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Table 1 Summary of Recommendations of Nursing CPG on 'Prevention of Falls in Hospitals and Long Term Care Institutions'

From: Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals

Assessment & Interventions Recommendations
Assessment of Fall Risk All patients admitted to hospitals should undergo falls risk assessment at the point of admission, within 24 hours, to identify those at higher risk of falls.
  Risk assessment should be multi-dimensional and include medical, functional and behavioral assessments of patients. No one risk screening tool alone will identify all persons at risk or risk factors.
  In acute care settings, reassessment of fall risk should be carried out at least twice a week and when there is a change in patient's status or environment.
Risk Factors Contributing to Falls A fall risk assessment should include the following:
  • Medical
     - History of falls
     - Medications associated with increased falls risk
     - Secondary or specific diagnoses known to affect fall risk
     - Postural hypotension
     - Seizures, dizziness, vertigo
  • Functional
     - Altered mental status
     - Altered elimination status
     - Impaired/deterioration of activities of daily living
     - Impaired mobility or gait
     - Poor visual acuity
  • Behavioral
     - Poor safety awareness
     - Lack of insight into own health condition
     - Risk taking behavior
Multifactorial Falls Prevention Approach A falls prevention programme should comprise multifactorial interventions incorporating both general and individual-specific/tailored strategies:
     ▪ Environment safety
     ▪ Identification systems
     ▪ Interventions for patients with altered mental status
     ▪ Interventions for patients with altered elimination status
     ▪ Mobility and exercise
     ▪ Medication review
     ▪ Education
  The fall prevention programme should involve all members of the multi-disciplinary healthcare team.
Post Fall Analysis and Management All patients who experience an inpatient fall should undergo a post-fall assessment.
  The post-fall assessment should be accompanied by:
     ▪ Attention to patients' injuries
     ▪ Medical review to exclude acute causes of fall
     ▪ Investigation into the circumstances of fall