Falls Risk Plan - A Guide

Will Holmes à Court
Will Holmes à Court
Last updated 
Developing a Falls Risk Plan for a client who is a falls risk.  

What is contained in Falls Risk Plan?
Many interventions are available to eliminate or reduce falls and fall-related injuries that you can implement based on the client's specific risk factors. Below are some of the major risk factors that should be considered in the client's Falls Risk Plan.

What interventions to include in the client's Falls Risk Plan
An indication of a history of falls: all clients with a recent history of falls, such as a fall in the past 3 months, should be considered at higher risk for future falls and this is the rationale for a falls risk assessment, falls prevention recommendations and a Falls Risk Plan.
  • Impaired Gait or Mobility
    Clients with impaired gait or mobility will always need assistance with mobility. They should have mobility equipment, such as canes or walkers, at the bedside or chair and within safe reach. 
    • Even with this equipment, clients will need help from staff for transfers to the bathroom, between furniture and when mobilising in and around the home, or the community.
    • Support Workers to stay with the client when standing or mobilising.
  • Medications: clients on many (polypharmacy) prescription medications, or patients taking psychotropic medicines that could cause sedation, confusion, impaired balance, or orthostatic blood pressure changes are at higher risk for falls. Sometimes, the client needs to stay on a medication that increases the risk of falls because the benefits outweigh the risks. Support workers must ensure they attend to the client when mobilising. 
  • Mental status: clients with dementia be agitated and confused, putting them at risk for falls. They may experience delirium, a disturbed state of mind or consciousness, especially an acute, transient condition associated with infections, fever, electrolyte imbalances, or a medication side effect. It is characterized by confusion, delirium, psychosis, disorientation, agitation, and hallucinations. Delirium can cause people to leave their bed or chair when the support worker leaves the room; they may wander or refuse care services. Their agitation and delirium may cause a fall, especially if they have impaired mobility. 
    • Support workers must ensure they attend to the client when mobilising. 
  • Continence: clients who have urinary frequency or urgency and who have frequent toileting needs are at higher fall risk. Clients with frequent toileting needs will require support to use the bathroom. Support workers should regularly take the client to the toilet using their mobility equipment.
  • Feet and Footwear: For clients with foot problems and who wear orthotics, have orthotics placed in shoes, ill-fitting shoes, or inappropriate shoes, footwear soles and laces are in good condition. Support Workers to stay with the client when standing or mobilising.
  • Vision impairment: Client has has access to their corrective vision glasses at all times and are easily within reach, particularly when mobilising. Support Workers to stay with the client when standing or mobilising.
  • Syncope: includes vasovagal syncope, orthostatic hypotension, and cardiac arrhythmias. The client may fell lightheaded and become unstable on their feet, they may pass out or faint. Support Workers to stay with the client when standing or mobilising.
  • Dizziness and Vertigo: Vestibular disorders and acute/chronic health conditions, such as sinusitis, can cause dizziness and vertigo. Support Workers should stay with the client when standing or mobilising, as they may become lightheaded or pass out.
  • Nutrition and Hydration: Are the client's nutrition and hydration choices affecting them? Are they underweight or overweight? Does their condition make them feel dizzy or unstable when mobilising? Support Workers should stay with the client when standing or mobilising.
  • Pets: Ensure that pets are not near the client when they are mobilising in the home. Support workers to separate pets from the client when mobilising the client.
  • Other client risks include being tethered to equipment, such as an IV pole or oxygen ventilator, that could cause a client to trip while in a hospital or at home. Support Workers to clear any obstacles and stay with the client when standing or mobilising.
Universal Fall Precautions
Support Workers are always required to implement universal fall precautions. They are called "universal" because they apply to all clients regardless of fall risk. Universal fall precautions revolve around keeping the client's environment safe and comfortable. 
  • Maintain call device within reach, i.e., battery-operated doorbell/ or handbell.
  • Keep the client's possessions within their safe reach, especially their vision glasses and hearing aids.
  • Familiarize the client with where you have placed objects in their environment.
  • Have sturdy handrails in client bathrooms.
  • If there is a hospital bed, place it in a low position when a client is resting; raise the bed to a comfortable height when the client is transferring in and out of bed.
  • Keep hospital bed brakes locked.
  • Keep wheelchair wheel locks in the "locked" position when stationary.
  • Keep nonslip, comfortable, well-fitting footwear on the client.
  • Use night lights or supplemental lighting.
  • Keep floor surfaces clean and dry. Clean up all spills promptly.
  • Keep client care areas uncluttered.
  • Follow safe manual handling practices.
  • Separate the client and pets during mobilisations
  • Encourage balance and strength exercises in the lower limbs
Frequent Falls and Incident Reports
Completing incident reports fully and in detail is important for these reasons:
  • Communication is critical for the safety of our clients, and incident reports help us discover new risk factors for our clients.
  • It provides a post-fall clinical review, which is useful for the CCM, physiotherapist or occupational therapist.
  • Falls can be unwitnessed, and the client may be unable to provide accurate information about what occurred, so look around the environment where the fall occurred and describe it in detail.
  • It creates an understanding of the events surrounding a fall and a root cause analysis of the fall.
  • It can inform the care instructions and a fresh fall prevention plan for the client who fell, and it provides information that may help prevent the next fall in this client or future clients. 
  • It provides ongoing guidance to continuous improvement efforts for the company in quality client care. 
References
Australian Commission on Safety and Quality. https://www.safetyandquality.gov.au/sites/default/files/migrated/Guidelines-HOSP1.pdf