Interventions to Reduce Fall Risk for Patients with Difficulty with Mobility and/or Activities of Daily Living (ADLs)

Some patients have weakness, or gait or balance impairments that make it unsafe to engage in independent ambulation, transfers, or ADLs such as dressing. These impairments may be long-standing for the patient or may be acute changes due to a patient’s current medical condition. They may also stem from medication side effects. Interventions directed at difficulty with mobility or ADLs seek to either reduce or compensate for these challenges. A list of interventions that may be of benefit to these patients include:

Potential Interventions                     

Rationale  

Assistive devices/equipment Devices and equipment make mobility and ADLs easier and safer for the patient and staff. Examples include (but are not limited to) walkers, canes, wheelchairs, commodes, dressing equipment, and mechanical transfer devices.
Documentation of mobility/ADL assistance                                   Promotes understanding among staff for how to best assist a given patient. Documentation within the medical record can be supplemented by signage within the patient’s room to quickly share information about a patient’s mobility status.
Gait/transfer belt Provides staff with a point of contact near the patient’s center of mass to more safely and effectively assist a patient with mobility or ADLs, or control a fall, should one occur.
Handoff to communicate risk Transfer important information about a patient’s fall risk to another staff member caring for that patient.
Medication review by pharmacy       Address medication side effects that may be contributing to a patient’s current difficulty with mobility and/or ADLs. Alternatively, a pharmacist may have recommendations for medications to safely address impairments such as pain that may be interfering with a patient’s mobility and/or ADLs.
Nonslip, well-fitting footwear                                 Reduce slip and trip hazards. Assist the patient’s balance.
Occupational therapy evaluation Occupational therapists (OTs) assess and train patients in the performance of ADLs such as dressing, grooming, bathing, and toileting. This may include the use of various pieces of equipment. OTs also provide recommendations to other hospital staff and the patient’s family for how to most effectively and safely assist patients with various tasks.
Pain management Safe management of pain, either by pharmacological or non-pharmacological means, can enhance a patient’s ability to engage in mobility and ADLs.
Patient/family education Help patients and families understand why patients may need assistance and how to safely engage in mobility and ADLs.
Physical therapy evaluation Physical therapists (PTs) assess and train patients in the performance of mobility tasks such as transfers and ambulation. This may include the use of various pieces of equipment and the performance of exercises to reduce impairments interfering with mobility. PTs also provide recommendations to other hospital staff and the patient’s family for how to most effectively and safely assist patients with mobility.
Seating assessment Proper sitting posture and comfort can improve a patient’s sitting balance, reduce the chance he/she will attempt to change positions unassisted, and ease a patient’s ability to transfer in and out of a chair. Physical and occupational therapists can make recommendations on proper seating options for a given patient.
Supervised mobility and/or
activities of daily living
Provide close monitoring and/or physical assistance as needed to reduce fall risk or assist a fall, should one occur.
Supervised toileting Provide close monitoring and/or physical assistance as needed to reduce fall risk or assist a fall, should one occur. While there are competing tensions between patient privacy and safety when it comes to toileting, the bathroom is an important place for staff to provide supervision and assistance due to the difficulty patients may have with transferring and managing clothing, as well as multiple hard surfaces that can cause injury in the event of a fall.
Visible identification of risk    Use of signage, colored bracelets, and/or socks helps all staff visually identify if a patient is at risk for falls.