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The High Fall Risk Room Set Up

A majority of hospital and nursing home falls, at least in part, are associated with extrinsic or unsafe environmental factors in the patient’s bedroom. Consequently, creating a ‘safe room environment’ for patients at high fall risk is an important component of fall prevention. The following checklist can be used by hospitals and nursing homes to ensure maximum bedroom safety for ‘at-risk’ patients.
 
Recommendations Rationale
Place patient in bedroom close to nursing station. Allows for closer observation by greater number of staff.
Place high risk signage (falling star) in bedroom and on outside of room door. Alerts all staff that patient is at fall risk.
Place fall prevention storyboard (identified risk factors and interventions) on wall in front of patient's bed. Used to increase staff awareness of patient's care plan.

Used as a teaching aide for patients/families in ways to prevent falls.
Place bed in low position so that knees are at 90 degrees to floor. Bed position provides maximum safe egress.
Place side rails down on exit side of bed and two split rails up on non-exit side of bed.

If patient exhibits impaired transfers, place head split rail up on exit side of bed and two split rails up on non-exit side of bed.
Protects and directs patient to exit on 'safe side' of bed.

Side rail used as 'enabler' (hand-hold) for safe transfers.
Place anti-slip strips on floor where patient exits bed. Protects patient from slipping on spilled items (urine, feces, blood, water, etc.).
Place over-the-bed table on non-exit side of bed. Prevents patient from using table for hand support during transfers.
Place sturdy chairs with armrests and seats no higher or lower than 18 inches. Avoid chairs with wheels. Provides maximum support for safe chair egress.
Place commode chair next to bed, on exit side of bed for patients with urinary impairment (e.g., incontinence, nocturia). Provides safe option to meet toileting needs.
Keep room illuminated during day.

Place 'motion-activated' night light by bed and in bathroom.
Provides greater visibility.

Provides safe pathway to bathroom during night.
Place call bell/personal items within reach of patient. Patient doesn't have to stretch or exit bed to reach items.
IV pole on exit side of bed (tubes/lines not across bed). Prevent lines from being pulled out/patient getting tangled in lines.
Bed/chair alarm. Alarm provides audible alert when patient is attempting to stand.

Alarm utilized as an 'assessment tool' to help identify a patient's pattern of bed or chair exits and supervision needs.

Tideiksaar, R. Falls in Older People: Prevention and Management. 4th Edition.
Health Professions Press, Baltimore, MD 2010

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