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Falls
When a patient falls, it is a serious event. Whether the patient falls from bed or falls elsewhere in the hospital, be mindful of the following two questions after the fall: Is the patient injured? And, what was the cause of the fall?
Phone Call 
Questions
- 1.
Was the fall witnessed?
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Anyone who witnessed the fall should be contacted, and his or her story should be documented.
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- 2.
Is there an emergent injury?
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Head injuries and fractures are particularly worrisome.
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- 3.
Is there a change in the patient’s mental status?
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A non-contrast computed tomography (CT) scan of the head is immediately indicated if a significant head injury or change in mental status is apparent. Consider CT of the head if the fall was unwitnessed.
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- 4.
Was there an obvious identifiable cause?
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The cause of a fall is often multifactorial.
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- 5.
Has the patient undergone a surgical procedure, and if so, how long ago?
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Protection from falls is an important part of postoperative management in neurosurgical and orthopedic patients.
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- 6.
Are there any other symptoms?
- 7.
Are there any changes in vital signs?
- 8.
Did orthostasis lead to the fall?
Orders
- 1.
Ensure the safety of the patient, and respond to any injuries present.
- 2.
If mental status changes or direct impact to head, ask the RN to initiate in-line cervical spine precautions.
- 3.
Instruct the bedside caregiver to call if there are any further changes in vital signs or mental status.
Informing the RN
Tell the RN you will be at the bedside in XX minutes.
If there is a significant change in vital signs or symptoms, especially if the patient has an obvious injury such as a fracture or if there is a significant change in mental status, the patient must be evaluated immediately. Also, if the baseline condition of the patient was serious before the fall, it is important to evaluate the situation quickly.
Elevator Thoughts 
What are the causes of falls?
- 1.
Mental status changes
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Organic causes include Alzheimer’s disease, multi-infarct dementia, delirium, confusion, and other organic brain syndromes. Acute changes such as stroke, transient ischemic attack, and epileptic seizure also may cause falls. Patients also may have vasovagal reactions in response to anxiety, severe coughing, or sustained Valsalva’s maneuver. Fall after change in position may indicate orthostasis and the patient’s volume status should be considered.
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- 2.
Medications
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Medications include sedatives, opiate pain relievers, muscle relaxants, antihypertensive medications, and sleeping aids. Be mindful of any newly started medications.
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- 3.
Cardiac events
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Cardiac events include myocardial infarction (MI), dysrhythmias, and hypotension. Be mindful that postoperative patients often are fluid depleted and are predisposed to orthostatic hypotension.
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- 4.
Infections
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Infections include sepsis associated with hypotension, delirium associated with fever, or primary central nervous system (CNS) infections such as meningitis.
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- 5.
Respiratory
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Respiratory causes include hypoxia as a result of pulmonary edema or embolism.
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- 6.
Metabolic derangements
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Metabolic derangements include azotemia, hypoglycemia, liver failure, and electrolyte abnormalities.
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- 7.
Environment
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Patients often are unfamiliar with their surroundings, and additionally, they are surrounded by inconvenient obstacles such as intravenous (IV) poles, tubes, wires, catheters, and bed rails. It is amazing that falls do not happen more often. A little preventive organization in the patient’s room is helpful, for example, putting the telephone or call button within the patient’s reach. Bed rails are a safety measure for alert or comatose patients.
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Major Threat to Life 
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