PATIENT SAFETY: Step up to prevent falls in acute mental health settings
Angela Malik MSN, RN
Norma Patterson MSN, RN

July 2012 
Volume 42  Number 7
Pages 65 - 66
  PDF Version Available!

FALL PREVENTION is an ongoing challenge in older patients in the inpatient acute mental health setting (IAMHS). Fall prevention and patient safety committees should work together to minimize the risk.This article discusses why falls occur and how to prevent them in older adults with mental health problems in an inpatient setting. Incorporating fall prevention toolkits and evidence-based practices is vital.Each year, one in every three adults age 65 and older falls.1 Preventing or reducing the number of falls is a challenge in most healthcare settings, but the challenge is even greater in the IAMHS. In the psychiatric or behavioral health setting, fall rates range from 4.5 to 25 falls per 1,000 patient days.2In the IAMHS, many factors contribute to patient falls. These factors can be intrinsic, extrinsic, situational, or a combination.3 * Intrinsic factors associated with an increase in falls in an IAMHS include impaired cognition resulting from a chronic condition such as Alzheimer disease or an acute condition such as delirium. In addition, psychotropic medications and their adverse reactions may increase the likelihood of patient falls. Other intrinsic factors that may lead to falls include mobility, gait, vision, and balance disorders. * Extrinsic factors (environmental factors) that may contribute to patient falls on the IAMHS include a lack of support equipment, such as side rails when patients are getting into and out of bed, or a lack of durable medical equipment (DME), such as walkers, canes, and lifting devices. To add to these problems, mental health units have environmental restrictions to protect patients from harm.4 For example, wired chair and bed alarms, side rails, and call systems with cords can endanger patients and staff. These issues can account for the lack of support equipment or DME. * Situational factors (factors related to activities) occur when patients are attempting to perform more than one task at a time, such as getting out of a wheelchair

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