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FALLS RISK IN THE ACUTE CARE ENVIRONMENT

Patient Stride Characteristics

Non-slip socks have become a very commonly issued product to patients that are identified as a “falls risk patient.” These are a very useful tool for both assisting in falls prevention, as a patient reminder of their falls risk, and a very simple alert system for staff to be on the lookout “for the man in the red socks!”

However – we need to be aware of the patient’s gait and posture. What are their stride characteristics? Do they step, or do they shuffle? We need to remember non slip socks have a very grippy base, and with an unnatural gait, this could actually increase the falls risk!

We need to also assess the patient’s confidence in being given non slip socks to wear. It has been noted that patients can take a more cautious gait after applying the socks which is changing something their body knows what to do.

A key indicator in the use of socks can be the patient’s deceleration time. How quickly do they stop walking? If they are weak and frail and have a jarring stop to the step, this can increase the risk of a fall with the non slips socks, due to the continued momentum of the body from a sudden stop, and the socks not allowing any movement in travel. 

With the assistance of a physio, you can check the step length, heel horizontal velocity at heel strike and foot floor angle at heel strike. 

Reports have shown bare feet offer a very similar grip and support to non-slip socks.

Note* Socks are very beneficial with the right patient!

Postprandial Hypotension

Postprandial hypotension is a fall in blood pressure that can occur within two hours of food/ meal consumption1. A fall in blood pressure can result in light-headedness, dizzy, nausea, blurred vision, weakness, confused and ultimately lose of consciousness1. With these things in mind, one certainty is, the patient if at all possible will try to make there way to the bathroom, and most likely unassisted! 

If we have identified our patient as having postprandial hypotension, we should encourage them to take very short, regular walks at an easy pace throughout the two hours after their meal. This, with good water intake at meal time, may help reduce the onset of postprandial hypotension and reduce the risk of a fall.

The Brain - Special Senses

Underneath the foot, you have many sensors (nerves) that carry information to the brain about what is going on in the body. These are your special senses. In a typical nerve in the body that runs to one of your muscles, as many as 80% of the nerve fibers are bringing information back to the brain about how hard the muscle is contracting, its position, the limb position etc. All this information then results in a decision being made – what to do next to control the body. When we stand up, there is a process going on in the brain telling all the various muscles required, to coordinate their actions to make it happen, and the following steps are the same. What happens is, when a patient has been lying down for a long period of time, these signals may slow down, and the message may not be coordinated like it should be! And remember over 65 years of age, the senses are not reacting as quickly.

This is like when we jump on a trampoline. With a changing surface level, but being soft and being propelled back up, and the surface following our feet for a short distance, the brain becomes “dulled” as to where the actual contact point is. This is not noticeable until we step off the trampoline. The first few steps are what I call, “Elephant Steps”! For the first 2-5 steps, the impact is quite hard, your posture and gait can be affected trying to work out what has changed. It is at this point, if we were to fall, it would happen!

This example helps to understand, the patient who has been lying in bed for quite some time, could and will have this experience. The simplest way to explain it is like a momentary case of peripheral neuropathy or mononeuropathy. For those first few steps, it can present the same problems.

So how do we overcome this? There are two quite simple techniques; 

When sitting a patient up in view of standing or walking them, before standing, push down through there knees. This will allow for the feet to make good contact with the ground, and the brain will receive the signals that “here is the new contact point.” 

With the use of the Romedic ReTurn, we can now safely ask the patient to do a few safe sit to stands from the bed, with the safety of the ReTurn frame to assist and support, until we are confident they are doing a strong, co-ordinated stand. With this done we have reduced the risk of a fall, and kept both staff and patient safe.

Safe Room Spacing

Ensure you have adequate spacing between furniture. It is critical to ensure the patient has room to move without bumping into equipment. Too often a fall has occurred as a result of cluttered patient spaces. Here are some interesting facts:

The average woman is 395mm wide at the shoulders, and 370mm at the hips, (don’t forget to include the arms and hands.) The average man is 465mm wide at the shoulders, and 360mm wide at the hips (don’t forget to include the arms and hands.)