concerns
Inpatient nurses: fall risk interventions that are applied to the patient environment/room include...
clear of clutter, signage outside of room, white board updated with level of assistance. bed and chair alarm on.
The nurse should fill out a....
MIDAS/Variance
Inpatient nurses: name one category that is assessed when completing the fall risk score.
-predisposing disease
-altered mental status
-altered elimination
-history of fall within last 12 months
-dizziness/vertigo/syncope
-impaired judgment
-high risk meds
-visual impairement
patient and family _______________ plays a key role in fall risk prevention.
education
The nurse should also notify....
family
What is considered a high risk medication when assessing the fall risk score?
Does this differ for inpatient vs outpatient?
anticoagulants, narcotics, sedatives, insulin, diuretics, antihypertensive.
Expectations of all staff walking past a patient room and noticing a patient attempting to get up without assistance. Fall risk signage outside of room.
Enter the room, call for help (call light), stay with patient until help arrives.
After the fall _______________ of the event is crucial. If this wasn't done it didn't happen...
Documentation