Reducing Fall Risk in a Confused Elderly Patient

Scenario

You are caring for an elderly patient with mild dementia who frequently attempts to get out of bed unassisted, often forgetting to use the call light. The patient denies pain, is on a diuretic, and has unsteady gait when ambulating.

Question: What interventions should you prioritize to prevent falls while maintaining dignity and safety?

Best Practice Answer

1. Assess and Identify Risk Factors:
   Conduct a fall risk assessment using a standardized tool (e.g., Morse or Hendrich II).
   Contributing factors include cognitive impairment, frequent toileting needs, and impaired mobility.
   Recognizing these early allows you to implement tailored prevention strategies rather than generic measures.

2. Implement Environmental and Safety Controls:

   • Bed position: Keep the bed in lowest locked position, with call light and personal items within reach.
   • Non-slip footwear: Ensure patient wears non-skid socks at all times.
   • Lighting: Maintain adequate lighting, especially at night.
   • Clutter-free environment: Remove cords, trays, or equipment near walking path.
   • Bed alarm: Activate to alert staff of unassisted exit attempts.

3. Enhance Supervision and Visibility:

   • Move patient closer to the nurses’ station for frequent visual checks.
   • Assign a sitter or implement virtual monitoring (video observation) if repeated attempts persist despite interventions.
   • Increase rounding frequency — every hour or more often as needed, with the “4 Ps” approach (Pain, Potty, Position, Possessions).

4. Promote Patient Engagement and Dignity:

   • Explain all safety measures clearly:

     “We’ve turned on this alarm so we can help you walk safely when you need to get up.”

   • Encourage safe participation (call before getting up, use assistive devices).
   • Avoid restraints unless absolutely necessary and per provider order — restraint use increases fall-related injury risk.

5. Family and Interdisciplinary Collaboration:

   • Educate family about safety protocols and encourage calm reinforcement of call-light use.
   • Engage PT/OT for gait and balance evaluation, and pharmacy for medication review (especially sedatives, antihypertensives).

6. Documentation:
   Record risk level, interventions implemented, patient/family teaching, and reassessment of effectiveness.
   Document any near-miss or attempted unassisted exits as safety events.

Real-World Application

This question reflects one of the most common safety scenarios in inpatient care.
Falls are a core quality indicator, and managers evaluate your understanding of proactive prevention versus reactive restraint.
Strong answers demonstrate awareness of both physical and psychological safety.

This applies to geriatrics, med-surg, telemetry, and rehab units where fall prevention is a daily priority.

Tip: In interviews, phrase it confidently:
“I would move the patient near the nurses’ station, keep the bed alarm on, round frequently, and avoid restraints — focusing on proactive prevention and dignity.”