Fall Prevention

Historical Context

Standards for fall prevention have evolved over decades of clinical research and regulatory development. Current evidence-based guidelines reflect lessons learned from adverse events, clinical trials, and quality improvement initiatives. Staying current with guideline updates is part of professional continuing education requirements.

Related Procedures

Oral care:

1. Brush teeth/dentures with soft brush
2. Swab oral cavity for unconscious patients
3. Position at 45 degrees or side-lying if unconscious

Bathing:

1. Wash face first (no soap), distal to proximal
2. Offer privacy by closing curtain/door
3. Check water temperature (105-110 F)

Assessment Techniques

Assessment observations for fall prevention that must be reported to the nurse:

• Fall risk factors: history of falls, medications (sedatives, diuretics), mobility impairment, cognitive decline
• Report to nurse: elevated temperature, blood pressure outside baseline, new pain, skin breakdown
• Behavioral changes: new confusion, agitation, refusing meals, sleep pattern changes
• Weight changes: report gain/loss of 2+ lbs in a day or 5+ lbs in a week
• I and O (intake and output): measure and record all fluids consumed and excreted in mL

Troubleshooting

When fall prevention does not go as expected, systematically review each step of the procedure. Check equipment calibration, verify technique, and repeat the measurement if results seem inconsistent with the clinical picture. Report discrepancies to the supervisor rather than guessing at the correct value.

Common Errors

Common nursing assistant errors with fall prevention:

• Not applying proper body mechanics: get help for residents over 35 lbs or who are combative; wide base of support with feet shoulder-width apart, one foot slightly forward; bend at the knees and hips, not at the waist
• Forgetting to identify the resident before providing care
• Not reporting changes in condition promptly to the nurse
• Performing tasks outside the CNA scope of practice

Step-by-Step Procedure

Step-by-step procedure for bathing (applicable to fall prevention):

1. Gather supplies
2. Offer privacy by closing curtain/door
3. Check water temperature (105-110 F)
4. Wash face first (no soap), distal to proximal
5. Wash, rinse, dry each area in order: face, neck, arms, chest, abdomen, legs, back, perineum
6. Perineal care: front to back for females
7. Apply lotion to prevent dryness
8. Document skin observations

Safety note: Test water on inner wrist. Never leave resident alone in tub.