Several rating scales exist to assess the risk of falling for a patient. These analytical frameworks are invaluable tools for the nursing staff.
The very first step in providing care is to assess the patient. Each person has his or her own story and way of reacting to the caregiver’s suggestions.
This is where the rating scales can be useful. They make it possible to optimize interventions. By assessing the patient accurately, we can precisely target the patient’s needs and increase his or her commitment to the prescribed treatment. Evaluating also helps to guide policy.
Regular assessment of the risk of falls allows:
- to adapt the best care of a patient and offer personalized protocols
- to anticipate as well as possible the potential evolutions of the patient, and therefore to be able to respond to them as quickly as possible, with a more fluid organization of care.
For caregivers, understanding the patient and understanding the risk of falling is therefore a necessity. This allows actions and the environment to be adapted to make it as secure as possible.
Based on the clinical opinion of healthcare workers
Another valuable source of information to assess the risk of falls is the clinical advice of caregivers.
The Belgian College of Geriatrics is moving in this direction.
It defines a patient at increased risk of falling:
- if he/she has been hospitalized following a fall
- if he/she has had a fall in the past six months or during hospitalization
- if healthcare workers believe he/she presents an increased risk of falling
The caregiver’s empathy and genuine concern are invaluable!
The ability to evaluate patients is an essential nursing skill
Read, explore, go back and forth between theory and practice. This is also the art of caregivers, putting into action the written results of studies in light of clinical experiences.
The ISA system is a real opportunity to refine the intuition and opinion of the caregiver
The ISA fall detector goes one step further. It provides another look, and images to back it up. Reviewing the fall provides the nursing staff with objective data.
Comprehensive Geriatric Assessment (CGA)
During the Comprehensive Geriatric Assessment (CGA), the parameters taken into account are:
- functional status (AVL / Activities of Daily Living)
- cognitive assessment
- mood assessment
- visual and auditory assessment
- nutritional status
- balance disorders
- the risk of falling
Traditionally, it is the Tinetti scale that is used, since it is a condition for part of the funding of institutions.
However, this scale only measures walking and balance disorders, but does not address falls directly.
The Morse scale
The Morse scale, for example, allows a specific assessment of the risk of falling. It can be quickly used by the nursing staff. Its sensitivity is 72 to 83% and its specificity 29 to 83%.
Six items are rated on this scale:
- history of falls
- secondary diagnosis
- technical aids (cane, wheelchair, etc.)
- intravenous therapy
- the patient’s mental state
The analysis of ISA videos makes it easy to highlight changes in the Morse scale score.
For example, the mere fact of seeing a patient, who has already fallen during hospitalization, holding onto furniture while moving, defines a high risk of falling.
Diversify scales to change perspective?
There are several scales for assessing the risk of falling. Putting them in place takes some effort, but also offers a new perspective on patients.
As caregivers, changing perspective allows us to shake up our habits a bit and pushes us to look at our patients a little outside the usual framework (which can turn into a straitjacket effectively removing us from what our patients really face).
The reality of what the patient is going through is always a little out of step with the assumptions of the caregiver.
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